Positive Hepatitis C Antibody Test: Does It Mean an Active Infection?

Hepatitis C is a common viral infection of the liver, and like hepatitis B it often causes no symptoms for years. The usual first test is a blood test for antibodies, called anti-HCV. Many people who get a positive hepatitis C antibody test assume it means they have hepatitis C, but that isn't always so. This guide explains what the result means, the follow-up test that answers the question, and when to test. Ovio's hepatitis C test is done at home in Bangkok.

What Is Hepatitis C?

Hepatitis C is caused by the hepatitis C virus (HCV). It infects liver cells and causes inflammation, usually without noticeable symptoms. About three in ten people clear the virus by themselves within six months. In the rest it becomes chronic, and over many years it can lead to cirrhosis (scarring of the liver) and liver cancer. There is no vaccine, but there is a cure.

How Is Hepatitis C Transmitted?

Hepatitis C spreads mainly through blood:

• Shared needles, syringes or other drug equipment, including straws for snorting.
• Unsterile equipment for tattoos, piercings, and medical, dental or beauty procedures. Blood transfusions and organ transplants before donor blood was screened also spread it.
• Sharing razors, toothbrushes or nail clippers that may carry traces of blood.
• Sex, less commonly. The risk is higher with sex that can involve blood, such as anal sex without a condom, sex during a period, group sex or sex with drug use, and for people living with HIV.
• From mother to baby during pregnancy or birth.

Hepatitis C isn't spread by coughing, sneezing, hugging, breastfeeding, or sharing food, drinks or cutlery.

How Is Hepatitis C Diagnosed?

Testing has two steps, both from a blood sample taken from a vein:

1. Anti-HCV (hepatitis C antibody test): the screening test. It looks for antibodies your immune system makes after meeting the virus.
2. HCV RNA: done if the antibody test is positive. It looks for the virus's genetic material (RNA) and shows whether the virus is in your blood now.

What Does a Positive Hepatitis C Antibody Test Mean?

A positive hepatitis C antibody test means you've been infected with HCV at some point. The antibodies usually stay for life, whether the virus is still there, your body cleared it, or you were treated and cured. So a positive result can mean either a current infection or a past one. Occasionally it's a false positive.

A negative result usually means you haven't had hepatitis C. The exceptions are a test taken too soon after an exposure, and people with a weakened immune system, such as those on dialysis or with advanced HIV, who may not make antibodies. In either case a doctor may recommend an RNA test or a repeat antibody test.

What Should You Do If Your Hepatitis C Antibody Test Is Positive?

Your doctor will arrange an HCV RNA test. Ideally it's run on the same blood sample, or soon after, so you don't wait for an answer.

• HCV RNA positive: you have hepatitis C now. A doctor checks your liver and starts treatment with direct-acting antiviral tablets.
• HCV RNA negative: you had hepatitis C in the past and your body cleared it, or you were treated and cured, or the antibody result was a false positive. You don't have an active infection.

Hepatitis C Test Results Explained

When Should You Get Tested If You Suspect Hepatitis C?

After a possible exposure, the antibody test becomes reliable at about 8 to 11 weeks (2 to 3 months), once the body has had time to make antibodies. Testing earlier can give a false negative. An HCV RNA test can find the virus sooner, from about 1 to 2 weeks, so a doctor may use it if you need an earlier answer. Depending on the exposure, your doctor may also suggest a repeat test after three to six months to confirm your result. Check your own dates with the STI test window calculator.

Everyone should have a hepatitis C test at least once as an adult. Test regularly if you've ever injected drugs, had tattoos or procedures where you weren't sure the equipment was sterile, are a man who has sex with men, or are living with HIV or taking PrEP.

Hepatitis C Testing in Bangkok

Hepatitis C antibody testing is available at hospitals and clinics across Bangkok, about two to three months after a possible exposure.

If you'd prefer private testing, Ovio's at-home STI testing brings a doctor to your home, condo, hotel or office at a date and time you choose, for Thai and international clients. The anti-HCV antibody test is ฿1,290, and it's included in the Ovio Essential package (฿5,990) with HIV, syphilis, hepatitis B and an 18-infection PCR panel. If your antibody result is positive, the doctor will explain it and arrange the RNA test you need. Not sure which tests to have? See which STI tests should I get?

Frequently Asked Questions

What is a positive hepatitis C antibody test?

It means you've been exposed to hepatitis C at some time, but it can't tell you whether the virus is still in your body. An HCV RNA test confirms whether you have an active infection.

Can hepatitis C be completely cured?

Yes. Direct-acting antiviral tablets, usually taken for 8 to 12 weeks, cure more than 95% of people, according to the World Health Organization. They have few side effects for most people and no injections are needed. A cure is confirmed with an RNA test after treatment.

Is hepatitis C dangerous?

It can be, because it usually causes no symptoms early on. Left untreated, chronic hepatitis C can lead to cirrhosis, liver failure and liver cancer over many years. Found and treated, those risks fall sharply.

Will my antibody test be positive after a cure?

Usually, yes. The antibodies stay for life, so they can't show a new infection. A cure doesn't make you immune and there's no vaccine, so if you're exposed again, an RNA test is the one to have.

Can I have a false-positive hepatitis C antibody test?

Yes, occasionally, especially when hepatitis C is unlikely. A negative RNA test after a positive antibody test can mean a false positive, a cleared infection, or a past cure. Your doctor reads it alongside your history.