Hepatitis C test results: what they mean
Hepatitis C testing has two steps. An antibody test shows whether you have ever had the virus; if it is reactive (positive), an RNA test shows whether you have it now. A positive antibody test alone does not mean you have hepatitis C today. Your doctor decides what your results mean for you. (USPSTF, 2020) (CDC, 2020)
The two tests
- Antibody test (anti-HCV): the screening test. A reactive result means you have been infected at some point, either now or in the past. (CDC, 2020)
- RNA test (also called a nucleic acid test, PCR or viral load test): looks for the virus itself. If it finds the virus, you have a current infection. (CDC, 2020) (USPSTF, 2020)
The USPSTF recommends screening with the antibody test followed by PCR to confirm. (USPSTF, 2020) The CDC asks labs to run the RNA test automatically on any reactive antibody sample, from blood taken at the same visit. When the antibody test is reactive and no RNA test is done, the CDC calls the testing incomplete; historically about a third of patients were in that position. (CDC, 2023) If your report shows only a reactive antibody result, ask whether the RNA test was done.
What each combination means
| Antibody test | RNA test | What it means |
|---|---|---|
| Non-reactive (negative) | Not done | No hepatitis C infection, unless you were exposed recently. Test again if your risk continues. (CDC, 2020) |
| Reactive (positive) | Not detected | No current infection: either a past infection that went away (on its own or with treatment), or a false-positive antibody test. More testing may be needed. (CDC, 2020) |
| Reactive (positive) | Detected | Current (active) hepatitis C infection. It can be cured; you will need further checks before treatment. (CDC, 2020) |
| Non-reactive (negative) | Detected | Recent infection: the virus shows up before the antibodies do. (CDC, 2020) |
A reactive antibody test can come from an infection that has already gone away, on its own or with treatment, as well as from a current one; the RNA test tells the two apart. (CDC, 2020) Not everyone infected keeps the virus: the NIDDK says more than half of people with a new (acute) infection go on to a long-lasting (chronic) one, and the CDC report notes that recent data put natural clearance as high as 46%, varying with age at infection. (NIDDK, 2024) (CDC, 2020)
Testing soon after an exposure
Antibodies can be found 4 to 10 weeks after infection and are present in about 97% of people by 6 months after exposure. The RNA test can detect the virus as early as 1 to 2 weeks after exposure. (CDC, 2020) So a non-reactive antibody test is reassuring unless you were exposed recently, for example through recent injection drug use; in that case your doctor may test again. (CDC, 2020)
If the RNA test is positive
The CDC says people with a current infection should be told that they would benefit from curative treatment, and that they need a further check-up first, care for possible liver disease and ongoing follow-up. (CDC, 2020) Before treatment, doctors look for liver damage and test for other infections such as HIV and hepatitis B; tests may include blood tests, elastography (a scan that measures liver stiffness) or an ultrasound. (NIDDK, 2024) Many people have few or no symptoms for years, which is why the test matters. (NIDDK, 2024) Which treatment fits you is for your doctor to decide. More on next steps after any screening result: after an abnormal screening result.
When to test again
The USPSTF recommends screening adults 18 to 79 and says most adults need it only once; people with continued risk, such as past or current injection drug use, should be screened again from time to time, though the best interval is not known. (USPSTF, 2020) The CDC recommends at least one test for all adults 18 and older and a test during each pregnancy, except where fewer than 0.1% of people have the infection, and periodic testing while risk factors last. Anyone who asks for a test should get one, without having to say why. (CDC, 2020) The two differ on the upper age and on every pregnancy; the full comparison is on hepatitis C screening.
Cost and coverage
Medicare Part B covers hepatitis C screening ordered by your primary care doctor: once in your lifetime if you were born 1945 to 1965, had a blood transfusion before 1992 or used injection drugs in the past, and once a year if you have kept using injection drugs since your last negative test. You pay nothing if your provider accepts assignment. (Medicare.gov) For private plans, see preventive screenings covered by insurance.
Questions people ask
What does a reactive hepatitis C antibody test mean?
It means you have had contact with the hepatitis C virus at some point. It does not tell you whether you have it now: you may have a current infection, or a past infection that cleared on its own or with treatment. An RNA test on your blood answers that. (CDC, 2020) (NIDDK, 2024)
Why do I need an RNA test after a positive antibody test?
Only the RNA test shows whether the virus is in your blood now. The CDC says every reactive antibody test should be followed by an RNA test, ideally on the same blood sample so you do not need a second visit; without it, testing is incomplete. (CDC, 2020) (CDC, 2023)
Can the antibody test be negative if I was just infected?
Yes. Antibodies show up 4 to 10 weeks after infection and are present in about 97% of people by 6 months. The RNA test can find the virus as early as 1 to 2 weeks after exposure. If you had a recent exposure, tell your doctor. (CDC, 2020)
How often should I get tested for hepatitis C?
Most adults need one test in their lifetime. The USPSTF recommends screening adults 18 to 79, and the CDC recommends at least one test for all adults 18 and older and a test in every pregnancy. People whose risk continues, such as people who inject drugs, should be tested again from time to time. (USPSTF, 2020) (CDC, 2020)
Does Medicare cover the hepatitis C test?
Medicare Part B covers it when your primary care doctor orders it: once in your lifetime if you were born 1945 to 1965, had a blood transfusion before 1992 or used injection drugs in the past, and once a year if you have kept using injection drugs since your last negative test. You pay nothing if your provider accepts assignment. (Medicare.gov)