hepatitis C virus testing in primary care

Last reviewed 04/2019

Testing for hepatitis C in primary care:

  • the primary screening test is a blood test for antibodies to the virus (anti-HCV), which indicates if a person has ever been infected with HCV
  • a positive test should be confirmed by testing a second sample
    • can take three months for antibodies to become detectable
    • a negative test should be repeated if the exposure was within three months of the test
    • about 20-40% of people will clear the virus naturally, so a test to detect HCV RNA is required to establish if the patient is still infected

Pre-test discussion about the HCV test:

  • this should include (1):
    • hepatitis C, its natural history and the benefits offered by treatment
    • what the test involves, testing timescale and confidentiality of results
    • assessment of exposure risks and establishing when the last risk activity took place
    • implications of both a positive result and negative result for the individual and his/her family or close contacts (2)
    • importance of giving informed consent to the process (2)
    • what personal support network the individual may have; information about national/local organisations that provide support
  • testing for hepatitis C may also offer the opportunity to advise injecting drug users about harm minimisation and to offer them the hepatitis A and hepatitis B vaccine

Post-test discussion about the HCV test:

  • discussion will vary with respec to result of the HCV test (1)
    • negative antibody result
      • further testing will be required if the last exposure risk occurred in the preceding three month ?window period?
      • there should be a discussion concerning ways of avoiding infection in the future
    • positive antibody result
      • positive antibody results should be confirmed on a second blood sample, when tests for HCV RNA can also be performed if the positive antibody results are confirmed
      • the patient should be advised not to donate blood or carry an organ donor card
    • positive HCV RNA result
      • patients should be referred to a specialist for further assessment
      • the patient should be advised to stop or reduce alcohol consumption (associated with more rapid progression of liver disease)
      • there should be discussion concerning ways of avoiding infecting others
      • consider the need to test other family members or close contacts
    • negative HCV RNA result
      • a positive antibody and negative HCV RNA test indicates a previously resolved infection, but not immunity to further infection
      • patients who are antibody positive but HCV RNA negative should have a second HCV RNA test after 4?6 weeks to confirm their negative status