Testing for HCV Infection

Jane P. Getchell, DrPH; Kelly E. Wroblewski, MPH; Alfred DeMaria Jr, MD; Christine L. Bean, PhD; Monica M. Parker, PhD; Mark Pandori, PhD; D. Robert Dufour, MD; Michael P. Busch, MD, PhD; Mark E. Brecher, MD; William A. Meyer, PhD; Rick L. Pesano, MD, PhD; Chong-Gee Teo, MD, PhD; Geoffrey A. Beckett, MPH; Aufra C. Araujo, PhD; Bernard M. Branson, MD; Jan Drobeniuc, MD, PhD; Rikita Hatia, MPH; Scott D. Holmberg, MD, MPH; Saleem Kamili, PhD; John W. Ward, MD

Disclosures

Morbidity and Mortality Weekly Report. 2013;62(18):362-365.

Future Studies

Research, development, validation, and cost-effectiveness studies are ongoing to inform the best practices for detecting HCV viremia and for distinguishing between resolved HCV infection and biologic false positivity for HCV antibody in persons in whom HCV RNA is not detected. Outcomes of these studies will provide comprehensive guidance on testing, reporting, and clinical management, and will improve case definitions for disease notification and surveillance.

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Table. Interpretation of results of tests for hepatitis C virus (HCV) infection and further actions
Test outcome	Interpretation	Further action
HCV antibody nonreactive	No HCV antibody detected	Sample can be reported as nonreactive for HCV antibody. No further action required. If recent HCV exposure in person tested is suspected, test for HCV RNA.*
HCV antibody reactive	Presumptive HCV infection	A repeatedly reactive result is consistent with current HCV infection, or past HCV infection that has resolved, or biologic false positivity for HCV antibody. Test for HCV RNA to identify current infection.
HCV antibody reactive, HCV RNA detected	Current HCV infection	Provide person tested with appropriate counseling and link person tested to medical care and treatment.^†
HCV antibody reactive, HCV RNA not detected	No current HCV infection	No further action required in most cases. If distinction between true positivity and biologic false positivity for HCV antibody is desired, and if sample is repeatedly reactive in the initial test, test with another HCV antibody assay. In certain situations^§ follow up with HCV RNA testing and appropriate counseling.

* If HCV RNA testing is not feasible and person tested is not immunocompromised, do follow-up testing for HCV antibody to demonstrate seroconversion. If the person tested is immunocompromised, consider testing for HCV RNA.
^†It is recommended before initiating antiviral therapy to retest for HCV RNA in a subsequent blood sample to confirm HCV RNA positivity.
^§If the person tested is suspected of having HCV exposure within the past 6 months, or has clinical evidence of HCV disease, or if there is concern regarding the handling or storage of the test specimen.

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