everything about hep c

NOMOREC

Test for hepatitis C

Key messages:
- Take a hepatitis C test every three months if the sex you have puts you at risk of getting the virus, or if infections occur in your sex network.
- There are several ways to get tested for hepatitis C in Amsterdam.
- There are different types of tests. It is useful to know the advantages and disadvantages of each test.
- Would you like a cheap and reliable home test that detects recent infections? Order NoMoreC’s C-test .
 

Why take tests (often)?

The sooner you find out that you have hepatitis C, the sooner you can begin treatment and be cured. There are ways to get early treatment in Amsterdam shortly after your diagnosis. You can’t pass on the virus once you’ve been cured.
[Read more]

Even if you are careful, you can still get hepatitis C. And if you don’t know you have the virus, you could easily pass it on. Therefore, it is important to get tested frequently if you are at risk, and to get early treatment once you are infected. If the time between getting infected and finding out is short, you reduce the chance of unknowingly transmitting the virus.

Your health insurance will only cover the cost of treatment with the latest and most effective medication if you have chronic hepatitis C (officially, hepatitis C becomes chronic six months after infection). Does it make sense, then, to test more than twice a year if you always have to wait six months to be treated? Yes, it does, because it is now possible to get the latest medication even if you have an acute (= recent) hepatitis C infection. You can be treated roughly a month after diagnosis. The doctor will always wait a month to see if your body gets rid of the virus on its own. You have a 30-40% chance of self-healing if you are HIV-negative. This drops to 10-15% if are HIV-positive. To receive early treatment, you have to agree to take part in a study. If you are okay with this, you can shorten the waiting time between diagnosis and treatment considerably.

The doctor will always wait a month to see if your body gets rid of the virus on its own. You have a 30-40% chance of self-healing if you are HIV-negative. This drops to 10-15% if are HIV-positive.

To receive early treatment, you have to agree to take part in a study. If you are okay with this, you can shorten the waiting time between diagnosis and treatment considerably.

How often to get tested

Get tested every three months if the type of sex you have puts you at risk of hepatitis C, or if infections occur in your sex network.

When to take extra tests

Take extra tests if you have had risky sex and your next planned test will not happen for another two or three months. We recommend an RNA test if you want a test that can detect the virus very soon after infection. See Which test.

Where to take a test

There are several ways to arrange a hepatitis C test in Amsterdam. Below are ways to get tested in three situations:

1. You are HIV–positive

Home test (You can test yourself as often as you like)
You can test yourself at home using NoMoreC’s reliable C-test
You take the C-test by pricking your finger to get a blood sample. You can take the test whenever you like! You post the blood sample to a laboratory at no cost and get the results online within a week.
The C-test can detect a very recent infection, just like a standard RNA test does. If you’ve had risky sex, we recommend you wait 14 days before taking the test.
Go to Which test to read more about this home test. Or go straight to Order the C-test.

At the HIV-treatment centre (You can take two hepatitis C tests a year at the HIV-treatment centre)
The HIV-treatment centre checks for hepatitis C indirectly. What the doctors are actually checking is your liver activity. They will sometimes also test for antibodies or RNA of the virus.
Do you think you are at risk of hepatitis C, or that you have done anything that may have put you at risk? Always tell your HIV consultant or HIV doctor about this so that they can select the right test for you. See Which test.

At GGD Amsterdam’s STI clinic (If you are HIV-positive, you can take two hepatitis C tests a year at this clinic)
You will not be tested if you:

  • visited your HIV doctor less than three months ago
  • were tested for hepatitis C at the STI clinic less than six months ago.

    You can ALWAYS go to the STI clinic between tests if a sex partner warns you that he has hepatitis C. Note: you can’t just go into the clinic and say you’ve been warned. They will ask for your ‘warning code’ if you request an immediate test. Your sex partner can arrange to send you a code via a nurse, HIV nurse or GP. This can be done via the website www.partnerwaarschuwing.nl.

    Via your GP (You can go to your GP for this as often as you like).
    You will be asked to pay for the cost of the test itself (but not for the cost of the consultation). This fee will be taken from the ‘eigen bijdrage’ part of your health insurance.
    If you are HIV-positive, you are likely to have already used up your ‘eigen bijdrage’. If so, the test via your GP won’t cost you anything. Depending on the situation, your GP can request all types of hepatitis C tests for you. See Which test.

