From the Guidelines
A positive hepatitis C antibody test with a negative quantitative RNA test typically means you were infected with hepatitis C in the past but your body has cleared the infection or you have successfully received treatment for hepatitis C. This interpretation is based on the most recent guidelines, which recommend that anti-HCV positive, HCV RNA-negative individuals should be retested for HCV RNA 3 months later to confirm definitive clearance 1. The antibody test detects proteins your immune system made in response to the virus, which remain in your bloodstream long after the infection is gone. The negative RNA test (quantitative test) confirms no active virus is currently in your bloodstream.
Some key points to consider in this scenario include:
- About 15-25% of people who contract hepatitis C naturally eliminate the virus without treatment.
- If you previously received treatment for hepatitis C that was successful, this same pattern of test results would occur.
- You should still inform healthcare providers about your past infection, and you remain susceptible to reinfection if exposed to the virus again.
- A follow-up RNA test in 3 months might be recommended to confirm the negative result, especially if you have risk factors for hepatitis C exposure, as suggested by the EASL recommendations on treatment of hepatitis C 2016 1.
It's also important to note that false-negative anti-HCV test results can occur during the first weeks after infection, and in certain cases, antibody seroconversion might be delayed for months after exposure 1. However, the current recommendation is to retest for HCV RNA 3 months later to confirm definitive clearance, which is based on the most recent and highest quality study 1.
From the Research
Hepatitis C Antibody Positive but Quantitative Negative
- A person can test positive for the hepatitis C antibody but have a negative quantitative test result, indicating that the virus is not currently active in their system 2.
- This can occur in individuals who have been cured of the virus through treatment or have spontaneously cleared the infection 2.
- The hepatitis C antibody test detects the presence of antibodies against the virus, which can remain in the blood even after the virus has been cleared 2.
- A quantitative test, also known as a viral load test, measures the amount of the virus present in the blood 2.
- If the quantitative test result is negative, it means that the virus is not detectable in the blood, and the person is considered to be in a state of sustained virological response (SVR) 3, 4, 5, 6.
Treatment and Management
- The treatment for hepatitis C typically involves a combination of direct-acting antivirals (DAAs) such as sofosbuvir and velpatasvir 3, 4, 5, 6.
- The duration of treatment is usually 12 weeks, but can be longer for patients with decompensated cirrhosis 3, 4, 5, 6.
- The goal of treatment is to achieve a sustained virological response (SVR), which is defined as an undetectable viral load 12 weeks after completing therapy 2.
- Patients who achieve SVR are considered to be cured of the virus and have a reduced risk of developing liver-related complications such as cirrhosis and hepatocellular carcinoma 2.