How is Hepatitis C Tested & Diagnosed?

Hepatitis C Testing

Damage to the human body is often resolved immediately by several measures inherently in place to avoid any significant deviation from the body’s normal state.

When delivered in small and gradual instances, these damages may not even be detected as an abnormal occurrence as the human body is designed to expect damages from its environment and subsequently address these problems to ensure that the essential processes of the human body are not interrupted at all. With such failsafe measures in place, the human body is expected to survive these deviations, provided that no variation is significant enough to not only alert the protective systems of the body but likewise cause failures in the body’s processes – resulting in several manifestations that humans commonly perceive as “diseases.”

In some cases, these damages may be external because a physical force was applied to cause such injuries to the body. However, there are likewise instances wherein this damage is caused by another organism – a pathogen that causes untoward effects to the human body, turning the body’s processes haywire and causing several manifestations that may then worsen when no intervention is implemented to resolve the damages caused by this microorganism.

Such is the case of hepatitis C infections – an infection of the liver caused by the hepatitis C virus that causes damage to the structures of the liver and subsequently causes several complications once left unchecked and unmanaged. Without any intervention or management strategy, hepatitis C infections may cause liver inflammation, scarring, and failure – all of which may be lethal when not resolved immediately and adequately.

The problem arises when the question of hepatitis C diagnosis comes into play. Hepatitis C infections are widely undiagnosed as the condition typically remains asymptomatic within the human body – making it harder for physicians to accurately detect the presence of the pathogen unless it was seen accidentally through another diagnostic procedure or when the patient is already showing signs and symptoms of liver damage.

With this in mind, it becomes even more critical not only for professionals but for laypeople as well to understand how to recognize the early signs of hepatitis C infections and seek the necessary diagnostic procedures that can be used to detect the presence of the pathogen within your system. With such a condition that results in severe complications once the infection is allowed to progress, it becomes even more significant for people to be more critical of their symptoms and understand what to do moving forward after recognizing certain red flags for particular conditions.

Please do note, however, that while this copy promotes the recognition of certain hard-to-detect conditions, it does not, in any way, encourage self-diagnosis and medication. Do note that only experts are knowledgeable enough to understand your condition thoroughly. Self-medicating based on technical laboratory results or even through intuition may result in more harm dealt.

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Understanding Hepatitis C Infections

It is more efficient first to understand the disease and its distinct characteristics to establish the context of this copy and better integrate the description of the necessary tests for this condition.

Symptoms and Manifestations

Hepatitis C infections, unlike other hepatitis infections, are distinguished based on two different stages or phases: an acute and a chronic stage.

The acute phase of a hepatitis C infection commonly occurs within the first six months following exposure to an infected individual. During this stage, the condition may remain asymptomatic, but it may likewise be mildly symptomatic, with the following manifestations being particularly prominent for the condition:

  • Yellow skin and eyes
  • Loss of appetite
  • Upset stomach
  • Nausea and vomiting
  • Fever
  • Dark urine
  • Light colored stool
  • Joint pain
  • Feeling tired

On the one hand, the chronic phase of a hepatitis C infection typically occurs once an acute-stage HCV infection is allowed to persist and progress. In this case, the infection may become a lifetime infection, albeit certain novel medications can now be used to “cure” the chronic condition entirely. During the chronic stage, the patient is now at risk for several long-term complications, including liver scarring (cirrhosis), liver failure, and liver cancer.

Disease Complications

As previously discussed, hepatitis C infections, particularly their chronic form, are infamous for their tendency to result in severe complications once the condition is left to progress and persist. Hepatitis C infections may cause severe life-threatening complications, which may include:

  • Liver cirrhosis
  • Liver cancer
  • Liver failure

Common Treatment Plans

Hepatitis infections, including hepatitis C infections, are commonly managed using a course of antiviral medications that would be prescribed to you by your physician. However, unlike other hepatitis variations, vaccination is not yet available for hepatitis C to prevent future infections due to the complex nature of HCV’s genotype and subtype. There are novel vaccines that are starting to become available for hepatitis C, but most, if not all, of these products are still under observation and are not yet recommended by the Centers for Disease Control and Prevention for the mitigation of hepatitis C cases in high-incidence areas.

