What is the management plan for a patient with a positive Hepatitis C Antibody (Hepatitis C Ab) test, a reactive HCV RNA (Hepatitis C Virus Ribonucleic Acid) reflex test, but a non-detectable HCV RNA quantitative real-time Polymerase Chain Reaction (PCR) result?

Management of Positive HCV Antibody with Undetectable HCV RNA

This test pattern indicates no current HCV infection and requires no treatment or further action in most cases. 1

Test Result Interpretation

Your laboratory results show:

• HCV antibody reactive = antibodies to hepatitis C are present 1
• HCV RNA not detected = no active virus in the blood 1
• This definitively means "no current HCV infection" 1

What This Means Clinically

There are two possible explanations for this pattern:

1. Past Resolved HCV Infection (Most Likely)

• You had HCV infection that either cleared spontaneously (15-25% of acute infections do this) or was successfully treated in the past 1, 2
• The antibodies remain detectable even after the virus is gone 1
• Approximately 20% of HCV infections spontaneously clear, with higher rates (40-45%) in those infected as children or younger adults 2

2. False-Positive Antibody Test

• The initial antibody test may have been falsely positive, which occurs in approximately 35% of reactive results in low-prevalence populations 1
• To distinguish between these two scenarios, the American College of Obstetricians and Gynecologists recommends repeat HCV antibody testing using a different antibody assay platform 2
• If the alternative assay is negative, the initial test was false-positive and no HCV infection ever occurred 2
• If the alternative assay is positive, this confirms past cleared infection 2

Management Algorithm

Standard Management (Applies to Most Patients)

• No further action is required 1
• Do not treat for hepatitis C - there is no active infection 1
• No follow-up HCV testing needed unless new risk exposures occur 2

When to Consider Repeat HCV RNA Testing

Repeat testing is indicated ONLY in these specific situations: 1, 2

• Recent exposure within the past 6 months - you may be in the window period before RNA becomes detectable 1, 2
• Clinical evidence of active liver disease - unexplained elevated liver enzymes or symptoms suggesting hepatitis 1, 2
• Immunocompromised status - HIV infection, transplant recipients, or on immunosuppressive therapy 1, 2
• Concerns about specimen handling or storage - if the sample may have been improperly processed 2

Note: HCV RNA can be intermittently positive in persons with chronic infection, but a single negative result in the context of reactive antibody typically indicates cleared infection 2, 3

Critical Patient Counseling Points

What You Should Know

• You do not have active hepatitis C infection 1
• You are not infectious to others and do not require isolation precautions 1
• If this represents past resolved infection, you can be reinfected if exposed again - HCV antibodies do not provide protective immunity like other viral infections 1
• You do not need antiviral treatment 2

Common Pitfalls to Avoid

• Do not assume a single negative HCV RNA definitively rules out infection without considering timing of exposure - if exposure was within the past 6 months, repeat testing is needed 2
• Do not order unnecessary repeat testing in confirmed cleared infections - this wastes resources and causes patient anxiety 2
• Do not miss recent acute infection by failing to ask about timing of exposure relative to testing 2
• Do not treat patients who have no active infection 1