Confirmatory Testing for HCV Infection Often Not Performed

Neil M. Ampel, MD

Among 245 individuals in New York City with a new positive antibody test for hepatitis C virus, only 67% received HCV RNA testing to confirm active infection.

Approximately 3 million people in the U.S. are infected with the hepatitis C virus (HCV), a major cause of cirrhosis and hepatic cancer. Although HCV infection results in a persistently positive antibody test, spontaneous clearance of infection occurs in about 20% of cases. In such cases, the antibody test will remain positive, but the HCV RNA test will be negative. National guidelines recommend HCV RNA testing for anyone with a positive antibody test to ascertain true infection, but several studies have found that confirmatory testing is often not performed.

To examine the situation in New York City, Department of Health and Mental Hygiene researchers analyzed the records of 245 HCV antibody–positive individuals reported between July 2009 and July 2011. Initial investigation revealed that 90 (37%) of them had no HCV RNA testing performed. On follow-up 9 months later, 81 (33%) patients still had not been tested. Moreover, in 34 (14%) cases, testing was performed only after the health department contacted the clinician to request that it be ordered. Among those who received HCV RNA testing, 45 (27%) had negative results. Reasons for not ordering HCV RNA testing included failure to return for follow-up (35%), not offering the test at that facility (22%), incarceration (15%), death (6%), and lack of health insurance (3%).

Citation(s):

McGibbon E et al. Half a diagnosis: Gap in confirming infection among hepatitis C antibody-positive patients. Am J Med 2013 Aug; 126:718.