Your Initial Positive HCV Antibody Test Was a False Positive
Yes, your initial positive HCV antibody test was a false positive, confirmed by the negative follow-up antibody test two months later. 1
Understanding Your Test Results
Your testing sequence followed the recommended diagnostic algorithm and provides clear evidence of a false-positive result:
- Initial positive HCV antibody → followed by negative HCV RNA indicates either a false positive or cleared infection 1
- Negative repeat antibody test on a different platform → definitively confirms the initial test was a false positive 1
Why This Confirms a False Positive
The Society for Maternal-Fetal Medicine (SMFM) and CDC guidelines explicitly state that when an initial positive HCV antibody test is followed by negative HCV RNA, you must perform repeat antibody testing using a different antibody assay platform to distinguish between false positivity and cleared infection 1, 2:
- If the alternative assay is negative (as in your case) → the initial test was false positive, and no HCV infection is present 1, 2
- If the alternative assay is positive → the infection has cleared (occurs in ~20% of HCV infections) 1, 2
The rationale behind this approach is that HCV antibody assays vary according to their antigens, test platforms, and performance characteristics, so biologic false positivity is unlikely to be exhibited by more than one test when multiple tests are used 1
What This Means for You
- You do not have HCV infection (past or present) 2
- No further HCV evaluation is needed unless you have new risk exposures in the future 2
- You are not infectious and do not require antiviral treatment 2
Important Caveats
The only scenario where additional testing would be warranted is if you had a known HCV exposure within 6 months before your initial testing, as HCV RNA can be detected 1-3 weeks after exposure while antibodies may take 2-6 months to develop 1. However, given that your follow-up antibody test two months later was negative, this scenario is extremely unlikely 1.
False-positive HCV antibody tests can occur, particularly in certain clinical contexts such as acute viral hepatitis where elevated IgM levels and inflammatory markers may contribute to false positivity 3.