Hepatitis C Antibody Reactive with Reflex to HCV RNA Reactive: Meaning and Management
A reactive Hepatitis C antibody test with a confirmatory reactive HCV RNA test indicates current, active Hepatitis C virus infection requiring antiviral treatment. 1
What This Result Means
You have active Hepatitis C infection. The testing sequence works as follows:
- Reactive HCV antibody indicates exposure to Hepatitis C virus at some point, which could mean current infection, past resolved infection, or rarely a false positive 1
- Reactive (detected) HCV RNA definitively confirms current, active viral replication and ongoing infection 1
- In most cases, persons with HCV viremia (detectable RNA) have chronic HCV infection 1
Immediate Next Steps
Refer to specialist care for treatment evaluation immediately. 1 The following assessments are required:
- Quantitative HCV RNA testing to measure viral load 1
- HCV genotype testing to guide treatment selection 1, 2
- Assessment of liver fibrosis through either liver biopsy or non-invasive testing to determine urgency of treatment 1, 2
- Testing for hepatitis B (HBsAg and anti-HBc) before initiating HCV treatment, as HBV reactivation can occur during HCV therapy 3
Treatment Approach
Antiviral therapy is indicated for all patients with confirmed HCV viremia. 1 Modern treatment considerations include:
- Direct-acting antiviral regimens (such as ledipasvir/sofosbuvir or sofosbuvir-based combinations) are the current standard of care, replacing older interferon-based regimens 1, 3, 4, 2
- Treatment duration typically ranges from 12-24 weeks depending on genotype, prior treatment history, and presence of cirrhosis 1, 3, 4
- Goal of therapy is viral eradication (sustained virologic response) to prevent complications including cirrhosis, hepatocellular carcinoma, and death 1
Preventive Measures During Evaluation
While awaiting specialist evaluation, patients should:
- Avoid or reduce alcohol intake to limit disease progression 1
- Receive vaccination against hepatitis A and hepatitis B if not immune 1
- Take precautions to prevent transmission to others through blood exposure 1
- Inform healthcare providers of HCV status for appropriate precautions 1
Critical Pitfalls to Avoid
Do not assume this is a false positive or past infection - detectable HCV RNA always indicates current infection requiring treatment 1, 5
Do not delay specialist referral - earlier treatment prevents progression to cirrhosis and reduces mortality 1
Do not start treatment without HBV testing - HBV reactivation during HCV treatment can cause fulminant hepatitis, liver failure, and death 3
Do not use interferon-based regimens as first-line unless direct-acting antivirals are unavailable, as newer regimens have superior efficacy and tolerability 1, 2
Reporting Requirements
This is a reportable condition. Healthcare providers and laboratories must report confirmed HCV infection to local health departments as "hepatitis C (past or present)" per jurisdictional requirements 1