Testing and monitoring
HCV testing if you are HIV positive
If you are living with HIV, annual HCV testing is recommended in the UK as part of your routine care.
But HCV testing is also based on your risks. For example, if you are sexually active and/or if you have another STI and/or if you shared anything when injecting drugs then HCV tests are more important.
HCV testing is also recommended if your liver enzymes become raised.
Tests to diagnose HCV
HCV testing has two stages, but depends on your HCV history, see Table 1.
1. The first test is usually an HCV antibody test.
A positive antibody result means that you have either had HCV and cleared it or that you still have HCV.
A negative result means that you might not have HCV. This test doesn’t detect recent HCV because it can take 6 to 24 weeks for HCV antibodies to develop. Also, if your CD4 count is less than 200 you may not make HCV antibodies.
If you have already cleared HCV or been cured, routine testing for reinfection needs to use an HCV viral load or HCV core antigen test.
2. An HCV viral load (RNA) or HCV core antigen test will confirm or rule out current infection.
These tests looks for direct evidence of HCV or viral replication.
If the results are positive it means that you currently have HCV.
If the results are undetectable/negative, you might have spontaneously cleared HCV. A second test six months later will confirm this.
The HCV core antigen test is a cheaper and quicker alternative to HCV viral load and gives similar information. It looks for a protein produced by ongoing HCV, but is not always accurate if HCV viral load is very low.
Testing for HCV re-infection
Reinfection with HCV can occur after clearing the virus or being cured by treatment.
In this case, HCV RNA or core antigen tests will detect re-infection.. The European Treatment Network for HIV, Viral Hepatitis and Global Infectious Diseases recommends testing for HCV reinfection for people who are at ongoing risk every 3-6 months. https://journals.lww.com/aidsonline/fulltext/2020/10010/recently_acquired_and_early_chronic_hepatitis_c_in.1.aspx
Table
1: HCV tests and what the results mean for HCV infection
| Diagnosis | Antibody test result | HCV RNA (viral load) or HCV core antigen | ALT: liver enzyme |
| Cleared or cured HCV. | Positive. | Undetectable. | Return to normal. |
| Recently acquired HCV. | Negative; but positive within 6 to 24 weeks. | Detectable within 1 to 2 weeks, usually very high. | May be up to 7 to 10 times above normal. |
| Chronic HCV. | Positive. | Detectable. | May be persistently normal, fluctuate, or persistently raised. |
| HCV reinfection | Positive | Detectable HCV RNA/core antigen. | Elevated liver enzymes. |
Other routine blood tests
After an HCV diagnosis, you will need other blood tests.
The most important of these are HCV genotype, liver enzyme tests (ALT/AST) and a non-invasive scan (see below).
Testing for hepatitis A and B is important so that you can have these vaccinations, if needed.
Coinfection with HIV, HCV and HBV needs ART to include one or two active drug against HBV. This is usually tenofovir (DF or TAF)..
Other monitoring includes a complete blood count (CBC), blood clotting time and other liver enzymes (including albumin and GGT), kidney function and pregnancy.
Last updated: 1 November 2024.