Synopsis
Confirm active hepatitis C after antibody screening, stage liver and interaction risk, deliver curative direct-acting antivirals, and prevent reinfection and missed post-cure surveillance.
- Anti-HCV indicates exposure, not necessarily current infection; confirm active viraemia with HCV RNA or an accepted core-antigen pathway.
- Antibody commonly remains positive after spontaneous clearance or cure, so it cannot diagnose relapse, reinfection or sustained virological response.
- A negative antibody result can miss very recent infection or infection in severe immunosuppression; request RNA when clinical risk persists.
Key red flags
Ascites, encephalopathy, jaundice or variceal bleeding demands transplant-linked specialist care and excludes protease-inhibitor treatment without relying on a compensated-looking clinic letter.
Investigation priorities
Screen for previous or current exposure to hepatitis C virus.
Management branches
Anti-HCV is reactive, exposure was recent, or immunosuppression makes antibody testing unreliable.
- Arrange reflex or prompt HCV RNA, explain that antibody alone does not mean current infection, and repeat RNA when timing or fluctuating early viraemia leaves uncertainty.
- If RNA is detectable, notify and refer through the local HCV operational pathway while assessing urgent liver failure or decompensation and offering partner or contact advice proportionately.
Key medicines
Glecaprevir 100 mg with pibrentasvir 40 mg tabletsAdults take three tablets together once daily with food when this specialist-selected regimen is appropriate; treatment duration depends on cirrhosis, previous therapy and the current commissioned pathway.