Chronic Hepatitis C
This patient has chronic hepatitis C (Answer C). The combination of positive HCV antibody and detectable HCV RNA at 1.5 million IU/mL definitively confirms active, chronic hepatitis C virus infection requiring treatment evaluation. 1
Diagnostic Interpretation
The presence of both positive anti-HCV antibodies AND detectable HCV RNA simultaneously establishes the diagnosis of chronic hepatitis C. 1 This dual positivity distinguishes active infection from past resolved infection, where antibodies would persist but HCV RNA would be undetectable. 2
Key Laboratory Findings Explained:
HCV antibody positive + HCV RNA 1.5 million IU/mL: This confirms current active viral replication and chronic infection, not just past exposure. 1 The high viral load indicates ongoing disease requiring antiviral therapy consideration. 1
HBsAg negative: This rules out chronic hepatitis B, as chronic HBV infection requires HBsAg positivity for at least 6 months. 3 The patient does not have hepatitis B.
HBcAb (anti-HBc) positive: This indicates past resolved hepatitis B infection or immunity, which is protective rather than indicative of chronic disease. 1 Approximately 5-10% of the general population has isolated anti-HBc positivity from prior exposure. 4
Hepatitis A IgG positive: This indicates past exposure with immunity. 1 Hepatitis A never causes chronic hepatitis—it only causes acute self-limited infection. 4
Why Not the Other Answers
Not Answer A (Chronic Hepatitis A): Hepatitis A virus does not cause chronic infection under any circumstances. 4 HAV IgG simply indicates immunity from past infection or vaccination.
Not Answer B (Chronic Hepatitis B): Chronic HBV requires HBsAg positivity, which this patient lacks. 3 The negative HBsAg definitively excludes chronic hepatitis B.
Not Answer D (Chronic Hepatitis D): Hepatitis D virus (delta virus) is a defective virus that requires HBsAg for replication and can only infect individuals with active hepatitis B infection. 5 Since this patient is HBsAg-negative, hepatitis D infection is impossible.
Critical Clinical Context
Chronic HCV infection is defined by persistence of HCV RNA for more than 6 months after initial infection. 3 Once established beyond 4-6 months, spontaneous viral clearance becomes extremely rare. 1
Immediate Next Steps for This Patient:
- Liver function tests and complete blood count to assess disease severity 1
- HCV genotype determination (though less critical with pangenotypic direct-acting antivirals) 1
- Fibrosis assessment via elastography or serum biomarkers 1
- Abdominal ultrasound for baseline liver imaging 1
Treatment Implications:
The goal of direct-acting antiviral therapy is HCV eradication to prevent progression to cirrhosis, hepatocellular carcinoma, and death, with sustained virological response rates exceeding 95%. 1 Once cirrhosis develops, patients face hepatocellular carcinoma risk of 1-7% per year. 1
Common Pitfall to Avoid
Never confuse positive HCV antibody alone with active infection. 1 Antibodies persist indefinitely after viral clearance and cannot distinguish current from past infection—HCV RNA testing is essential for this determination. 2, 6 Approximately 15-45% of HCV-infected individuals spontaneously clear the virus, leaving them with positive antibodies but negative HCV RNA. 6