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Pregnant. Tested reactive for hepatitis C. What is going on?

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General & Family Physician
Practicing since : 2005
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My wife has been test "reactive" for Hep c. She is pregnant with our third child.

1st child - Reactive, then she took the RIBA test - Negative.
2nd Child - Reactive - then they checked the viral load, nothing. So they chalked it as a false-negative.
3rd - Child - Reactive - they said they think she just produces false-negatives, we are waiting for the RIBA results.

My question is, what is going on? Neither of us every had blood tranfusion, no needles, no tattoo's, very little protected sex.
Posted Wed, 29 Aug 2012 in Pregnancy
Answered by Dr. Shanthi.E 3 hours later

Thanks for posting your query.

It seems like your wife is just having the serum antibodies to the HCV (HCV infection in her.

It is that she is showing false positive anti-HCV titre, wherein she actually does not have the virus in her.

The usually done enzyme assays for HCV can be falsely positive due to cross reactions of various antibodies present in the blood.

RIBA is a good sensitive test. It can truly detect the active cases in most patients. However, it does have a small percentage of false positive reports. Your wife may be just one case.

In the current pregnancy, to know about her actual HCV infection status, it would be better to get a Nucleic Acid Test (NAT) where in the actual virus particle can be detected in her blood. If it is positive, then she has an active HCV infection. If it is negative, then she is absolutely fine, nothing needs to be done.

You are right in saying about the modes of transmission of HCV. However, a small group of patients do get HCV due to an unnoticed percutaneous exposure in the past. Occupational exposure to the virus can be another cause.

All said, I do not think your wife has the Hepatitis C virus in her; she is just having the antibodies against it. She may have been vaccinated earlier for Hepatitis B virus, the antibodies of which may have cross reacted to Hepatitis C virus now.

Just a word of information - your wife is probably false-positive and not false negative as you say. If she is to be false negative, that means she has the active disease.

Please write back for further discussion on this.

Above answer was peer-reviewed by
Follow-up: Pregnant. Tested reactive for hepatitis C. What is going on? 1 hour later
Thank you for getting back to me so fast.

The only thing that I don't understand is that (3) pregnancies (3) times her first test which is the very sensitive one that test if its reactive came back positive for reaction. Why does that first test always come back positive?

The first time the first test came back positive, they then gave her a RIBA which was negative. She never had a positive RIBA.

And yes you are right they said false-positive. Not false-negative.
Answered by Dr. Shanthi.E 2 hours later

Thanks for writing back.

The overall sensitivity (True positive) of the ELISA tests or the serology tests for HCV is 78.4% and specificity (True negative) is 98.6%.

Therefore, the chances of people with falsely positive result are 2%. Simple way for you to understand is the positive predictive value of this test is 97.5%.

Cross-reactions are expected with ELISA tests though the best of tests are being re-discovered recently.

To label a person as HCV infection, the virus should be detected in the blood by XXXXXXX or Viral RNA PCR tests. These are a bit costly. The same holds good for any viral infection like HIV.

Your wife is having specific antibodies in her blood that react with the antigen in the first test to give a false positive result.

I am glad that she never had a positive RIBA. Neither is she having an active HCV infection.

If you have no more queries, please accept my answer and write a review.

Wish your wife and you good health.

Take care.
Above answer was peer-reviewed by
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