Confused about testing window period

[ScaryMum]

Dear all,

I hope you could help me. My daughter got a blood test done at medical clinic in Greece while we were on holiday. The blood test was done by lancet pen from fingertip. I saw the nurse to take a new unused lancet (like a pin) BUT the new lancet was put to a lancet holder that was not a single-use pen which means that the lancet holder pen is used on multiple patients. When we returned home from our holiday I learned that these lancet holders should not be used on multiple people even if a new lancet is used and that this procedure could put my daughter to a risk for blood-borne viruses such as HIV, HBV or HCV. I took my daughter to a pediatrician and they did "baseline" tests at 6,5 weeks (46 days) post this incidence. All tests were negative. We also learned that my daughter has a good response to Hepatitis A/B vaccination she received when she was 2 yrs. old (thank god for that).

The doctor said that she does not think that my daughter could have HCV or HIV but ordered new tests at 12 weeks. I know that HIV test is conclusive at 12 weeks but there is inconsistent information about HCV. Is 12 weeks also conclusive for HCV?

I read from CDC that lancet holders are linked to hepatitis B infetions but I do not know what is the risk regarding HCV.

I am very scared for my child. She is only 9-years old.  We are going to laboratory for 12 week tests next Wednesday. If they remain negative can I consider it conclusive for HCV as well?

Thank you for your help!

[Lynn K]

Hep c antibody tests are conclusive at 12 weeks unless the person has a compromised immune system for example if they have HIV then it can take up to 6 months for antibodies to the hep c virus to develop to detectable levels.

But for the majority of people 12 weeks is good enough.

Yes her 12 week test will be conclusive.

[lporterrn]

Your doctor is right - the chances of contracting hep C or HIV this way are pretty much zero. Hepatitis B is potentially more infectious. Your experience is a ringing endorsement for immunization.

Personally, I would accept the 12 week results.

Generally HCV antibodies show up by 12 weeks, but 24 weeks is the absolute time limit. However, rather than put your daughter through a blood draw at 12 weeks and 24 weeks, perhaps your doctor will order a more expensive test - the HCV RNA (viral load) test. This is accurate 2 to 3 weeks after exposure.

[ScaryMum]

Thank you for your replies. Yes, I agree that this is a good example why people should get vaccinated.

Lynn: Is that 24 weeks same as 6 months and applies to those who are immunecompromised? My daughter is otherwise healthy little girl. Is the 12 weeks same for adults and children (not infants)?

The doctor said that PCR-test needs not to be done and anti-HCV is enough at this point.

Thank you!

[Lynn K]

The 24 week is the same as 6 months and only would apply to someone who is immune compromised not to a healthy person.

The antibody test is conclusive at 12 weeks no additional testing would be needed. The HCV RNA by PCR is to verify current infection if the antibody test is positive

[ScaryMum]

Thank you somuch Lynn!

Please, wish my daughter good luck for next Wednesday´s 12 week tests.

[Lynn K]

Sure thing mum good luck to you and your family!

[ScaryMum]

Hello,

We received the results today. HCV antibody was negative (12 weeks) BUT her serum aminotransferase levels (ALT) was elevated and value was 89 (normal below 40). 

Today they repeated the liver tests and also took HCV RNA (qualitative test). I am so scared that her ALT level is indication of acute HCV. She does not take any medicines and her other lab test were ok (no current infection - normal CRP).

I read an article that the ALT level goes up before antibodies. Her ALT level was normal in the first tests taken 6,5 weeks after this incident.

I do not know how to cope with this. I also read that children under 12 cannot be treated with the new medicines. She is only 9-years old. 

[lporterrn]

Hi,
You did not say why your daughter was tested in Greece, but presumably it was because there was a medical issue. So, does your daughter have a medical issue, is she taking any medications or supplements (in addition to drugs, many supplements will raise ALTs), is she overweight, does she eat a healthy diet, is she physically active. For instance, in SuperSize me, the journalist ate McDonald's diet for a month and had raging liver enzymes.

Enzymes go up and down - you want them to, as that is their job. A single raised liver enzyme is insignificant.

Also, they are now treating children over age 3 with new meds but I highly doubt this is hep C.

[Lynn K]

 The 12 week hepatitis C antibody test is conclusive.  I am surprised they did an HCV RNA test. As Lucinda said, there are many things that can cause a small transient rise in liver enzyme test.

 Hepatitis C is spread by blood to blood contact. Blood infected with the hepatitis C virus must enter the bloodstream of an infected person. This would occur most commonly through sharing IV drug needles or a blood transfusion. However, even if a healthcare worker experiences and accidental needlestick involving a patient with known hepatitis C the odds of transmission are only about 1.8%.

 I very much doubt your child has hepatitis C.  I’m sure the doctors will get this all sorted out soon.

Best of luck to you and your family.

[Lynn K]

Just to add elevated ALT in acute infection would be likely 10 times above normal.

