A reactive result on a Hepatitis C Virus (HCV) screening test can be alarming, but it is the first step in understanding your exposure history to this bloodborne pathogen. The initial test detects the body’s immune response, indicating whether you have encountered the virus at any point. Since this finding does not distinguish between a past, resolved infection and a current, active one, a reactive result always necessitates further investigation to determine your present infection status.
Understanding the Reactive Screening Result
A “reactive” result on the initial screening test for Hepatitis C means your blood sample contains antibodies to the virus. Antibodies are specialized proteins the immune system creates to fight off a pathogen, and their presence signals past exposure to HCV. This test, often called the anti-HCV antibody test, functions as a historical marker of exposure, not a measure of current viral activity.
A positive antibody test alone does not mean the Hepatitis C virus is currently replicating in your body. Roughly 15% to 25% of people who contract HCV spontaneously clear the virus without treatment. Even after the virus is naturally eliminated, these antibodies typically remain in the bloodstream indefinitely, leading to a permanent reactive result on the screening test.
The Necessity of Confirmation Testing
Because the initial screening test only detects antibodies, a reactive result must be followed by a second, more specific test to determine your infection status. This involves using a highly sensitive molecular assay known as the Hepatitis C Virus Ribonucleic Acid (HCV RNA) test. This test is also frequently referred to as a Polymerase Chain Reaction (PCR) test or Nucleic Acid Test (NAT).
The HCV RNA test does not look for the body’s immune response; instead, it directly searches for the genetic material of the virus in the bloodstream. Detecting the viral RNA confirms the presence of the active virus, which is called viremia. This confirmation test is necessary because antibodies cannot differentiate between someone who has cleared the virus and someone who still has a chronic infection.
The HCV RNA test can be qualitative, reporting “detected” or “not detected,” or quantitative, which measures the concentration of the virus, known as the viral load. A quantitative result is expressed in International Units per milliliter (IU/mL) and provides a baseline measurement used to monitor future treatment effectiveness. Current guidelines recommend reflex testing, where the HCV RNA test is automatically performed if the initial antibody screen is reactive.
Determining Active Infection Status
The combination of the initial antibody result and the subsequent HCV RNA test provides a clear diagnosis of your infection status. The primary concern for a person with a reactive antibody test is determining if they have a current, active infection requiring medical intervention. The RNA test answers this directly by determining if the virus is actively replicating.
If the antibody test is reactive and the HCV RNA test result is “detected” or positive, this confirms a current Hepatitis C infection. This means the virus is present and multiplying in the blood, classifying the infection as active. The infection is considered chronic if detectable for more than six months, although treatment is recommended regardless of duration.
Conversely, if the antibody test is reactive but the HCV RNA test result is “not detected” or negative, it signifies past exposure where the virus has since been cleared. This is considered a resolved or past infection, and no current treatment is needed. In rare instances, this result combination can also indicate a false-positive result from the initial screening.
Modern Treatment and Management
For individuals diagnosed with an active HCV infection, the prognosis is highly favorable due to advancements in medical science. Chronic Hepatitis C is now considered a curable disease using modern Direct-Acting Antivirals (DAAs). These medications target various stages of the virus’s life cycle.
DAA therapies are taken orally, usually for a short course lasting between eight and twelve weeks, and are associated with minimal side effects compared to older treatments. These regimens achieve a cure, defined as a sustained virologic response (SVR), in over 95% of patients treated. SVR means the HCV RNA remains undetectable in the blood twelve weeks after completing therapy, indicating the virus has been eradicated.
After achieving a cure, patients typically require follow-up monitoring, especially if the infection caused advanced liver damage, such as cirrhosis, before treatment began. Eradicating the virus significantly reduces the risk of liver-related complications like liver cancer and liver failure. Treatment effectively halts the progression of liver disease.