Hepatitis C testing sequence
| Test | Purpose | What positive means |
|---|---|---|
| HCV antibody (anti-HCV) | Initial screening test | Past or current HCV infection (antibodies persist lifelong) |
| HCV RNA (viral load) | Confirms active infection | Virus is present — active infection requiring treatment |
| HCV genotype | Type of virus (1–6) | Guides choice and duration of antiviral treatment |
| LFT + liver fibrosis assessment | Assess liver damage | Cirrhosis affects treatment decisions |
Understanding the antibody vs RNA test
Why both tests are needed
A positive HCV antibody test means you have been exposed to hepatitis C at some point. However, about 15–25% of people clear the virus naturally after acute infection — they have a positive antibody but negative RNA. Only an HCV RNA test can confirm current (active) infection. All anti-HCV positive patients need an HCV RNA test. If RNA is positive, they have chronic hepatitis C and are candidates for curative antiviral treatment with direct-acting antivirals (DAAs).
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?