Counseling a Patient with a Reactive Hepatitis C Screening Test
A reactive hepatitis C screening test requires confirmation with HCV RNA testing to determine if the patient has current infection. You should explain that this is a preliminary result that needs further testing before making any definitive conclusions about their hepatitis C status.
What to Tell Your Patient Now
Explain that a reactive (positive) screening test for hepatitis C antibodies means one of three things:
- Current active HCV infection
- Past resolved HCV infection (the body cleared the virus)
- Rarely, a false positive result 1
Reassure the patient that this is only a screening test and the next step is a confirmatory HCV RNA test (quantitative molecular study) to determine if there is active virus present 1
Emphasize that they should return for their follow-up test results, as this is crucial for proper diagnosis and care
Advise that until the confirmatory test results are available, they should:
Interpreting the Pending HCV RNA Test Results
When the HCV RNA test results return, explain the following based on the outcome:
If HCV RNA is detected (positive):
- This confirms current HCV infection 1
- Additional testing will be needed to determine:
- Viral load (quantitative HCV RNA)
- HCV genotype (to guide treatment decisions)
- Degree of liver fibrosis/damage 1
- Treatment options are highly effective with modern direct-acting antiviral medications 2
- With proper treatment, hepatitis C is curable in most cases
If HCV RNA is not detected (negative):
- This indicates either:
- Past infection that has resolved (cleared by the body)
- A false positive antibody test 1
- No treatment is needed as there is no active infection 1
- To distinguish between past infection and false positive, a different antibody test can be performed 1
Risk Factors and Prevention
Discuss potential risk factors for HCV infection:
- Past or current injection drug use
- Blood transfusion or organ transplant before 1992
- Healthcare exposures (needlestick injuries)
- Birth to an HCV-infected mother
- High-risk sexual practices
Provide prevention guidance:
- HCV is primarily transmitted through blood exposure
- Sexual transmission is possible but less common than with other viruses like hepatitis B or HIV 1
- Household transmission is rare but possible through shared items with blood exposure
Common Pitfalls to Avoid
Don't assume active infection: Many providers mistakenly tell patients they have hepatitis C based solely on a positive antibody test. Always wait for the HCV RNA result 1
Don't create unnecessary anxiety: Explain that even if active infection is confirmed, modern treatments are highly effective with cure rates over 90% 2
Don't miss the opportunity for education: Use this time to educate about hepatitis C transmission and prevention
Don't neglect follow-up: Emphasize the importance of returning for confirmatory test results and potential referral to specialists if needed
By following this approach, you can provide accurate information to your patient while awaiting the definitive HCV RNA test results that will guide further management decisions.