Chronic Hepatitis C
This patient has chronic hepatitis C. The presence of detectable HCV RNA (1.5 million copies) combined with positive anti-HCV antibodies definitively establishes the diagnosis of chronic hepatitis C infection 1, 2.
Diagnostic Interpretation
The HCV RNA positivity is the critical diagnostic marker. The diagnosis of chronic hepatitis C requires both:
- Positive anti-HCV antibodies (indicating exposure to HCV) 1
- Detectable HCV RNA in serum (confirming active viral replication and ongoing infection) 1, 2
This patient meets both criteria with a high viral load of 1.5 million copies, which confirms active chronic infection rather than resolved past infection 2.
Hepatitis B Status
The patient does NOT have chronic hepatitis B. The serologic pattern indicates:
- HBsAg negative: Rules out active hepatitis B infection 2
- HBcAb positive: Indicates past exposure to hepatitis B virus 2
- This pattern represents either past resolved HBV infection or occult infection, but NOT chronic hepatitis B 2
Hepatitis A Status
The patient does NOT have hepatitis A. The HAV IgG positive indicates:
- Past exposure with immunity to hepatitis A 2
- Hepatitis A virus never causes chronic hepatitis—it only causes acute self-limited infection 2
Clinical Significance of High Viral Load
The HCV RNA level of 1.5 million is clinically significant. This high viral load:
- Confirms active viral replication 3
- May predict treatment response, as higher pretreatment viral loads are associated with lower sustained response rates to some therapies 3
- Is commonly seen in chronic hepatitis C patients, particularly those with genotype 1 or 4 4
Answer to the Question
The patient has chronic hepatitis C (Answer: C). The combination of positive HCV RNA and anti-HCV antibodies, along with chronic liver disease, establishes this diagnosis unequivocally 1, 2. The negative HBsAg excludes chronic hepatitis B, and HAV IgG positivity only indicates immunity to hepatitis A, which does not cause chronic disease 2.