Anti-HCV

The anti-HCV test detects the presence of antibodies against the hepatitis C virus and indicates the possibility of past or active infection. It is used as a screening test, and positive results may require additional molecular investigations for confirmation.

Anti-HCV serological assessment provides an estimate of when the infection developed. The appearance of antibodies usually occurs weeks after exposure, and this timeline is clinically important for determining the acute phase.

Anti-HCV screening is performed in high-risk groups for early diagnosis. Regular screening in haemodialysis patients, healthcare workers and individuals who use intravenous substances enables rapid detection of possible infections.

Monitoring anti-HCV positivity supports community-based hepatitis C control programmes. Screening results help identify chains of transmission, guide treatment planning and contribute to the development of national elimination strategies.

What Is Anti-HCV?

Anti-HCV is a blood test that shows the antibodies that develop in the body against the hepatitis C virus. This test is used to determine whether a person has previously been exposed to the hepatitis C virus. If the result is positive, the person may have had the infection in the past or may still be carrying it. For a definitive diagnosis, additional tests are required to evaluate the HCV RNA level. Hepatitis C is a serious viral infection that affects the liver.

What Is the Hepatitis C Virus (HCV) and Why Is It Known as a “Silent” Enemy?

Hepatitis C is a virus that primarily targets the liver. Transmitted mainly through blood, it causes a liver infection once it enters the body. The most important feature of this infection is that it can progress silently for years without causing any symptoms.

In the initial “acute” phase (the first 6 months) after exposure to the virus, most people (70–80%) do not experience any significant complaints other than mild flu-like tiredness and loss of appetite, and often do not even realise they are infected. A minority with a strong immune system (about 15–25%) can completely clear the virus from the body spontaneously at this stage.

However, in the majority of people (75–85%) the virus cannot be eliminated and becomes “chronic”, meaning persistent. This is where the “silent” nature of the disease begins. Chronic hepatitis C can continue to cause slow and progressive damage to the liver for 20–30 years without any symptoms. The end result of this silent damage is unfortunately very serious and life-threatening conditions such as cirrhosis (hardening and loss of function of the liver) and liver cancer. Because of this silent course, many people are unaware that they are carrying the virus. For this reason, screening before entering an important health process such as trying to have a child is critically important.

What Does the Anti-HCV Test Show?

We can think of our immune system as an intelligent army that protects our body. When a virus enters the body, this army recognises it and produces special “soldiers” against it. These soldiers are called antibodies. Each antibody is specialised to recognise and attack only a specific enemy.

The anti-HCV test looks at whether there are antibodies in the blood that have been produced specifically against the hepatitis C virus. In other words, the test does not look for the virus itself, but for the “memory record” that the immune system has encountered this virus.

• Anti-HCV Negative (−): If the result is “negative” or “non-reactive”, this usually means that your body has never encountered the hepatitis C virus. There is no “record” of this virus in your blood.
• Anti-HCV Positive (+): If the result is “positive” or “reactive”, this shows that your immune system recognises this virus and has mounted a defence against it. This means that at some point in your life you have been exposed to the virus.

If Anti-HCV Is Positive, Does That Mean I Definitely Have Active Hepatitis C?

No, this alone is not sufficient evidence and is not a reason to panic. Anti-HCV positivity reflects the “memory” of the immune system, not the current “presence” of the virus. At this point there are two possible and very different scenarios:

Past and Cleared Infection: Your body may have encountered the virus in the past, but your immune system may have mounted a strong response and completely eliminated the virus. The virus is no longer present in your body, but the “victory record” in the form of antibodies remains in the blood. In this case, you are not ill and you cannot transmit the virus to anyone.

Active (Chronic) Infection: Your body has encountered the virus but has not been able to eliminate it, and the virus has become persistent. In this situation, both the “memory record” (anti-HCV) and the virus itself circulate in your blood. This means that you have an active infection and may be infectious.

Distinguishing between these two situations is critically important, especially for couples who are planning to have children, as it determines all subsequent steps.

Which Test Is Used for Definitive Diagnosis After Anti-HCV Positivity?

Every individual with a positive anti-HCV screening test should undergo a confirmatory test to clarify the situation. This is called the HCV RNA (PCR) test.

This test does not look at antibodies (the memory record), but at the genetic material of the virus itself (that is, the virus directly). It determines whether there is an actively replicating virus in your blood. It is a very sensitive test and clearly reveals the presence of the virus.

By interpreting these two tests together, a definitive diagnosis can be made.

How Are Anti-HCV and HCV RNA Test Results Interpreted Together?

The combination of these two tests clearly reveals a person’s status with respect to hepatitis C. Possible results are:

• Anti-HCV Positive (+) / HCV RNA Negative (−)
• Anti-HCV Positive (+) / HCV RNA Positive (+)
• Anti-HCV Negative (−) / HCV RNA Negative (−)
• Anti-HCV Negative (−) / HCV RNA Positive (+)

The first result, anti-HCV positive but HCV RNA negative, is the best scenario. This shows that your body has fought the virus and won. You do not have an active infection, you are not infectious and there is no risk to your liver. It does not pose an obstacle to IVF treatment or pregnancy.

