From the Guidelines

The approach to evaluating a patient with a positive Hepatitis C (HCV) antibody is to confirm the diagnosis with HCV RNA testing.

HCV RNA testing should be performed to confirm the diagnosis, as a positive anti-HCV test can indicate current or past infection 1.
Assessment of liver disease severity is essential prior to antiviral treatment, and can be done using liver biopsy and/or noninvasive tests for assessment of hepatic fibrosis 1.
HCV RNA quantitative assay and genotyping should be performed prior to antiviral treatment to guide treatment decisions 1.
Follow-up testing is recommended for individuals with a positive anti-HCV test but negative HCV RNA, to confirm clearance of the virus 1.

Immunocompromised patients may require HCV RNA testing even if anti-HCV is negative, due to the risk of acute HCV infection 1.
Acute HCV infection should be suspected in patients with symptoms of hepatitis, and HCV RNA testing should be part of the initial evaluation 1.
Exposure to infected blood or body fluids requires immediate testing for anti-HCV and serum ALT level, with follow-up testing for HCV RNA 4-6 weeks after exposure if initial tests are negative 1.

From the Research

The approach to evaluating a patient with a positive HCV antibody involves confirming the diagnosis and assessing the severity of the infection 2, 3, 4.
A positive Anti-HCV test represents a true positive result only in a variable proportion of subjects (35 to 95%) 2.
The qualitative interpretation as positive or negative Anti-HCV report is associated with a general lack of understanding regarding the interpretation of results, when more specific testing should be performed, and which tests should be considered for this purpose 2.

Confirmatory tests for the diagnosis of HCV infection are in general unnecessary in anti-HCV-positive patients who present with chronic liver disease 3.
When indicated, the most appropriate test in this setting is a qualitative PCR assay for HCV RNA 3.
The most appropriate approach is to retest for anti-HCV using recombinant immunoblot assay (RIBA) and then test for HCV RNA using PCR assay in those who are RIBA positive or indeterminate 3.

An assessment of the degree of liver fibrosis with liver biopsy or noninvasive testing is necessary to determine the urgency of treatment 4.
Liver histology is the gold standard in assessing severity of liver disease 3.

Treatment of patients with chronic HCV infection should be considered based on genotype, extent of fibrosis or cirrhosis, prior treatment, comorbidities, and potential adverse effects 4.
The goal of therapy is to reduce all-cause mortality and liver-associated complications 4.
Primary care clinicians play a crucial role in screening, diagnosing, and linking patients with hepatitis C to appropriate care 5, 6.

Less than 50% of newly diagnosed anti-HCV positive patients are referred to an appropriate clinic for further investigation and management 5.
Reasons for this are multifarious and complex, reflecting both systems failure and patient choice 5.
Good communication between the physician, the physician's office staff, and the patient is necessary to overcome the challenge of losing patients between the initial positive HCV antibody test and follow-up HCV RNA testing 6.