Hepatitis C virus (HCV) (Guidelines)

Hepatitis C antibody testing is performed as the initial screening test (brown serology tube to Virology). If the patient is already known to be HCV antibody positive, please send HCV RNA quantitative PCR to confirm active infection (1 x 7.5 mls EDTA tube).

The Virology lab will reflexively send the sample to the West of Scotland Virology laboratory to test HCV RNA on all new HCV antibody positive samples.

HCV antibody positive and RNA negative patients should have repeat testing after 3 months for confirmation and be counselled regarding risk factors for re-infection and offered regular screening with HCV RNA if there is ongoing exposure.

Consider window period for repeat testing if HCV antibody negative (3 to 6 months). Check HCV RNA if the risk period has occurred within the last 2 weeks and offer regular testing if the patient is at ongoing risk of BBV acquisition.

Who to refer:

All those with evidence of active HCV infection (HCV RNA positive) should be referred for consideration of antiviral treatment.

Those who are hepatitis C antibody positive and HCV RNA negative do NOT require referral (this indicates past infection).

Please obtain confirmatory sample plus HIV, HBV and a full liver screen and refer to the Viral Hepatitis service. Repeat sampling should not delay referral.

Any patient with active HCV infection should be encouraged to attend a treatment clinic. Even if they are not currently wanting treatment they will be seen for liver fibrosis assessment, monitoring and support. Patients with chronic hepatitis C should be aware that they are at risk of complications of cirrhosis / cancer and should be strongly encouraged to accept referral

How to refer:

Directly to nhsh.viralhepatitisnurses@nhs.scot or to Gastroenterology via SCI gateway for FAO of the Viral Hepatitis team

• HCV drug interaction checker interaction checker
• ​​​​​​​​​​​​​​​​Hepatitis C Elimination: Test. Treat. Cure.
• NHS Highland Viral Hepatitis (Hepatitis C)
• https://britishlivertrust.org.uk/information-and-support/liver-conditions/hepatitis-c/
• Scottish guidelines on the pre-treatment assessment and on-treatment monitoring for patients with hepatitis C undergoing treatment with DAA's
• https://cks.nice.org.uk/topics/hepatitis-c/

• AFP: alpha-fetoprotein
• EDTA: ethylenediaminetetraacetic acid
• HBV: Hepatitis B virus
• HBsAg: Hepatitis B surface antigen 
• HBcAb/anti-HBs: Hepatitis B surface antibody
• HBcAb/anti-HBc: Hepatitis B core antibody
• HCV: Hepatitis C virus
• HIV: human immunodeficiency virus
• RNA: ribonucleic acid