The second result, both anti-HCV and HCV RNA positive, means that you have an active, chronic hepatitis C infection. The virus is present in your blood and is replicating. This requires precautions to be taken both for your own health and for those around you (your partner, your baby).

The third result, both negative, means you are clear.

The fourth and very rare result (anti-HCV negative, HCV RNA positive) is seen either in the very early (acute) period of infection, called the “window period”, when the body has not yet had time to produce antibodies, or in individuals whose immune system is severely suppressed. This also indicates an active infection.

Why Is Hepatitis C Screening Always Requested Before IVF Treatment?

Screening all couples (both women and men) undergoing IVF (ART – Assisted Reproductive Techniques) for infectious diseases is an international standard and a legal requirement. Hepatitis C screening is one of the most important components of this panel. There are three main reasons for this requirement:

• Protecting the baby’s health (vertical transmission)
• Protecting the partner’s health (horizontal transmission)
• Ensuring laboratory safety (cross-contamination)

First and foremost, the most important aim is to prevent transmission of the virus from mother to baby (vertical transmission). If the mother is HCV RNA positive (i.e. has an active infection), the risk of transmitting the virus to the baby during pregnancy or at birth is around 5–7%. This is not a negligible risk, and in order to protect the baby’s right to be born healthy, it is essential to know and manage the mother’s status before pregnancy.

Secondly, if one of the partners (female or male) is an active carrier of hepatitis C, there is a risk of transmitting the infection to the other partner. Although the risk of sexual transmission is considered very low in stable, monogamous heterosexual relationships, it is not zero. Identifying the infected partner is important in order to protect the other.

Thirdly, and perhaps most critically, there is laboratory safety. The IVF laboratory (embryology laboratory) is a highly sterile environment where eggs, sperm and embryos from many couples are handled. In a person with active hepatitis C infection, the virus may be present in the blood, in seminal fluid, and in follicular fluid obtained during egg collection. There is a theoretical risk that the devices used to process these biological materials or, more importantly, the liquid nitrogen storage tanks in which embryos are frozen and stored, could become contaminated with the virus (cross-contamination):

To eliminate this risk of “cross-contamination”, eggs, sperm and embryos from individuals known to be infected are never processed or stored in the same environment as material from other patients. Special dedicated equipment and dedicated storage tanks are used for these materials. This screening test informs the laboratory team which samples should follow standard procedures and which require these special safety protocols. This is a basic rule that ensures the safety of the embryos not only of that couple, but of all patients being treated in the clinic.

Does Hepatitis C Infection Have an Effect on Infertility?

This is a complex question that both patients and physicians are curious about. Current scientific evidence paints a conflicting picture.

• Effects on the Male Partner:

Studies on the effects of hepatitis C on male reproductive health are divided into two groups. Some research has reported impaired sperm count, motility and the proportion of normally shaped sperm (morphology) in men with chronic hepatitis C infection. Chronic infection and the associated general inflammation (oxidative stress) in the body, as well as hormonal imbalance due to liver damage, have been suggested as possible mechanisms.

However, in contrast, large-scale IVF studies involving high numbers of patients have found no significant difference in sperm parameters between HCV-positive and HCV-negative men. This discrepancy suggests that hepatitis C does not cause infertility in every man, but may affect sperm quality in some men depending on the duration of the disease or the severity of liver damage.

• Effects on the Female Partner:

The situation is similarly complex in women. Some studies have found that IVF outcomes (number of eggs retrieved, embryo quality, etc.) are not affected in HCV-positive women. However, some recent large-scale studies have highlighted an important detail: although all other parameters were similar, the clinical pregnancy rate (the rate of seeing a gestational sac after embryo transfer) was lower in the HCV-positive group compared with controls.

This suggests that the problem may lie not in the eggs or embryos but in the uterine lining (endometrium). The state of systemic inflammation caused by chronic hepatitis C may alter the structure of the endometrium and make it more difficult for the embryo to implant. This is a strong indication that treatment may be important not only to prevent transmission but also to increase the chances of pregnancy.

If I Have Active Hepatitis C Infection (HCV RNA Positive), Does That Mean I Cannot Have IVF?

In today’s medicine, the answer to this question is very clear and definite: you must be treated first.

If you have an active hepatitis C infection (HCV RNA positive), the strong, shared recommendation of all international health authorities and reproductive medicine societies is that all fertility treatments (ovulation induction, insemination or IVF) should be postponed.

The main reason for this “Treat First” approach is the Direct-Acting Antiviral (DAA) drugs that have revolutionised the medical management of hepatitis C. In the past, hepatitis C was treated with methods such as interferon injections, which were associated with severe side effects and low success rates. However, DAA drugs developed over the past 10 years have turned this disease into a fully treatable condition.

