What does a reactive HCV (Hepatitis C Virus) antibody test and a non-detectable Hepatitis C Quantitation result indicate?

Interpretation of HCV Test Results

These results indicate no current hepatitis C infection—the patient either had a past HCV infection that has resolved spontaneously or through treatment, or this represents a false-positive antibody test. 1

What These Results Mean

Your test results show:

• HCV Antibody: Reactive - antibodies to hepatitis C virus are present
• HCV RNA (Quantitation): Not Detected - no active virus in the blood

According to CDC guidelines, when HCV antibody is reactive but HCV RNA is not detected, this definitively indicates "no current HCV infection." 1

Two Possible Explanations

1. Past Resolved HCV Infection (Most Common)

• The patient was previously infected with hepatitis C but the infection cleared, either spontaneously (15-25% of acute infections) or through successful antiviral treatment 1
• The antibodies remain detectable as an immunologic "scar" even though the virus is gone 1
• The patient is NOT infectious and does NOT have active liver disease from HCV 1

2. False-Positive Antibody Test (Less Common)

• Even with modern HCV antibody tests having >99% specificity, false-positives occur in approximately 35% of reactive results in low-prevalence populations 1
• The undetectable HCV RNA confirms there is no actual infection 1

Recommended Next Steps

No further action is required in most cases. 1

Optional Confirmatory Testing

If you want to distinguish between true past infection versus false-positive antibody:

• Perform a second HCV antibody test using a different FDA-approved assay/platform 1
• Different antibody assays use different antigens and platforms, making it unlikely that a false-positive would occur on multiple tests 1

When to Repeat HCV RNA Testing

Repeat HCV RNA testing is indicated only in these specific situations: 1

• Suspected HCV exposure within the past 6 months (window period concern)
• Clinical evidence of active HCV disease (elevated liver enzymes, symptoms)
• Immunocompromised patients (who may have delayed antibody response) 1
• Concerns about specimen handling or storage 1

Critical Clinical Pitfalls to Avoid

• Do NOT treat this patient for hepatitis C - there is no active infection 1
• Do NOT repeat HCV RNA testing routinely - it is unnecessary unless one of the specific situations above applies 1
• The patient is NOT infectious and does not require isolation precautions 1
• Do NOT perform ongoing HCV monitoring unless new risk exposure occurs 1

Patient Counseling Points

• Inform the patient they do not have active hepatitis C infection 1
• They are not infectious to others 1
• If this represents past resolved infection, they can be reinfected if exposed again, as HCV antibodies do not provide protective immunity 1
• No restrictions on blood/organ donation apply if this is confirmed as false-positive, though blood banks have their own protocols 1