Management of Reactive HCV Antibody with Non-Reactive HCV RNA

Interpretation of Test Results

A reactive HCV antibody with non-reactive HCV RNA indicates either past resolved HCV infection or a biologic false positive antibody test, with past resolved infection being the most common scenario, according to the Centers for Disease Control and Prevention 1, 2, 3
The patient should be informed that they do not have evidence of current HCV infection and are not infectious to others, as stated by the American Association for the Study of Liver Diseases 1, 2

For most patients, no antiviral therapy is indicated, and no specific monitoring is needed, as recommended by the Centers for Disease Control and Prevention 3, 4, 5
Patients with ongoing risk factors should be counseled on HCV transmission prevention and considered for periodic HCV RNA retesting to detect potential reinfection, according to the American Association for the Study of Liver Diseases 1, 5
Patients with recent exposure within 6 months should undergo repeat HCV RNA testing at appropriate intervals, as recommended by the Centers for Disease Control and Prevention 2, 4, 5

The patient should not be treated with antiviral therapy, as HCV RNA negativity definitively rules out current infection requiring treatment, according to the American Association for the Study of Liver Diseases 1, 2
It should not be assumed that the patient has never been infected, as the positive antibody likely represents past resolved infection rather than false positivity, although this distinction rarely matters clinically, as stated by the Centers for Disease Control and Prevention 1, 3