Found this about symptoms of acute hep C infection:

“Symptoms of acute hepatitis C range from very mild to severe. They include:

nausea
vomiting
loss of appetite
fever
fatigue
abdominal pain
joint pain
dark urine
light, clay-colored bowel movements
jaundice, or yellowing of the skin and eyes”

If your child was having an acute phase she would be having at least some of these symptoms.

[ScaryMum]

Hi Lucinda and Lynn,

Thank you for your supportive messages! My daughter is not overweight and only medicines she has taken since week 6,5 when all tests (also ALT) were negative/normal are ibuprofen and nosespray for cold for a couple of days in the end of September.

We took her to a doctor in Greece because she had a flu and ear pain. I could have never imagined that a visit to a doctor would cause something like this to my child and to our family. 

I just heard today that receiving the PCR results might take until Thursday.

Is it really possible to treat 9-year old with the new medicine? We are in Scandinavia and they have started to use the new medicines to all adult patients (treatment is free for all patients). I read that the medicines are not approved for children under 12. Has that changed?

Please keep your fingers crossed for my little girl! <3

[Lynn K]

According to doctors at the Henry Ford Health System's Gastroenterology and Liver Disease Forum, ibuprofen is not hepatotoxic or toxic to the liver as acetaminophen is. However, ibuprofen can cause a transitory rise in alanine aminotransferase (ALT)

As of right now the only thing that has happened to your family is a scare. Your daughter has tested negative for hep c antibodies so the odds are very high she is not infected. The HCV RNA test commonly takes week to 10 days to get results.

Even if she somehow should test positive on the HCV RNA test her doctors will likely want to wait at least 6 months to see if the infection resolves in its own.

I don’t know if hep c treatment is approved for children in your country but first wait for results as you are very likely worrying over nothing.

My suggestion is take a breath and step back. Even if she should have hep c it is a very slowly acting illness taking decades to cause liver damage. Also with the new meds hep c is very curable. So even in the unlikely event she has hep c she can be treated and cured very readily with a simple highly effective well tolerated treatment that can be as simple as one pill a day for as few as 8 weeks.

Again, mum take a breath. This will pass.

[ScaryMum]

Thank you Lynn,

The results have not come yet. I know that right now all we can do is wait.

I talked to the doctor yesterday and she said that she doesn´t believe that the cause for rise in ALT was due to the ibuprofen. My daughter has also complained joint pains and that is also one reason why I am scared.

I know that there is a cure nowadays but all articles that I have read about the treatment says that the new meds are for adults only. We have another child as well. Kids tent to hurt themselves while playing etc. so naturally I am scared that her sister could become infected as well if we have to wait for 8 years for her to get treated. Kids are not that cautios as adults. I am also scared that my daughter may face discrimination if her medical records say that she has HCV. This might sound stupid, I know but there are so many thoughts in my mind right now. Not knowing is the worst thing at least for me.

The old treatment causes severe side effects and can even stop growth when used for children. It makes me relly sad that the new effective medication is for adult only. I think that the EU Med agency has not approved the new medication for children. 

I will report to you when we get the results.

Thank you for your supportive messages!

[Lynn K]

Household transmission is extremely rare. Hep c infected blood has to enter the blood stream of an uninfected person. So I very much doubt your child assuming she is infected would be able to transmit any infection to her sibling or any other household member.

I had hep c for 37 years I now have some mild joint pain but I am also 60. The only symptom I had for most of my years of infection was some tiredness which is the most often reported symptom. Could it be just growing pains your child is experiencing?

Also even though I suspect I was infected in 1978 my liver enzymes were normal as far as I knew until 1989 and I was being blood tested periodically as I was in the US Army.

I really don’t think your daughter has hep c but you will know soon. One would certainally hope no medical professional would harbor prejudice against any patient for any reason. As far as anyone else no one needs to know.

[ScaryMum]

Hi,

I promised to report how things are going with my daughter. We were supposed to receive the results yesterday. Well, we did not. Today, I received a call for the lab that the qualitative PCR could not be done or analyzed because there has been something wrong with the sample...

So, today they took 5 new tubes of blood from my crying daughter and they will perform the quatitative PCR (not qualitative that they could not do) in two different laboratories to obtain a result. They will also perform the antibody test once more. They promised to do the test today and the medical director of the lab promised to call me this evening.

I can´t even describe my feelings... We have been scared and waited for three months after the incident and learned that all antibody tests were negative, only to learn that her ALT had gone up since the last tests and that we need to go through new tests with PCR and then we wait for more that a week just to learn that the PCR could not be analyzed and we need to through this again.

I will report the results if we finally get them... 

[Lynn K]

She has had a negative hep c antibody test after an appropriate testing waiting period so I very much doubt she will be positive for hep c.

Hopefully, they will find the cause of her slightly elevated ALT. I doubt her elevated ALT is due to hep c. It was only a minimal elevation and could have several causes.

Best of luck to you