Hepatitis C antibody-postive patients need but often don't get confirmatory testing

Hepatitis C infection needs to be confirmed by PCR (RNA or DNA amplification) because antibody levels can remain high for many years after the infection is completely cleared by antimicrobial therapy or innate immunity. This is true for numerous other pathogens as well including Borrelia b. (Lyme disease). A paper just published in The American Journal of Medicine documents that RNA testing for hepatitis C is often not done. The authors state:

"Recent guidelines recommend testing all individuals born during 1945-1965 for hepatitis C virus (HCV) antibody. For antibody-positive patients, subsequent RNA testing is necessary to determine current infection status. This study aimed to assess whether clinicians order HCV RNA tests as recommended for antibody-positive patients and to identify barriers to such testing."

They examined data from the New York City Department of Health and Mental Hygiene's hepatitis C surveillance system and from clinicians to determine how often RNA tests were ordered, and the reasons why if not. A large number of patients are not getting the confirmatory test they need:

"Of 245 antibody-positive patients, 67% were tested for HCV RNA (for 21% of these, the test was ordered only after our request); 33% had no RNA testing despite our request. Patients without RNA testing were seen in medical facilities (47%), detox facilities (30%), and jail/prison (15%). Reasons RNA testing was not done were that the patient did not return for follow-up (35%), the facility does not do RNA testing (22%), and the patient was tested in jail (15%)."

That leaves 28% of antibody-positive patients not having the follow-up test because...'whatever'. The authors conclude:

"In our study, one third of patients did not get complete testing for accurate diagnosis of HCV, which is essential for medical management. Additional education for clinicians about the importance of RNA testing may help."

Clinical note: practitioners must not base a treatment plan on antibody levels that can remain high when the infection is no longer present without further evidence.