2. You take PrEP

Home test (You can test yourself as often as you like)
You can test yourself at home using NoMoreC’s reliable C-test. You take the C-test by pricking your finger to get a blood sample. You can take the test whenever you like! You post the blood sample to a laboratory at no cost and get the results online within a week.
The C-test can detect a very recent infection, just like a standard RNA test does. If you’ve had risky sex, we recommend you wait 14 days before taking the test.
Go to Which test to read more about this home test. Or go straight to Order the C-test.

At GGD Amsterdam’s STI clinic (If you take PrEP, you will be tested for hepatitis C one to four times a year)
If you are part of the AmPrEP study, you will be tested twice a year for hepatitis C.
If you are part of the Discover study , it will be once a year.
If you are with InPrEP , it will be four times a year. These tests will be antibody tests.
You can ALWAYS go to the STI clinic between tests if a sex partner warns you that he has hepatitis C. Note: you can’t just go into the clinic and say you’ve been warned. They will ask for your ‘warning code’ if you request an immediate test. Your sex partner can arrange to send you a code via a nurse, HIV nurse or GP. This can be done via the website www.partnerwaarschuwing.nl

Via your GP(You can go to your GP for this as often as you like).
You will be asked to pay for the cost of the test itself (but not for the cost of the consultation). This fee will be taken from the ‘eigen bijdrage’ part of your health insurance.
Do you already have lots of medical bills because of some other treatment? You are likely to have already used some or all of your ‘eigen bijdrage’. If so, the test via your GP won’t cost you anything.
Some GPs in Amsterdam do the same checks that GGD Amsterdam’s STI clinic offers to people who arrange their own PrEP (online or offline). The checks by the GP should always include testing for hepatitis C. Depending on the situation, your GP can request all types of hepatitis C tests for you. See Which test.
 

3. You don’t have HIV and you don’t take PrEP

Note: HIV-negative gay men do not automatically have a high risk of becoming infected with hepatitis C. See Networks with a relatively high number of infections and How the virus is transmitted.

Home test (You can test yourself as often as you like)
You can test yourself at home using NoMoreC’s reliable C-test
You take the C-test by pricking your finger to get a blood sample. You can take the test whenever you like! You post the blood sample to a laboratory at no cost and get the results online within a week. The C-test can detect a very recent infection, just like a standard RNA test does. If you’ve had risky sex, we recommend you wait 14 days before taking the test.
Go to Which test to read more about this home test. Or go straight to Order the C-test.

At GGD Amsterdam’s STI clinic (In principle, you will only be tested here if a sex partner warns you that he has hepatitis C)
Hepatitis C is mostly found among HIV-positive gay men. However, the STI clinic checks HIV-negative men every now and then to see if the number of hepatitis C infections is staying low within this group. So don’t be surprised if a nurse suddenly decides to test you for hepatitis C. In principle, if you’re HIV-negative and don’t take PrEP, you will only be tested if a sex partner warns you that he has hepatitis C. Note: you can’t just go into the clinic and say you’ve been warned. They will ask for your ‘warning code’ if you request an immediate test. Your sex partner can arrange to send you a code via a nurse, HIV nurse or GP. This can be done via the website www.partnerwaarschuwing.nl.

Via your GP (You can go to your GP for this as often as you like.)
You will be asked to pay for the cost of the test itself (but not for the cost of the consultation). This fee will be taken from the ‘eigen bijdrage’ part of your health insurance. Do you already have lots of medical bills because of some other treatment? Then you are likely to have already used some or all of your ‘eigen bijdrage’. If so, the test via your GP won’t cost you anything. Depending on the situation, your GP can request all types of hepatitis C tests for you. See Which test.

 

Which test

There are different types of tests for hepatitis C. It is useful to know the advantages and disadvantages of each test.
 
Antibody test

This test detects hepatitis C as soon as your body starts producing antibodies.
[Read more]

Most people who become infected start producing hepatitis C antibodies about two months after infection. If you are HIV-positive, it may take longer; more than four months after infection is not unusual. So remember that you can test negative for antibodies (= no antibodies are detected) even though you have the virus. In other words, antibody tests are not the best tests for detecting a very recent infection.
The antibody test is also unsuitable if you have had hepatitis C before. After you’ve been cured of hepatitis C, the antibodies that your body produced will often remain in your body for the rest of your life. An antibody test would therefore be pointless. If you’ve had hepatitis C before, only an RNA test (see below) will tell you whether you’ve got it again.

