How do I get screened for Hepatitis C and check my viral load?

How to Screen for Hepatitis C and Check Viral Load

To determine if you are "undetectable" for Hepatitis C, you need a two-step blood test: first, an HCV antibody test, and if positive, an automatic reflex HCV RNA test—both can be done from a single blood draw. 1, 2

Initial Screening Process

The screening follows a standardized two-step approach that requires only one blood collection 1:

Step 1: HCV Antibody Testing

• Your healthcare provider orders an FDA-approved anti-HCV antibody test (enzyme immunoassay or rapid test) 3, 2
• This can be done through standard venipuncture blood draw, fingerstick whole blood, or even oral fluid (saliva) using rapid diagnostic tests 3
• Results are reported as either "reactive" (positive) or "nonreactive" (negative) 3

Step 2: Automatic Reflex HCV RNA Testing

• If your antibody test is reactive, the same blood sample is automatically tested for HCV RNA using polymerase chain reaction (PCR) without requiring you to return for another blood draw 1, 2
• This is the critical test that determines if you have active infection or are "undetectable" 3

Understanding Your Results

If HCV RNA is NOT detected (undetectable):

• This means you either had past HCV infection that resolved on its own, you were successfully treated and cured, or the antibody test was falsely positive 3, 1
• You do NOT have current active infection 2
• However, you are not protected from reinfection if exposed again 1

If HCV RNA IS detected:

• This indicates current active HCV infection requiring evaluation for treatment 1, 2
• A quantitative HCV RNA test (viral load) should then be performed to establish your baseline level before any treatment 2

If antibody test is negative:

• No evidence of current or past infection 1
• Exception: If you had recent exposure within the past 6 months, antibody production may be delayed 8-9 weeks, so direct HCV RNA testing or repeat antibody testing ≥6 months after exposure is needed 1, 2

Special Situations Requiring Direct RNA Testing

You should request direct HCV RNA testing (bypassing antibody testing) if 1, 2:

• You are immunocompromised (HIV-positive, on immunosuppressive medications, organ transplant recipient), as antibody production may be inadequate 3, 2
• You had potential HCV exposure within the past 6 months and want immediate testing 3, 1
• You were previously infected and cleared HCV (either spontaneously or with treatment) and need to check for reinfection, since antibody tests remain positive for life 1, 2

Who Should Be Screened

Universal screening is now recommended for 1:

• All adults aged 18-79 years at least once in their lifetime, regardless of risk factors 1
• All pregnant women during each pregnancy 1
• Anyone with ongoing risk factors (people who inject drugs, men with HIV who have unprotected sex with men) should be tested annually 1

Confirming You Are "Undetectable" After Treatment

If you were previously treated for Hepatitis C, the test to confirm cure is 3, 2:

• Quantitative HCV RNA test performed at 12 weeks after completing therapy (called SVR12 - sustained virologic response at 12 weeks) 3
• Undetectable HCV RNA at this timepoint indicates virologic cure with >99% durability 2
• The lower limit of detection should be ≤15 IU/ml for the assay 3

Common Pitfalls to Avoid

Never rely solely on antibody testing to determine if you are undetectable 1, 2. The antibody test only tells you if you were ever exposed to HCV—it remains positive for life even after successful treatment or spontaneous clearance. Only the HCV RNA test tells you if virus is currently present or undetectable 1, 2.

For those with past infection checking for reinfection: Always request HCV RNA testing directly, not antibody testing, since your antibodies will always be positive 1, 2.

If you are immunocompromised: Specifically request HCV RNA testing, as you may have false-negative antibody tests even with active infection 2.

Practical Steps to Order the Test

1. Request "HCV antibody with reflex RNA" from your healthcare provider—this ensures both tests are done automatically from one blood draw 1, 2
2. If you fall into special categories above, specifically request "HCV RNA PCR" testing 2
3. The reflex testing approach eliminates the need for a return visit, addressing a major barrier where patients are lost to follow-up between the two tests 1