Hepatitis C antibodies stay positive for life after infection, whether the virus cleared spontaneously, was cured with treatment, or is still active. About a quarter to a third of infected people clear the virus without treatment.
Only an HCV RNA test shows current infection. A positive antibody should be followed by RNA testing — ideally reflexed on the same sample — before a patient is told they have hepatitis C or is started on treatment. After cure, the antibody remains positive, so reinfection is checked with RNA, not antibody.
- Follow every positive HCV antibody with an HCV RNA test before giving a diagnosis.
- Ask the laboratory to run RNA on the same sample where it can, to avoid losing the patient to follow-up.
- Do not repeat antibody tests after cure; use RNA to check for reinfection.
- Assess for cirrhosis before choosing treatment length, since short courses are studied in non-cirrhotic patients.
Why it matters
Antibody-only diagnosis both alarms people who have cleared the virus and misses the chance to treat those who have not.
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