Hepatitis C Blood Tests

Hepatitis C testing sequence

Understanding the antibody vs RNA test

Hepatitis C treatment: cure is possible

Modern direct-acting antiviral (DAA) medications such as sofosbuvir/velpatasvir (Epclusa) or glecaprevir/pibrentasvir (Mavyret) cure hepatitis C in over 95% of patients with just 8–12 weeks of once-daily tablets. Treatment is recommended for virtually all patients with chronic HCV. After treatment, a sustained virological response (SVR), undetectable HCV RNA 12 weeks after finishing treatment, means the virus is cured.

Who should be tested for hepatitis C?

• All adults aged 18–79 (one-time universal screening recommended in the USA)
• Anyone who has ever injected drugs
• Recipients of blood transfusions before 1992
• People with HIV
• People with unexplained raised liver enzymes

Questions to ask your doctor

• Is my HCV RNA positive: do I have active hepatitis C?
• What genotype do I have?
• Do I have cirrhosis?
• Which antiviral treatment is right for me?

Frequently Asked Questions

References

The clinical information on this page is drawn from peer-reviewed sources indexed by the US National Library of Medicine. Links go to the source so you can read it yourself.

1. Hepatitis C. In: StatPearls. Treasure Island (FL): StatPearls Publishing. NCBI Bookshelf NBK430897

References

Sources cited on this page. PubMed links open the original abstract.

1. Pawlotsky JM, Negro F, Aghemo A, et al. EASL recommendations on treatment of hepatitis C: final update of the series. J Hepatol. 2020;73(5):1170–1218. PMID 32956768 · doi:10.1016/j.jhep.2020.08.018

HCV antibody versus HCV RNA – why both matter

Hepatitis C testing requires two different types of test at different stages:

• Anti-HCV antibody (HCV Ab): Detects the immune system's antibodies against the hepatitis C virus. Becomes detectable 8–12 weeks after exposure. A positive result confirms the person has been exposed to HCV – but does not distinguish between active infection, cleared infection, or successfully treated infection. Antibodies persist for life, even after the virus has been eliminated. Sensitivity is approximately 99% after the window period.
• HCV RNA (viral load / PCR): Detects actual virus RNA in the blood. This is the definitive test for active infection. A positive HCV RNA with a positive antibody = current active infection requiring treatment. A negative HCV RNA with a positive antibody = past infection that has been cleared or treated. HCV RNA is also used to monitor treatment response: it should fall to undetectable within 4 weeks of starting antiviral therapy.

Testing sequence: screen with antibody → if positive, confirm with HCV RNA. Do not begin antiviral treatment on the basis of antibody alone – always confirm with RNA.

The HCV genotypes and why they matter less now

There are six major hepatitis C genotypes (1–6), with regional variation: genotype 1 accounts for 70% of UK and US infections; genotype 3 is most common in South Asia. Historically, genotype determined treatment regimen and duration because older interferon-based therapies had different response rates by genotype. The modern pan-genotypic direct-acting antivirals (DAAs) – sofosbuvir/velpatasvir (Epclusa), glecaprevir/pibrentasvir (Maviret) – achieve 97–99% sustained virological response (SVR, effectively cure) regardless of genotype in most patients. Genotyping is still used in complex cases (prior treatment failure, decompensated cirrhosis) but is no longer required before starting first-line therapy in treatment-naive patients without cirrhosis.

Who needs testing – identifying at-risk populations

HCV is primarily transmitted through blood-to-blood contact. High-risk groups where one-time or periodic testing is recommended:

• Current or past injecting drug users (IDUs) – the primary transmission route in the UK; estimated 50% of IDUs are HCV-positive
• Anyone who received blood products or organs before 1992 (when HCV testing of blood supplies began)
• Men who have sex with men (MSM), particularly those with HIV or multiple partners
• Prisoners (high prevalence in prison populations)
• People born or raised in high-prevalence countries (Egypt, Pakistan, Central Asia)
• Healthcare workers with needlestick injuries from HCV-positive patients

NICE (2020) recommends offering HCV testing opportunistically in primary care and drug services to all individuals from these groups. Universal opt-out testing in emergency departments and inpatient settings is expanding in the UK as part of the national HCV elimination strategy.