Preventive Measures Against Hepatitis C Infections

Hepatitis C infections are typically transmitted through parenteral or percutaneous means – referring to the transfer of contaminated blood samples from one infected patient to another healthy individual. With this, it is essential to take note that hepatitis C infection is a significant risk in areas where sharing needles and other invasive equipment that involve the transfer of blood. As such, to prevent the transmission of HCV, it is crucial that all individuals, particularly those that are exposed daily to used needles, i.e., healthcare workers, are careful when handling contaminated sharp objects. In addition, sharing syringes during intravenous drug use is likewise highly discouraged, especially when both parties are unaware of their respective health status. Lastly, while sexual transmission is a low-risk activity for hepatitis C due to the low efficiency of pathogen movement, abstinence, and safe sex practices are still recommended to minimize the risk of transmission further and, likewise, to aid the prevention of STD transmission among sexual partners.

The Significance of Hepatitis C Testing and Diagnosis

Why Do You Need to Take the Test?

Hepatitis C infections typically remain asymptomatic and mild until the damage to the liver has progressed to a level where significant manifestations are now prominent in the patient’s body. As such, it is crucial for all persons at risk for the condition to have themselves tested and prevent the progression of the condition during its early stages. In addition, proper diagnosis of the condition will likewise aid the movements to minimize preventable diseases and perhaps even minimize the need for liver transplant cases on top of those with inherent conditions that could not be resolved through any other means.

When Should You Take the Test?

According to the Centers for Disease Control and Prevention, hepatitis C diagnostic tests are recommended for all adults aged 18 and up, pregnant women before every pregnancy, and those at high risk for developing or contracting the condition. On the one hand, routine testing is recommended for patients routinely injecting and sharing needles. It is likewise recommended for those on maintenance hemodialysis therapy as the risk for HCV infections increases during these procedures.

What to Expect for the Test?

In most, if not all, cases, no preparation is necessary for hepatitis C diagnostic tests. Serologic or blood samples are typically drawn from your arm veins, and you may experience some pain during the sample extraction. Apart from these events, no other significant expectations are necessary for the conduct of this diagnostic procedure.

Who Should Take the Test?

According to the Centers for Disease Control and Prevention, the following individuals are at high-risk for hepatitis C infections and should be diagnosed with the condition either routinely or at least once:

  • 18 years old and older
  • All pregnant women during every pregnancy
  • People who shared injections and syringes
  • People living with HIV
  • People who are undergoing maintenance hemodialysis
  • People with consistently abnormal ALT levels
  • People who received clotting factor concentrates before 1987
  • People who received a blood transfusion before 1992
  • People who received an organ donation before 1992
  • People who were notified that they received a blood transfusion from a person that later tested positive for an HCV infection
  • Infants with HCV-positive mothers
  • Any person that requests an HCV diagnostic test

What are the Available Tests, and What Makes Them Unique?

The following table outlines the available tests in the market and what they are used for in the process of HCV infection diagnosis:

Anti-HCV Antibody Test

HCV RNA Nucleic Acid Test

Sample Required

Blood Sample

Blood Sample

Waiting Time

At least 1 day

Up to 6 days

Tool Used

Syringe or Lancet

Syringe or Lancet


Detection of a current HCV infection

Necessary to confirm chronic infection and rule out spontaneous clearing of HCV antigen

Hepatitis C Diagnosis: Available Diagnostic Procedures

Anti-Hepatitis C Virus Antibody Test

Mechanism of Action

HCV Antibody tests are typically performed using enzyme immunoassay techniques. Initially, a blood sample is extracted from the patient to be analyzed using the immunoassay technique. The blood sample is then diluted and is then incubated in a microwell that contains a recombinant HCV antigen. Following the incubation period, the anti-HCV antibody is expected to form a conjugate with the antigens present in the microwells – creating a reaction that would generate an orange color with varying intensities, depending on the number of conjugates formed during the reaction. The presence or absence of a color is then categorized as either positive or negative. Repeated positive results are then supplementally tested using other processing systems to confirm the observation and produce a positive anti-HCV result.

