I recently saw a patient for the first time who was referred to me for evaluation and treatment of chronic hepatitis C. In my urban clinic, this is something that happens quite frequently, at least a few times a week. In general I prefer that the referring physician do only the hepatitis C antibody test and a viral load (level of virus in the blood) to confirm that the patient has gone on to develop chronic infection. In a small percentage, 10-15% of the time, patients will spontaneously clear the infection without treatment, so they will have positive antibody but the virus will not be detected in their blood.
In an attempt to be helpful, the referring physician in this case had done a more extensive work up, and the patient was surprised and a bit dismayed to find out she needed more testing. I carefully explained the additional tests that I needed and the ones that would need to be repeated. I needed to make sure the results were recent enough for her insurance to approve the expensive but effective new treatments for hepatitis C. After my explanation, she agreed to do the lab work and the ultrasound of her liver. We scheduled a three-week follow up to review the results. (more…)