Explanation

Hepatitis C antibodies (anti-HCV): what is measured?

The test looks for antibodies (anti-HCV) that the body makes after infection with the hepatitis C virus. This virus spreads mainly through blood and can inflame the liver. Antibodies show that you have been in contact with the virus, but not whether the virus is still in your blood now: some people clear the virus themselves, and antibodies can remain detectable for a long time even after healing. Whether there is a current infection only becomes clear from a test for the virus itself (HCV RNA).

What can it detect?

A current or past hepatitis C infection
Chronic hepatitis C, which can exist for decades without symptoms

Result

What does the result mean?

Positive result

A positive result means that antibodies against hepatitis C have been found. There are then three possibilities: a current infection, an infection that has already healed (on its own or through treatment), or a false-positive result. Follow-up tests are needed to tell these apart, in practice usually a test for HCV RNA. Without treatment, according to the LCI, 60 to 90 out of 100 infected people remain chronically infected; in some of them, liver cirrhosis (severe scarring of the liver) develops after 20 to 30 years. With current medicines, a course of tablets for 8 to 12 weeks, almost everyone is cured.

Negative result

A negative result means that no antibodies against hepatitis C have been found. Antibodies develop on average only 2 months after infection; after 3 months, more than 90 out of 100 infected people have detectable antibodies. A test within 3 months after a risk can therefore still be negative. With a severely weakened immune system, for example due to HIV or immunosuppressive medicines, it can take up to 12 months, or no antibodies develop at all. A past hepatitis C infection does not protect against a new infection.

After an abnormal result

After a positive antibody test, the GP has HCV RNA measured; if the virus is detectable, you are referred to a gastroenterologist (MDL doctor) or an internist specializing in infectious diseases for treatment and a test for HIV and hepatitis B. Hepatitis C is notifiable (group B2, Public Health Act) if the virus has been shown for the first time or if someone has recently developed antibodies; the GGD (municipal public health service) then starts source and contact tracing.

Reliability

How reliable is the test?

According to the LCI guideline (RIVM), the antibody test is the first step to detect hepatitis C if a possible infection was more than 3 months ago. A positive antibody test must always be followed by an HCV RNA test and, if needed, a confirmation test (immunoblot). With a risk less than 3 months ago or a weakened immune system, the guideline advises combining the antibody test with HCV RNA, because the antibody test can then be falsely negative. Liver values are not a good way to preselect: in a large proportion of people with hepatitis C, they are normal.

What can affect the result?

Window period: antibodies can on average only be detected after about 2 months, and with a weakened immune system sometimes only after 12 months or never.
A positive result does not distinguish between a current, a healed and a false-positive result.
After a healed infection, antibodies often remain detectable for a long time; a new infection can then only be shown with HCV RNA.

Who it is for

Who is the test useful for?

Useful for

The result says the most if you have ever injected drugs or shared drug equipment, received a blood transfusion before 1992, were born in a country where hepatitis C is common, got a tattoo or piercing with possibly unclean needles, or if you are a man with HIV who has sex with men. Also with unexplained abnormal liver values. In sex between a man and a woman, the chance of transmission is very small. Without any of these risk factors, the chance of hepatitis C is very small, which makes a positive result more often false-positive.

How common is it?

Hepatitis C is uncommon in the Netherlands: an estimated 6 to 27 in 10,000 inhabitants have antibodies, one of the lowest percentages in the world. According to the RIVM (Dutch National Institute for Public Health and the Environment), about 25,000 people had chronic hepatitis C in 2023. The largest group consists of people born in a country where hepatitis C is common; most new infections in the Netherlands occur in men with HIV who have sex with men.

LCI guideline (RIVM) on hepatitis C (Koopsen 2019); the RIVM

Drawbacks and risks

A positive antibody test with a healed or false-positive result can cause unnecessary worry until the HCV RNA result is known.
Testing within 3 months after a risk can give false reassurance if no repeat test follows.

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