If you haven’t tested for hepatitis C (HCV) yet, you should consider it. The American Association for the Study of Liver Disease (AASLD) recommends that everyone age 18 and older get tested for HCV at least once in their life. If you test negative and have no other ongoing factors that could lead to acquiring HCV, then you’re done. If you test positive, you can work to get treated and cured.
Hepatitis C test results can be confusing as it’s not just a simple matter of testing positive or testing negative. By comparison HIV tests are pretty straightforward: If you test negative for the HIV antibody test, then you do not have HIV. If you test positive for HIV antibodies, you do have HIV. There’s always a risk of a false positive and there are times when a person could have so recently acquired the virus that their antibody test comes back negative, but for the most part a negative HIV antibody test means you don’t have HIV, while a positive HIV antibody test means that you do.
Hepatitis C testing is a little more complicated. It’s a two-step process. Step one is an antibody test. If the test comes back HCV antibody-positive, then a person will get a confirmatory test that looks directly for the hepatitis C virus. There are situations where an individual could be antibody-positive but negative for the virus. There can be situations where a person is antibody-negative but positive for the virus. And there are situations where a person is antibody-negative and viral load-negative or antibody-positive and viral load-positive.
Take this article with you when you get tested for hepatitis C and get your results. It will provide you with the various options for test results, what those results mean and what your next steps should be based on your results.
How do they test for hepatitis C?
Testing for hepatitis C is a two-step process. The first test is an antibody test. If it comes back negative, then no further testing is needed. If the antibody test does come back positive, then a second test—an HCV viral load (an RNA test)—is done to check for infection.
The most important thing to remember is this: If you test positive on the HCV antibody test, you must confirm it with a viral load test. If you are told “you are positive for HCV because you tested positive for the antibody test,” then you should follow up by asking, Are you sure? Did you confirm that antibody result with an HCV viral load? If they didn’t do a viral load test, ask for one.
Why are there two types of tests?
When you acquire HCV, your body will make antibodies in an effort to fight it off. These antibodies will be with you for the rest of your life, but it doesn’t necessarily mean you actually have HCV. Some people clear the virus naturally on their own within the first 6 months of infection. This happens in about 25% (1 in 4) of people. When someone clears the virus, the HCV antibodies will remain but there’s no virus damaging the liver.
Testing for HCV reinfection
If you tested positive for hepatitis C antibodies and are among the 25% of people who clear the virus, or if you were treated and cured of hepatitis C, you will always test antibody-positive. From this point forward, if you want to know if you have hepatitis C or not, you will need to get an HCV RNA (viral load) test. An antibody test alone won’t tell you if you have hepatitis C or not. You need a test that looks directly for the virus (viral load).
When you go for hepatitis C testing and if you have a history of a positive antibody test, make sure you inform the clinic or testing site. They may still run an antibody test, but they’ll also know to run a viral load test in order to give you an accurate result.
Conclusions
Everyone should test for HCV at least once in their life. If a person uses drugs, is sexually active while living with HIV or has other HCV risk factors, they should test at least once per year. Knowing your HCV status will allow you to know if you have it or not, and if you do, you can get treated and cured.
What you need to know
HCV antibody testing:
- The HCV antibody test will come up either negative or positive (sometimes called “reactive”).
- There is a rapid test for HCV antibodies. It is a finger stick (a drop of whole blood can be taken); results are ready in 20 minutes.
- If you test HCV antibody- negative, then you don’t have HCV; there is no need for a viral load test.
- In rare cases, a person can have no HCV antibodies but a detectable viral load. In these situations, a person has very recently acquired HCV and their body hasn’t had time to produce antibodies.
- There is a period of time, called the “window period,” in which your body needs to make antibodies. The window period for HCV is 6 months. It can happen sooner, but if you’re concerned about a specific event, like sharing a syringe, but you test antibody-negative 6 months afterward, you did not acquire HCV.
HCV viral load testing:
- If you test HCV antibody-positive, the next step is to get a viral load test to confirm if you have chronic HCV.
- If you are HCV antibody-positive, but viral load-negative, then you’ve cleared the virus.
- If you are HCV antibody-positive and HCV viral load-positive, then you have HCV until you get treated and cured.
- HCV viral load testing is done for people who cleared the virus on their own or through cure to test for reinfection.