Hepatitis C Infection: Carrier Status

When a person's blood tests positive for hepatitis C virus (HCV) antibodies but negative for HCV RNA, that person does not have hepatitis C infection. The state of having anti-HCV antibodies without detectable HCV RNA is known as "anti-HCV positive, HCV RNA negative". The vast majority of individuals and cases worldwide with this so-called "carrier" or "non-infectious" state have had, or currently have, HCVinfection. Some of these people have active chronic infection, and some have controlledchronic infection. Recovery from hepatitis C virus infection and development of protective HCV-specific immunity typically is associated with clearance of HCV from theblood and resolution of viremia.

Causes and Risk Factors

Transmission of Hepatitis C

Hepatitis C is spread by blood-to-blood contact, that particular means are: sharing needles. Over time, the medical industry injudiciosly re-used equipment that had not been properly sterilised; injecting drug use; reusing and poor procedures for body piercing or tattooing; sharing razors or toothbrushes (which may be contaminated with small quantities of blood); and occasionally, it can be passed from mother to baby during childbirth. In the past, blood transfusions have been responsible for the spread of the virus, however in modern times the blood supply is screened so the risk of being infected in this manner is minimal.

Factors that Increase the Risk of Infection

People who are at greatest risk of falling ill with serious hepatitis C infection are people who are engaged in high-risk practices such as illegal drug use and people with a high risk of blood-to-blood contact, including medical staff. Other practices and health problems can raise the level of risk but, for most people, practically if they practice good hand and respiratory hygiene, avoiding direct blood-to-blood contact and sexual practices that can lead to blood-to-blood contact.

Identifying Carrier Status

The hepatitis C virus (HCV) is typically diagnosed at the acute or chronic phases of infection. However, as a primary care physician competently assess and manage the health of your patients, there may be cases in which you are able to identify that a person is a carrier of HCV by chance. It is important to have a basic understanding of carrier status and how it can be identified in order to diagnose a patient with HCV at any stage of infection.

Implications and Management

Health Consequences of Being a Carrier

Carriers of the hepatitis C virus are at risk for developing chronic hepatitis, whereas individuals without the carrier state can either clear the virus or rarely develop persistent viremia. The risk of hepatocellular carcinoma has not been demonstrated to be higher in chronic carriers than in the general population, and this outcome is uncommon in this group. The hepatitis C virus carrier state is not associated with a higher mortality rate, disability rate, or specific extrahepatic diseases. Carriers do not have higher chronic fatigue scores or other measures of poor health than their family members, and no significant difference has been reported concerning infertility, birth defects, and complications of pregnancy or delivery, diarrhea, or urinary symptoms.

The proportion of carriers who report symptoms such as muscle aching or pain, fibromyalgia, skin rashes, or arthritis is no different from family members of carriers. A detailed look at the life insurance claims and actuarial experiences of both carriers and noncarriers at USAA (an insurance company that offers services to the military community), taken from the national insurance database, demonstrate a similar mix of diseases and causes of death, which indicates a lack of selection.

Treatment Options for Hepatitis C

The available treatments for Hepatitis C infection have undergone significant changes since the first antiviral agents were approved for use. Since the approval of the first direct-acting antivirals (DAAs) in 2013, the number of available drugs has quickly increased. Recommendations for the management of patients with HCV infection typically change several times a year as additional drugs or combinations become approved. Given the multitude of agents with different viral targets and high sustained virologic response (SVR) rates, and the frequent new drug approvals, up-to-date management guidelines should be frequently consulted.

Preventive Measures for Carriers

Preventive measures for carriers mainly involve reducing risk of spread to uninfected individuals. Though unlikely, getting exposed to an uninfected cut may carry a potential risk of transmission of the virus. One needs to ensure that they don't share their personal belongings with anyone else. Sexual transmission is impossible, unless a non-infected person gets exposed to the infected blood. Hence sexual activity is only advised to the stable partner. Carriers must inform their partners about their infection status before getting into any intercourses to reduce the chances of spread. Carriers who are enrolled in healthcare programs need to avoid working near patients and follow appropriate practices while attending to them to avoid transmission. This is mandated by the state laws and may vary depending on the locality.

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