Choosing Wisely:

Don’t repeat hepatitis C virus (HCV) antibody testing in patients with a previous positive (HCV) test. Instead, order hepatitis C viral load testing for assessment of active versus resolved infection.

Rationale and Comments: There are joint guidelines from the IDSA and the American Association for the Study of Liver Diseases, which are consistent with guidance from the CDC regarding the testing, management, and treatment of patients with HCV infection. A positive HCV antibody test remains positive for life. Repeat HCV antibody testing adds cost but no clinical benefit, so it should not be performed. A common reason for unnecessary repeat testing is the inclusion of this test in order sets (e.g., hepatitis and/or opioid screening order sets), or a result of problematic follow-up in patients positive for HCV in an outpatient setting. A positive HCV serologic test (or a proven history of positive results) should be followed by a hepatitis C viral load test, which distinguishes an active from resolved infection. The result of the hepatitis C viral load establishes a baseline in patients with active disease by which the efficacy of therapy can be monitored. Patients with active infection (i.e., positive serology and hepatitis C viral load) may often need an HCV genotyping assay to guide therapy. Patients who have had a remote and resolved HCV infection who are suspected to have been reinfected should be tested using the hepatitis C viral load test, rather than the HCV antibody test, since this latter test remains positive for life. Viral load reflects the degree and severity of active infection and also acts as a useful component in monitoring antiviral therapy in medication-managed patients.
Sponsoring Organizations:
  • American Society for Clinical Pathology
  • Sources:
  • IDSA guideline
  • American Association for the Study of Liver Diseases guideline
  • Disciplines:
  • Infectious disease
  • Gastroenterologic
  • References: • Infectious Disease Association of America. HCV guidance: recommendations for testing, managing, and treating hepatitis C. Accessed on July 22, 2016 at http://www.hcvguidelines.org/fullreport/initial-treatment-hcv-infection
    • Centers for Disease Control and Prevention. Viral hepatitis - hepatitis C information. Hepatitis C FAQs for health professionals. Accessed on July 22, 2016 at http://www.cdc.gov/hepatitis/hcv/hcvfaq.htm#section3
    • Kanakis CE. The “C” in HCV stands for “curable” [Internet]. Lablogatory. ASCP; 2018 [cited 2018Mar2]. https://labmedicineblog.com/2018/02/26/the-c-in-hcv-stands-for-curable/

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