No, You Do Not Have Chronic Hepatitis C
A positive HCV antibody test with a negative HCV RNA test means you do not have active (chronic or acute) hepatitis C infection. 1
What This Result Pattern Means
Your test results indicate one of two possibilities:
- Cleared infection (most likely): You had hepatitis C in the past but your immune system successfully eliminated the virus—this occurs in approximately 20% of HCV infections 1, 2
- False-positive antibody test (less likely): The initial antibody test was incorrect and you never had hepatitis C 1, 2
Recommended Next Step to Clarify
Repeat the HCV antibody test using a different antibody assay platform to distinguish between these two scenarios 1, 2, 3:
- If the second antibody test is negative: Your initial test was a false-positive, and you have never had hepatitis C—no further testing or follow-up is needed 1, 2, 3
- If the second antibody test is positive: You had hepatitis C that has cleared spontaneously—no treatment is needed, and routine HCV follow-up is not required 1, 2, 3
The rationale for this approach is that HCV antibody assays vary in their antigens and test platforms, making it extremely unlikely for a false-positive result to occur on two different assay types 1, 3
Important Caveats
Consider repeating HCV RNA testing (rather than just accepting the negative result) only in these specific circumstances 1, 2:
- You had a known HCV exposure within the past 6 months before testing (you may be in the early "window period" where RNA is detectable but antibodies haven't yet developed) 1
- You are severely immunocompromised (HIV/AIDS, hemodialysis, organ transplant) as antibody responses may be delayed or absent 1
- You have clinical signs of active liver disease that suggest ongoing hepatitis 2
- There are concerns about how the blood sample was handled or stored 2
What You Should Know
- You are not protected from future HCV infection: Cleared infection does not provide immunity, and you can be reinfected if exposed again 1
- No treatment is needed: Antiviral therapy is only indicated for active infection (positive HCV RNA) 2
- No ongoing monitoring is required: Unless you have new risk exposures, you do not need repeat HCV testing 1, 2
Common Pitfall to Avoid
Do not assume a single negative HCV RNA test definitively rules out infection without performing confirmatory antibody testing on an alternative platform, especially if you haven't completed the two-test algorithm described above 2, 3. However, in the absence of the special circumstances listed (recent exposure, immunocompromise, active liver disease), a negative RNA test is highly reliable for excluding active infection 1