What are the implications when someone tests positive for the Hepatitis C (Hep C) antibody?

From the Guidelines

When someone is positive for the Hep C antibody, they should immediately undergo HCV RNA testing to determine if there is an active infection present, as a positive antibody test does not necessarily indicate current infection. This approach is recommended by the American Association for the Study of Liver Diseases-Infectious Diseases Society of America, as outlined in their 2019 update on hepatitis C guidance 1. The HCV RNA test is crucial for confirming active infection, and if the result is positive, the person should be referred to a healthcare provider experienced in managing Hepatitis C for treatment evaluation.

Some key points to consider in the management of individuals with a positive Hep C antibody test include:

• The importance of HCV RNA testing for confirming active infection, as a positive antibody test can also indicate past resolved infection or a false positive result 1
• The need for quantitative HCV-RNA testing prior to initiation of antiviral therapy to document the baseline level of viremia (i.e., baseline viral load) 1
• The consideration of HCV genotype testing for those in whom it may alter treatment recommendations, although this is not universally required prior to treatment initiation 1
• The high effectiveness of modern treatments for Hepatitis C, which typically consist of direct-acting antiviral medications, with cure rates exceeding 95% and minimal side effects 1

Even if the HCV RNA test is negative, indicating no active infection, the person should still be counseled about liver health, including:

• Avoiding alcohol to prevent further liver damage
• Maintaining a healthy weight to reduce the risk of liver disease progression
• Getting vaccinated against Hepatitis A and B to prevent additional liver damage
• The importance of ongoing monitoring and follow-up to detect any potential reinfection or disease progression 1

From the Research

Hepatitis C Antibody Positive Diagnosis and Treatment

• When someone is positive for the Hep C antibody, it indicates that they have been exposed to the Hepatitis C virus (HCV) at some point in their lives 2.
• A positive HCV antibody test does not necessarily mean that the person is currently infected with the virus, as the antibody can remain in the blood even after the infection has been cleared 2.
• To confirm an active HCV infection, a follow-up test to detect the presence of HCV RNA (viral load) is recommended 2, 3.

Treatment and Viral Load Monitoring

• The treatment for HCV infection typically involves direct-acting antiviral therapies, which can achieve cure rates of greater than 95% in treatment-naive adults without cirrhosis or with compensated cirrhosis 2.
• Monitoring of HCV RNA levels during treatment can help predict treatment response and sustained virologic response (SVR12) 4.
• A sustained virologic response is associated with lower all-cause mortality and improves hepatic and extrahepatic manifestations, cognitive function, physical health, work productivity, and quality of life 2.

Reflex HCV RNA Viral Load Testing

• Reflex HCV RNA viral load testing, which involves automatic testing for HCV RNA after a positive HCV antibody test, can increase the uptake of HCV RNA testing and improve linkage to care 3.
• Laboratory-based reflex VL testing has been shown to increase HCV VL test uptake and may improve linkage to care among people with a positive HCV RNA test 3.

Predictors of Undetectable Viral Load

• Older adults (>65 years) and residents of areas with higher enrollment in health insurance have been found to have a greater likelihood of achieving an undetectable viral load 5.
• Higher tract median household income and higher tract levels of health insurance have also been found to be associated with an increased likelihood of undetectable viral load 5.