Why Are Modern Hepatitis C Treatments (DAAs) Such a Great Opportunity?

Modern DAA drugs have transformed hepatitis C treatment. The main reasons they are preferred are:

• A sustained cure rate of over 95%
• A short treatment course of about 8–12 weeks
• Oral administration in tablet form
• Far fewer side effects compared with older interferon-based treatments

Thanks to these features, postponing treatment for a few months is no longer a difficult decision for couples who wish to have children. With an 8–12 week course of simple oral medication, it is possible to completely clear hepatitis C in more than 95% of cases.

The advantages of completing this treatment before pregnancy are invaluable:

When you clear the virus from your body (become HCV RNA negative), your infectiousness disappears. The risk of transmission to the baby is eliminated. The risk of transmission to the partner is eliminated. The risk to laboratory safety is eliminated. In addition, any potential negative effects of the infection on the uterine lining or sperm quality are removed.

I Have Been Treated for Hepatitis C. When Can I Try IVF?

Treatment success is measured by achieving a Sustained Virological Response (SVR).

SVR means that the HCV RNA (PCR) test performed 12 weeks after the last day of DAA treatment (SVR12) is “negative” (undetectable).

This indicates that the virus has not only been suppressed but has been completely cleared from the body and is considered a cure. The risk of relapse is almost negligible. Once the SVR12 result has been confirmed as “negative” for the patient (female or male), they are no longer considered infectious with respect to hepatitis C and are regarded as cured. From this point on, IVF treatment can be safely initiated without any special precautions.

What If My Husband Is a Hepatitis C Carrier (Male) but Does Not Want Treatment?

The ideal scenario is always for the male partner to receive DAA treatment and achieve a cure. This is the best option both for his own health and to eliminate all risks. However, in rare cases where the partner refuses, delays or fails treatment for various reasons, there is a “Plan B”: sperm washing (sperm processing).

The hepatitis C virus is found primarily in the seminal plasma (the fluid in which sperm are suspended) and in other cells present in semen. It is very rare for the virus to enter the sperm cell itself. Sperm washing is an advanced laboratory technique used to separate healthy, motile sperm from this virus-containing fluid.

The most effective method combines “density gradient centrifugation” followed by “swim-up” techniques. In this method, the semen sample is passed through layers of different densities. Healthy, motile sperm pass through these layers and settle at the bottom, while virus-containing fluids and other cells remain in the upper layers. The clean sperm at the bottom are collected and can be used safely in IVF (intracytoplasmic sperm injection). This method reduces the viral load by more than 99%. However, it should be remembered that DAA therapy is a “risk elimination” method, whereas sperm washing is a “risk reduction” method.

How Is a Pregnancy Managed When Hepatitis C Is Active?

Given the availability of DAA therapy today, this is an “undesirable” scenario that should be avoided. However, when such a situation arises (for example, if a woman learns she is infected at the same time as she discovers she is pregnant), the process is managed through a highly disciplined, multidisciplinary approach involving an IVF specialist, a hepatologist and a perinatologist.

The main goals in this follow-up are:

• Clearly explaining to the expectant mother the risk of transmission to the baby (5–7%).
• Minimising the baby’s exposure to the mother’s blood during delivery.
• Avoiding invasive interventions, such as attaching a scalp electrode to the baby.
• Avoiding prolonged rupture of membranes.

Caesarean delivery is not recommended solely for the prevention of hepatitis C. Studies have not demonstrated clear evidence that planned caesarean section reduces the risk of transmission compared with vaginal birth. The mode of delivery is determined based on other obstetric indications.

One of the most important issues is breastfeeding. Breastfeeding is considered safe and is recommended for mothers who are hepatitis C positive. There is no convincing evidence that the virus is transmitted to the baby through breast milk. The only situation where breastfeeding is restricted is when the mother has active bleeding or cracked nipples. In such cases, breastfeeding should be temporarily stopped until the nipples heal.

How Are Babies Born to Hepatitis C Positive Mothers Followed Up?

Every baby born to an HCV-positive mother is considered to have been “exposed” to the virus and is placed on a special follow-up protocol.

The old approach was to wait 18 months before testing the baby, because the baby passively receives maternal antibodies (anti-HCV) through the placenta, and these antibodies can remain in the baby’s bloodstream for up to 18 months. Any antibody test performed during this period could therefore be misleading.

However, current best practice is no longer like this. There is no need to wait 1.5 years to determine whether the baby is truly infected. It is now recommended that the baby be tested directly for the presence of the virus using an HCV RNA (PCR) test. Performing this test when the baby is between 2 and 6 months old allows very early detection if infection occurred at birth. Babies diagnosed early are followed by paediatric gastroenterologists and, if necessary, can start DAA treatment from the age of 3, enabling them to be completely cured as well.

Frequently Asked Questions