What Other Tests Might I Need?

Once you’ve been diagnosed with Hepatitis C, your doctor will likely order a number of tests to find out about the health of your liver and decide on a treatment plan that’s most appropriate for you.

Hepatitis C Genotype

The Hepatitis C genotype refers to a specific “strain” or type of the Hepatitis C virus.  There are six major types of Hepatitis C around the world: genotypes 1, 2, 3, 4, 5 and 6.  In the United States, genotypes 1, 2, and 3 are common:

  • Genotype 1: Most Americans (nearly 75%) with Hepatitis C have this type
  • Genotype 2: About 10% of Americans with Hepatitis C have this type
  • Genotype 3: About 6% of Americans with Hepatitis C have this type

The genotype of Hepatitis C does not change over time, so you only need to get tested once.

Genotype tests are done before a person starts treatment.  Hepatitis C treatment works differently for different genotypes, so knowing your genotype helps your doctor choose the best treatment for you.

Testing for Hepatitis A and B

Your doctor may test to see if your body is immune to Hepatitis A and Hepatitis B.  If these tests show no prior exposure or protection, he or she will recommend that you be vaccinated against these two viruses to eliminate the chance of becoming infected.

Liver Function Tests (LFTs) or Liver Enzymes

Now that you have Hepatitis C, your liver may not work as well.  Liver function tests are a group of blood tests that detect inflammation and damage to the liver.  They are used to detect, evaluate, and monitor liver disease and damage.

The cells in the liver contain proteins called enzymes, which are chemicals that help your liver do its work. When liver cells are damaged or destroyed, the enzymes in the cells leak out into the blood where they can be measured by blood tests. Liver enzyme testing usually checks the blood for two main enzymes:

  • ALT (alanine aminotransferase)
  • AST (aspartate aminotransferase)

Liver function tests also include ALP (alkaline phosphatase) and total bilirubin, among other things.

If your liver is damaged due to inflammation, enzymes pass out of your liver into your bloodstream making the levels of ALT and AST higher than normal.  However, it’s common for people with chronic Hepatitis C to have liver enzyme levels that go up and down over time, sometimes returning to normal for as long as a year.  So even if you have Hepatitis C, it’s possible for your liver enzyme tests to come back as normal.

The ALT and AST levels do not tell you how much scarring (fibrosis) there is in your liver and they do not predict how much liver damage will develop.  However, if your total bilirubin is elevated, that could be a sign of cirrhosis (advanced scarring) and needs further investigation.

Tests to Measure Liver Scarring or Fibrosis

It’s important that you get some measure of the amount of scarring in your liver.  This will guide your Hepatitis C treatment, as well as the long-term management of your liver health.  Your Hepatitis C provider will make a recommendation for one of the following tests:

  • Liver Biopsy

In order to determine whether the virus has caused scarring to your liver, your doctor may order a liver biopsy.  During a biopsy, your doctor will insert a needle between your ribs into your liver to collect a small sample of liver tissue for laboratory testing.

  • Elastography

Instead of a liver biopsy, some providers will test for liver stiffness by using a special ultrasound machine, the most common being FibroScan.  The more scarring that is present in the liver the stiffer it is.  This exam, called transient elastography is painless and non-invasive.  If you are scheduled for this test, do not eat or drink for two hours beforehand.

  • Serum markers

There are a number of blood tests available to estimate the amount of scarring in the liver.

Imaging Tests

Your doctor may order tests that take images, or pictures, of your liver to make sure you do not have liver cancer.  Different types of images can be obtained by using various types of equipment including ultrasound, a CT (computerized tomography) scan, or MRI (magnetic resonance imaging).  If you have cirrhosis, these tests will be used to check for cancer as part of a screening program.  Unless your Hepatitis C is very advanced, these tests will not tell you about your liver function or the overall health of your liver.  Talk to your healthcare provider about why the test is being done.

Ask your doctor to explain all your test results and don’t hesitate to ask questions.  This will help you have a better understanding of what’s happening in your body and why your healthcare provider is recommending a particular course of treatment.

This page has been updated and medically reviewed September 2015.