Blood Borne Viruses

Blood borne viruses can be transmitted from person to person via blood or bodily fluids. Infections may be asymptomatic, and many people may be unaware that they have been at risk of acquisition. Late diagnosis of BBV infections can be associated with increased morbidity and mortality, as well as having implications for onwards transmission. Effective and well tolerated treatments are available for all 3 infections, and consequently every effort should be made to offer BBV testing to those with risk factors or clinical features that may suggest an underlying BBV.

Please also see individual pages on HBV, HCV and HIV for additional advice.

Who can test:

All doctors, nurses, midwives and trained health and social care workers as well as third sector organisations undertaking venepuncture or dried blood spot testing can offer BBV testing. Lengthy pre-test counselling is not required, but patients should be made aware that they are being tested and that testing is voluntary. They should be informed how their result will be managed, and how they will receive that result.

Who benefits from testing:

• Anyone with a clinical presentation that could be associated with a BBV, including HIV indicator conditions
• Anyone who requests a test
• Anyone who reports risk behaviours (current or in the past) including:
  • injecting drug use
  • sharing equipment for drug use (including straws for intranasal drug use)
  • condomless sex
  • unlicensed tattoos or piercings
  • unsterile medical/dental treatment abroad
  • anyone from an area of high prevalence.

When to test:

All BBV tests have a window period, which is the time after infection during which the antibody response and infection itself may not be detectable. If the person being tested could be in the window period, don’t delay the first test but offer re-testing after the appropriate period.

BBV screen	Window period
HIV (4th generation)	1-3 months
HCV antibody	3-6 months
HBV	3-6 months

In addition to the window period, repeat testing 6-12 monthly is advised for people at ongoing risk of BBV acquisition. People can access self-sampling kits from Chalmers, which include HIV, chlamydia, gonorrhoea and syphilis but not hepatitis B or C. Postal HIV tests are also available from HIV Self-Test Scotland. More frequent testing may be considered e.g. for people who inject drugs or share drug-taking equipment, and individuals in receipt of PrEP (who will be seen by Sexual Health services).

Repeat testing provides an opportunity to give risk-reduction advice and offer referral for additional support. Please see information about harm reduction for those using drugs.

GPs are resourced for screening through the Hepatitis C (BBV) LES and Drug Dependence NES enhanced services – please see the Primary Care Facilitator Team on the intranet for further detail.

What to test:

• HBV core antibody – if this is positive (or already known positive), test HBV surface antigen – the laboratory should add that test reflexively with a new positive core Ab test
• HCV antibody – if positive (or already known positive), test HCV PCR
• HIV combined antigen/antibody test.

As there is overlap in the routes of acquiring HBV, HCV and HIV, our recommendation would be to offer screening for all 3 infections when performing testing, provided the patient is not already known to be positive.

How to test:

• A single brown capped gel tube for Virology (RIE) for all antibody/antigen testing. If the HBV core antibody is positive, the lab will reflexively test HBV surface antigen.
• A 9mL red cap EDTA tube (or 2 x 2.6mL EDTA tubes) should be sent for quantitative HCV PCR if required.
• For patients with poor venous access or needle phobia, dried blood spot (DBS) testing  is also available – contact community BBV team at RIDU on 0131 537 2820 or email communitybbvteam@nhslothian.scot.nhs.uk.

Confirmatory samples will be requested for those who have tested positive, primarily to confirm patient identity. This should not delay referral as it is acceptable for them to be taken after referral to specialist care, or on occasion by the specialist teams.