What additional monitoring is recommended for a patient who is hepatitis C (HCV) antibody positive but HCV RNA quantification negative?

No Additional Monitoring Required for HCV Antibody-Positive, RNA-Negative Patients

Patients who are HCV antibody-positive but HCV RNA-negative do not have active HCV infection and do not need follow-up testing or additional monitoring. 1

Interpretation of Your Patient's Results

Your patient's test results indicate one of two scenarios:

• Resolved infection (most likely): The patient was previously infected with HCV but spontaneously cleared the virus, which occurs in approximately 20% of HCV infections 2
• False-positive antibody test: The initial antibody test was a biological false-positive 2

Optional Confirmatory Testing

While additional testing is typically unnecessary, you may consider the following only if you or the patient wish to distinguish between resolved infection versus false-positive:

• Repeat HCV antibody testing using a different assay platform (different manufacturer/methodology) 2, 3
  • If the second assay is negative: the initial test was false-positive, and no HCV infection ever occurred 2
  • If the second assay is positive: the infection has cleared 2
  • Modern HCV antibody assays vary in antigens and platforms, so biological false-positivity is unlikely with two different tests 2

When to Consider Repeat RNA Testing

Repeat HCV RNA testing should only be performed if: 1

• Recent exposure within the past 6 months: HCV RNA can be detected 1-3 weeks after exposure, while antibodies may take 2-6 months to develop 2
• Ongoing high-risk behaviors: Current injection drug use or other continued HCV exposure risks 1
• Immunocompromised status: HIV/AIDS, hemodialysis patients, or other severe immunosuppression where delayed seroconversion may occur 1, 3

No Routine Liver Monitoring Needed

• No liver function tests, imaging, or specialist referral is required for antibody-positive, RNA-negative patients without active infection 1
• These patients do not have chronic liver disease from HCV and do not require hepatocellular carcinoma screening 1

Common Pitfalls to Avoid

• Do not order serial liver enzymes or liver imaging in RNA-negative patients—this represents unnecessary testing 1
• Do not refer to hepatology unless RNA testing confirms active viremia 1
• Do not misinterpret intermittent viremia as a concern in truly RNA-negative patients—intermittent viremia is unusual and not clinically relevant in this scenario 1