Advantage: an antibody test is relatively cheap.
Disadvantage: antibody tests can miss a recent infection. It can sometimes take a while for your body to start producing hepatitis C antibodies.
Disadvantage: antibody tests are not suitable if you have had hepatitis C before.
 
Liver values(only available through an HIV doctor or your GP)
This is a blood test that detects any increase in particular liver values. An increase could indicate hepatitis C infection.
[Read more]

Your blood will be checked to see if there has been an increase in the ALAT liver enzyme. An increase can be a sign of liver inflammation caused by hepatitis C. There can also be other reasons for the increase. This is the first thing your GP will check. If think you have been at risk of hepatitis C, we advise you to tell to your doctor about it.

An increase in liver activity can also be caused by the use of alcohol, chems or medication (for HIV or other infections). Always tell your doctor if you use any of these. This will allow your him/her to diagnosis you correctly.


The next step will be an RNA test. Your GP will perform this test to know if you have hepatitis C or not.

A liver enzyme test is much cheaper than an RNA test. This is why you will first be given a liver enzyme test.


Measuring liver values has one disadvantage: it records just one moment in your liver values, while liver values move up and down over time. It is therefore possible to miss a peak in your liver’s production of ALAT enzymes; this peak may have passed by the time you take the test. Another possibility: the peak occurs after you take the test.

Advantage: it is a relatively cheap test.
Disadvantage: an increase in liver values may be caused by something that is not hepatitis C.
Disadvantage: it’s possible to miss the peak in liver values. You may have hepatitis C, but at the moment of testing the test has missed the increase of liver values.
 
RNA test
This test detects hepatitis C by checking your blood for particles of the virus. An RNA test can detect the virus very soon after infection.
[Read more]

An RNA test can tell you if you have been infected as soon as seven to ten days after contact with the virus. The test checks your blood for RNA (= virus) particles of hepatitis C. This gives it an advantage over the antibody test. The reason: it may take up to four months for your body to produce antibodies against the hepatitis C virus.
RNA tests are also suitable if you have had hepatitis C before, because it checks for the virus itself. If you’ve had hepatitis C before, you can no longer take an antibody test — see Antibody test. An RNA test is expensive (about €90). Doctors will usually only offer this test if they suspect you have hepatitis C. For instance, if your antibody test was positive (= antibodies were found in your body).

Advantage: RNA tests detect the hepatitis C virus very soon after infection (within a couple of weeks).
Disadvantage: the standard RNA test is expensive (about €90).
 
The C-test (you can only do this through NoMoreC)
NoMoreC’s C-test is also an RNA test. It’s a simple test that you take at home by pricking your finger to get a blood sample. You can take the test whenever you like! You post the blood sample to a laboratory at no cost and get the results online within a week. You pay only €25 for a C-test.
[Read more]

The test checks your blood for RNA (= virus) particles of hepatitis C. This gives it an advantage over the antibody test. The reason: it may take up to four months for your body to produce antibodies against the hepatitis C virus.
The C-test can therefore tell you if you have been infected very soon after contact with the virus. This is useful if you have recently been at risk and want to know whether or not you are infected, without having to go to your GP, HIV doctor or STI clinic. You post your blood sample to AMC’s laboratory, and your results are ready within a week. You check your results by logging in to a secure part of the NoMoreC.nl website.
If you’ve had risky sex, we recommend you wait 14 days before taking the C-test.
An RNA test normally costs around €90. The C-test costs €25. Keep the C-test for up to a year in a dry place and it will still work.

The difference between the C-test and a standard RNA test is that the size of the blood sample is smaller with a C-test. If you don’t have many virus particles in your blood, the C-test could miss the infection. The chance of this happening is very small, though: almost anyone with a recent infection will have enough virus particles in his blood for detection by the C-test.

Advantage: this RNA test detects the hepatitis C virus itself within a couple of weeks, and is cheaper than the standard RNA test.
Advantage: you can take this RNA test at home, and you can do this whenever you like.
Advantage: because the C-test detects the virus itself, it is also suitable if you have had hepatitis C before and can therefore no longer take an antibody test (see Antibody test).
Disadvantage: if you don’t have many virus particles in your blood, the C-test could miss the infection. However, the chance of this happening is very small: almost anyone with a recent infection will have enough virus particles in his blood for detection by the C-test.
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