Hepatitis C test

You do not need to do anything special before this test. A nurse or doctor will take a blood sample from a vein in your arm. No fasting or other preparation is needed.

What the tests measure 

Testing for hepatitis C usually involves more than one test. The tests are done in stages: first to find out whether you have ever been exposed to the virus, then to confirm whether the virus is still active in your body. 

Stage 1: Hepatitis C antibody test (anti-HCV). This is the first test used. When your body is exposed to HCV, it produces proteins called antibodies. This test looks for those antibodies in your blood. A positive result means you have been exposed to HCV at some point, but it does not tell you whether the virus is still active. 

Stage 2: HCV RNA viral load test. If the antibody test is positive, a second test checks for the actual virus by detecting its genetic material (RNA) in your blood. This confirms whether you have a current, active infection. It is also used to measure how much virus is in your blood and to track whether treatment is working. 

Viral genotyping. If you have an active infection and are starting treatment, a genotype test identifies which strain (genotype) of HCV you have. There are six main genotypes. This information can help your doctor plan the best treatment, although modern antiviral medicines are effective against all genotypes.

What your results mean 

If your antibody test is negative 

A negative result means no hepatitis C antibodies were found. This usually means you have not been infected with HCV. 

However, antibodies take several weeks to months to appear after initial infection. This is called the window period. If you have had a recent exposure and your test is negative, your doctor may recommend a repeat test after a few months to be sure. 

If your antibody test is positive 

A positive antibody result means you have been exposed to hepatitis C at some point. Your doctor will arrange a viral load test to find out whether the virus is still active. 

A weakly positive antibody result may occasionally occur in people who have not been infected. This is one reason why all positive antibody results are confirmed with a second test. 

If your viral load test is positive (HCV RNA detected) 

A positive viral load means hepatitis C is currently active in your body. You have a current infection and can pass the virus to others. 

Your doctor will discuss treatment options with you. Modern antiviral medicines called direct-acting antivirals (DAAs) are highly effective and clear the virus in more than 90% of people. Treatment is usually taken as tablets for 8 to 12 weeks. 

If your antibody test is positive but your viral load is undetectable 

This pattern means you were infected with hepatitis C at some point but your body has cleared the virus — either naturally or after successful treatment. You are not currently infected and cannot pass the virus to others. 

Note that your antibodies will remain in your blood for life, even after the virus has gone. This does not mean you are still infected.

If you have an active hepatitis C infection, you will be referred to a specialist in liver disease or infectious diseases. They will assess your liver health and discuss treatment with you. 

Treatment with direct-acting antivirals (DAAs) is available on the NHS. These are tablet-based medicines taken for 8 to 12 weeks. Around 90% of people are cured after one course of treatment. Your viral load will be checked at the end of treatment and then 12 weeks later to confirm the virus has been cleared. This is called a sustained virological response (SVR), which means the infection has been cured. 

While you have an active infection, there are steps you can take to protect others: 

• do not share needles, syringes, or other drug-use equipment 
• do not share personal items that might have blood on them, such as razors or toothbrushes 
• use condoms during sex, particularly if you have multiple partners 
• tell healthcare professionals about your infection before any medical or dental procedures 

Hepatitis C is a notifiable infection in the UK. Your doctor will report the diagnosis to the UK Health Security Agency (UKHSA). 

Even after successful treatment, your liver health will need to be monitored — particularly if there was significant damage before treatment started. People who had cirrhosis before treatment remain at higher risk of liver cancer and will need regular liver scans. 

• Window period – antibodies may not be detectable until several weeks to months after infection. Testing too soon after a possible exposure may give a false negative result. 
• Weakly positive antibody results – these do not always mean infection. All positive antibody tests are confirmed with a second test. 
• Immune system problems – people with weakened immune systems may not produce antibodies reliably, which can affect the antibody test result. In these cases, an RNA test may be used first. 
• Antibodies after cleared infection – once you have had hepatitis C, your antibodies remain detectable for life even if the virus has gone. This means a positive antibody test cannot distinguish between past and current infection without a viral load test. 

Your doctor may also request: 

• Liver blood tests (ALT, AST, GGT, bilirubin) – to assess liver inflammation and function 
• Albumin and prothrombin time (PT/INR) – to check how well the liver is making proteins; these can be affected in advanced liver disease 
• Hepatitis A virus antibodies and hepatitis B tests – to check for co-infection or immunity, as hepatitis A and B vaccinations are recommended for people with hepatitis C 
• Acute viral hepatitis testing – a broader panel if the cause of liver disease is not yet clear 

Hepatitis C is a viral infection that affects the liver. It is usually spread through contact with infected blood. Most people have no symptoms for many years, but without treatment the infection can lead to serious liver damage, including cirrhosis and liver cancer. There is no vaccine, but effective treatment is available on the NHS. For more information, visit NHS: hepatitis C.