Follow-up for Hepatitis C Reactive Test with Negative Viral Load

Understanding the Results

For patients with a hepatitis C (HCV) reactive antibody test but negative viral load, no further testing is required as this indicates either past resolved infection or false positive antibody result, and the patient should be reassured 1, 2
A positive HCV antibody test but a negative HCV RNA can indicate past HCV infection that has resolved, false positive antibody test result, or very rarely, intermittent viremia in chronic infection 1, 3, 4, 5, 6

If there is concern about the accuracy of the initial antibody result, perform a second HCV antibody test using a different assay platform, as different antibody assays use different antigens and test platforms, making biologic false positivity unlikely to occur across multiple tests 1, 2, 4
If the patient might have been exposed to HCV within the past 6 months, repeat HCV RNA testing is recommended, as during acute infection, HCV RNA may be transiently negative as antibody titers rise 1, 2, 5, 6

Among anti-HCV positive persons who acquired infection as older adults (>45 years), 15-25% spontaneously resolve their infection, while higher resolution rates (40-45%) are seen in those who acquired infection as children or younger adults 5, 6
Patients with resolved infection should be reassured that they are not infectious, and explain that antibodies may persist for life even after the virus has been cleared 2, 3, 7

Review for signs or symptoms of liver disease, and if clinical evidence of HCV disease exists despite negative RNA, repeat RNA testing 1, 3, 4