A positive anti-HCV on a blood test shows that you may have come into contact with the hepatitis C virus (HCV). But the most important point is this:
A positive anti-HCV does not on its own mean you have an active hepatitis C infection.
To find out whether an active infection is present, an HCV RNA test is usually needed.
What is anti-HCV?
Anti-HCV are the antibodies the immune system makes against the hepatitis C virus. Finding these antibodies in the blood shows that the person may have come into contact with the hepatitis C virus.
But an antibody test cannot on its own show whether the virus is still in the body. So:
- Anti-HCV → shows that contact with the virus may have taken place.
- HCV RNA → shows whether the virus is still in the blood.
This distinction matters a great deal.
Anti-HCV is positive — do I have hepatitis C?
Not always. A positive anti-HCV can point to several different situations:
- Hepatitis C may have been had in the past and cleared from the body. In some people the immune system clears the virus on its own. Anti-HCV can nonetheless stay positive for many years, even for life.
- You may have been treated for hepatitis C and cured. After successful treatment HCV RNA becomes negative but anti-HCV usually stays positive.
- You may have an active hepatitis C infection. HCV RNA is looked for to determine this.
- The test can sometimes be falsely positive. Particularly in people at low risk of hepatitis C, a positive antibody result may not mean active infection.
What is the next test if anti-HCV is positive?
HCV RNA.
When a positive anti-HCV is found, one of the most important next steps is to look for HCV RNA. HCV RNA detects the genetic material of the virus.
Anti-HCV positive + HCV RNA positive
The hepatitis C virus is present in the blood. There is an active HCV infection. The state of the liver should be assessed and appropriate treatment planned.
Anti-HCV positive + HCV RNA negative
No active virus has been found in the blood. This can point to:
- An infection had in the past and cleared
- Hepatitis C that has been treated successfully
- In some cases, a falsely positive anti-HCV result
Depending on the clinical picture, your doctor may consider further assessment or a repeat HCV RNA necessary.
Can I have hepatitis C if my ALT and AST are normal?
Yes.
Normal liver enzymes do not definitively rule out an active hepatitis C infection. So the reasoning “my ALT and AST are normal, therefore I do not have hepatitis C” is not correct.
For active infection, the HCV RNA result is what matters.
What other investigations are done if HCV RNA is positive?
When an active hepatitis C infection is found, the aim is not only to show that the virus is present. How far the liver has been affected is assessed too.
Where your doctor thinks it necessary, the following may be used:
- ALT and AST
- Bilirubin
- Albumin
- INR
- Full blood count and platelets
- Kidney function
- Other viral hepatitis tests
- Ultrasound
- Assessment of liver fibrosis
- Elastography
What does hepatitis C do to the liver?
In some people hepatitis C infection can go on for years without causing any obvious symptoms.
Untreated chronic infection can over time lead in some patients to chronic hepatitis → fibrosis → cirrhosis. In those who develop cirrhosis, the risk of liver cancer can also rise.
But this course does not develop in every patient, and effective treatments for hepatitis C are available today.
Can hepatitis C be treated?
Yes. There have been very important advances here compared with earlier years.
Today hepatitis C can be treated in most patients with direct-acting antiviral medicines (DAAs). Treatment is usually given as tablets taken by mouth, and the success rate is very high in most patients.
The length of treatment and the medicines used are determined by:
- The patient’s characteristics
- The state of the liver disease
- Whether they have had treatment before
- The other medicines they take
Is there a vaccine for hepatitis C?
No.
Unlike hepatitis B, there is currently no vaccine in use against hepatitis C. This is why preventing transmission matters.
How is hepatitis C transmitted?
Hepatitis C is transmitted mainly through contact with infected blood. Situations that may carry a risk include:
- Shared or non-sterile needles
- Non-sterile medical or cosmetic procedures
- Tattooing or piercing carried out without proper sterilisation
- Contact with infected blood
- Transfusions of blood and blood products in periods before adequate HCV screening was in place
Transmission through sexual contact and from mother to baby is possible, but the dynamics differ from those of hepatitis B.
Is it transmitted in everyday life?
Hepatitis C is not transmitted by ordinary everyday contact such as shaking hands, hugging, being in the same room, coughing, sneezing or eating together.
There is no need for a person found to have hepatitis C to be kept apart from social life.
Which personal items should not be shared?
It is best not to share personal items that blood may get onto:
- Razors and shaving blades
- Toothbrushes
- Nail clippers
Should all family members be tested?
Hepatitis C is not an infection that spreads easily by living in the same house. So simply sharing a home does not on its own mean transmission.
But the need for testing can be assessed by a doctor for people at risk of blood contact or carrying other risk factors.
Should I start medication straight away if anti-HCV is positive?
No.
First it has to be determined whether there is an active infection. In someone who is anti-HCV positive but HCV RNA negative, no active hepatitis C infection has been found, and antiviral treatment is not started on the basis of a positive anti-HCV alone.
Treatment is planned after an active HCV infection has been confirmed.
My anti-HCV value is very high — is my disease more severe?
No.
A high anti-HCV antibody level or test index does not show how severe the liver disease is.
In assessing the disease, HCV RNA, liver tests, the state of fibrosis and clinical assessment matter far more.
Does anti-HCV become negative after treatment?
Usually not.
Even after the virus has been eliminated by successful treatment, anti-HCV can stay positive for years or for life.
For this reason, to find out whether someone previously treated for hepatitis C has become infected again, HCV RNA — not anti-HCV — should be used.
Does having hepatitis C once give immunity?
Protective, lasting immunity is not considered to develop.
After hepatitis C has been cleared, whether by treatment or on its own, a person can become infected again if they encounter the virus. So having been cured does not entirely remove the risk of future transmission.
When is urgent assessment needed?
A positive anti-HCV is not on its own a reason to go to an emergency department. But medical assessment is needed without delay if there is:
Seek assessment without delay
Obvious jaundice · confusion or excessive sleepiness · rapidly increasing swelling of the abdomen · vomiting blood · black, tarry stools · obvious gastrointestinal bleeding · severe and persistent vomiting.
What should you do if anti-HCV is positive?
- Do not panic. A positive anti-HCV may not mean you have an active hepatitis C infection.
- Do not ignore the result. Whether there is an active infection needs determining.
- Find out your HCV RNA result. It is one of the most important steps after a positive anti-HCV.
- Find your previous tests. Earlier anti-HCV, HCV RNA and liver tests help with the assessment.
- If there is an active infection, do not delay treatment. Highly effective treatments for hepatitis C are available today.
- Do not take medicines or herbal products on your own. Ask your doctor about products that may affect the liver.
Remember
- Anti-HCV positive Shows that you may have come into contact with the hepatitis C virus.
- Anti-HCV positive + HCV RNA positive There is an active hepatitis C infection.
- Anti-HCV positive + HCV RNA negative No active virus has been found.
- Active hepatitis C Can be treated effectively in most patients today.
- Hepatitis C Has no vaccine.
- After treatment Anti-HCV can stay positive; this does not mean the treatment failed.
This is not enough to make a diagnosis
An anti-HCV result should not be judged on its own. HCV RNA, liver tests, the state of liver fibrosis, previous investigations and the person’s clinical features all have to be weighed together.
If your anti-HCV result is positive, rather than diagnosing yourself with hepatitis C, the right course is proper medical assessment to determine whether there is an active infection.
Sources
- Prof. Ali Tüzün İnce, MD