Duration and Waiting Time

The procedure typically takes at least a day to complete, and delivery of results to the patient is commonly expected the day after the conduct of the test. On the one hand, the extraction of the sample typically only takes minutes, and no special preparation before the specimen collection is necessary for the patients.

Needed Sample

A blood sample is drawn from an arm vein of the patient, and this serum is then subject to an immunoassay procedure to determine the presence of anti-HCV antibodies within the sample.

Cost and Expenses

The estimated national average for an anti-HCV antibody test is $62, but availing of the service using specific insurance policies and programs can cut the cost to $37.

Insurance Coverage

Hepatitis C diagnostic procedures are now covered under all health plans as a part of their policy for preventive services.

Sensitivity and Specificity

Third-generation enzyme immunoassay techniques for hepatitis C screening typically have a 99% sensitivity and specificity rate.

HCV RNA Nucleic Acid Test

Mechanism of Action

Similar to the specimen collection process of the anti-HCV antibody test, a serum sample is initially obtained from the patient through an arm blood draw. This blood sample is then prepared using automated processes that typically perform three operations:

  • The machine prepares the serological sample by isolating the HCV RNA present within the serum.
  • The machine then reverse transcribes the target RNA to generate a complementary DNA sample.
  • The machine performs a simultaneous PCR amplification of the target cDNA sample and detects a cleaved dual-labeled oligonucleotide detection probe specific to the target cDNA.

Quantifying the RNA present within the sample then proceeds through the same automated processes to determine whether the patient is HCV Ab Negative, HCV Ab Positive, HCV Ab Positive with RNA detected, or HCV Ab Positive with RNA not Detected. Those with a positive RNA result are confirmed to have an active chronic HCV infection within the last six months and must therefore be referred for the appropriate management of their condition.

Duration and Waiting Time

Due to the complex nature of the diagnostic test, the turnaround time for HCV RNA results typically takes up to 6 days, albeit the specimen collection procedure only takes a few minutes to complete.

Needed Sample

To perform the HCV RNA Nucleic Acid Test, a serological sample is required from the patient to be diagnosed.

Cost and Expenses

The total cost of HCV RNA Nucleic Acid Tests can range between $158 to $259, depending on the facility conducting the procedure.

Insurance Coverage

Hepatitis C diagnostic procedures are now covered under all health plans as a part of their policy for preventive services.

Sensitivity and Specificity

HCV RNA Nucleic Acid Tests have a 97.8% sensitivity rate and a 99.2% specificity rate.

Hepatitis C Diagnosis: Summary of Diagnostic Procedures

The following table describes the summary of costs of the available hepatitis C diagnostic procedures in the market, as well as whether insurance policies within the United States cover the procedures:

Anti-HCV Antibody Test

HCV RNA Nucleic Acid Test


Around $37.00 to $62.00

Around $158.00 to $259.00

Insurance Coverage



Frequently Asked Questions (FAQs)

Are there any other supplementary procedures that can assess the extent of liver damage?

Yes. Patients may be requested for one of the three procedures to determine the extent of liver damage caused by the HCV infection: 1) Magnetic resonance elastography (MRE). 2) Transient elastography. 3) Liver biopsy.

What conditions typically indicate extensive liver damage?

Liver fibrosis and cirrhosis are two common conditions that commonly indicate extensive and prolonged liver damage.

How long does it take for antibodies to become detectable following exposure?

On average, it takes 6 to 8 weeks for antibodies to become detectable in an infected patient’s systemic circulation.

Is the HCV RNA Test only requested once to confirm a chronic HCV infection?

No. RNA Tests are typically requested multiple times to confirm the extent of the HCV infection and determine the most appropriate intervention for the patient’s condition.

What does a negative HCV RNA test result mean?

A positive antibody result with a negative RNA result means that the HCV antigen within the patient’s body was spontaneously cleared following the resolution of the acute infection and that the patient did not develop any chronic condition.


Centers for Disease Control and Prevention

American Family Physician


Written by Mark Riegel, MD

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