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Viral Hepatitis and Liver Disease

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Hepatitis C Screening Flow Chart

for Health Care Providers

Steps for Diagnosis - Hepatitis C

Hepatitis C Virus Antibody Screening Flow Chart

* For persons who might have been exposed to HCV within the past 6 months, testing for HCV RNA or follow-up testing for HCV antibody is recommended. For persons who are immunocompromised, testing for HCV RNA can be considered.

** To differentiate past, resolved HCV infection from biologic false positivity for HCV antibody, testing with another HCV antibody assay can be considered. Repeat HCV RNA testing if the person tested is suspected to have had 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.

Source: CDC. Testing for HCV infection: An update of guidance for clinicians and laboratorians. MMWR 2013;62(18).

An Outline of Recommended Testing for Screening and Diagnosis of Hepatitis C

Step 1: Testing for HCV Antibody

  • A positive antibody result indicates that a patient has been infected with hepatitis C at some point.
  • A negative antibody result indicates that the patient has never been infected with hepatitis C.
  • A positive antibody result alone does not distinguish between an active or previous hepatitis C infection.

Step 2: Testing for HCV RNA

  • VA laboratories run an automatic "reflex" HCV RNA test for all hepatitis C antibody positive tests.
  • From a single blood draw, the patient had 2 specimens collected in 2 tubes; one for the HCV antibody test and, in case the antibody result was positive, a second for HCV RNA test.
  • The clinician does not need to place an additional order and the patient does not need to return to the lab to have another blood draw.