What are the next steps after receiving a positive hepatitis test result?

Next Steps After a Positive Hepatitis Test

After receiving a positive hepatitis test, you should immediately undergo HCV RNA testing (NAT) to confirm active infection and determine appropriate management. 1

Confirming the Diagnosis

The testing sequence following a positive hepatitis antibody test is critical for proper management:

1. HCV RNA testing (NAT) - This should be performed on the same blood sample used for the initial antibody test through reflex testing 1, 2

   • Positive RNA result = Current HCV infection
   • Negative RNA result = Either resolved past infection or false positive antibody result

2. Interpretation of results:

   • If HCV RNA is detected: This confirms current HCV infection requiring medical evaluation
   • If HCV RNA is not detected: Consider supplemental antibody testing to differentiate between resolved infection and false positivity 1

Medical Evaluation for Positive RNA Results

If HCV RNA is positive, the following steps are essential:

1. Liver health assessment:

   • Liver function tests (ALT/AST levels)
   • Assessment of fibrosis severity through non-invasive testing 2
   • Evaluation for signs of advanced liver disease

2. Hepatitis A and B testing:

   • Get tested for hepatitis A and B antibodies
   • If not immune, vaccination is recommended to prevent additional liver damage 1, 3

3. Alcohol cessation:

   • Complete abstinence from alcohol is crucial to prevent further liver damage 1, 2

4. Medication review:

   • Consult with healthcare provider before starting any new medications, including over-the-counter and herbal supplements 1

Preventing Transmission

To reduce risk of transmitting HCV to others:

• Do not donate blood, body organs, tissue, or semen
• Do not share personal items that might have blood on them (toothbrushes, razors, etc.)
• Cover cuts and sores to prevent spreading infectious blood 1, 2

For sexual partners:

• The risk of sexual transmission in monogamous relationships is low
• Discuss the risk with your partner and consider barrier protection if concerned
• Partners should be tested for HCV 1

Special Considerations

For pregnant women:

• Pregnancy and breastfeeding are generally safe with HCV
• Approximately 5% of infants born to HCV-infected mothers become infected
• Mode of delivery does not affect transmission risk
• Breastfeeding is generally safe unless nipples are cracked or bleeding 1

For recent exposures:

• If exposure occurred within the past 6 months, follow-up testing is recommended even if initial RNA is negative
• Immunocompromised patients may require additional testing 1

Common Pitfalls to Avoid

1. Misinterpreting antibody positivity as active infection - Always confirm with RNA testing 2

2. Missing intermittent viremia - A single negative RNA result may not definitively rule out infection in patients with recent exposure 2

3. Inadequate follow-up - Particularly for patients with ongoing risk factors 2

4. Failing to address alcohol use - Complete abstinence is essential for preventing disease progression 1, 2

5. Not testing for hepatitis A and B coinfection - These can cause additional liver damage in patients with HCV 3

Following these steps will ensure proper diagnosis, management, and prevention of complications from hepatitis C infection, ultimately reducing morbidity and mortality associated with chronic infection.