Hepatitis C Screening: Why One Test Is Recommended for Many Adults

Your clinician suggested a hepatitis C test, and you may feel surprised. You have no symptoms, and you may not think you were ever at risk. Many people with hepatitis C feel the same way. This guide explains why a single blood test is now recommended for many adults, how to read the results, and how Canadian and US advice compares.

What hepatitis C is

Hepatitis C is a virus that infects the liver. It spreads through blood. Common ways people got it include [5]:

• Sharing needles or other drug-use equipment, even once, many years ago.
• Blood transfusions or organ transplants before screening of donated blood began in the early 1990s.
• Medical or dental care with poor infection control, which is more common in some countries.
• Unsterile tattoos or piercings.
• Being born to a mother with hepatitis C.
• Less often, sexual contact.

Many people do not know how they got it.

Why it matters

Most people with a new infection have no symptoms. In many people the virus stays in the body for decades. Over time, it can cause scarring of the liver (cirrhosis), liver failure, and liver cancer. Because it is silent, testing is the only way to know [2].

The good news is that hepatitis C is curable. Direct-acting antiviral pills, taken for 8 to 12 weeks, cure most people [1].

How the test works

Testing has two steps [1][2]:

• Hepatitis C antibody test: shows if you have ever been infected.
• Hepatitis C RNA test (also called PCR or viral load): shows if the virus is in your blood now.

Many labs run the RNA test automatically on the same sample when the antibody test is positive.

What the results mean

• Antibody negative: no sign of infection. No further testing is needed unless you have new risk.
• Antibody positive, RNA positive: current infection. You need further assessment and treatment.
• Antibody positive, RNA negative: past infection that cleared, either on its own or with treatment. Some people clear the virus naturally. You are not infectious, but antibodies stay positive for life.

What your doctor looks at: who should be tested

US guidance

The US Preventive Services Task Force (USPSTF) 2020 recommendation [1]:

• Screen all adults aged 18 to 79 at least once (grade B), including during pregnancy.
• Consider testing people younger than 18 or older than 79 who are at high risk.

The Centers for Disease Control and Prevention (CDC) 2020 recommendations [2]:

• Test all adults aged 18 and older at least once in a lifetime.
• Test during each pregnancy.
• Test people with ongoing risk, such as people who inject drugs, regularly.

These replaced older US advice that focused on people born from 1945 to 1965.

Canadian guidance

The Canadian Task Force on Preventive Health Care 2017 guideline recommended against screening adults who are not at elevated risk [3]. It supported testing people with risk factors, such as:

• Past or current injection drug use.
• Time in prison.
• Immigration from a country where hepatitis C is common.
• Blood products or organ transplants in Canada before 1992.
• Hemodialysis.
• Health care where infection control may have been poor.

The Canadian Association for the Study of the Liver (CASL), a specialist group, took a broader view in its 2018 guideline. It supported one-time testing of adults born from 1945 to 1975, in addition to risk-based testing [4]. The Canadian Task Force ended its mandate in March 2026, and its guideline remains posted for reference. Testing approaches vary by province.

The key differences

• US: test almost all adults once, plus each pregnancy.
• Canada: national preventive guidance focused on risk factors. A Canadian specialist guideline also supports testing a broad birth cohort.

After a positive result

If you have an active infection, your clinician will usually:

• Check how much liver scarring you have, often with a blood score or a liver stiffness scan.
• Test for hepatitis B and HIV.
• Discuss treatment, which is usually a short course of pills with few side effects.
• Recommend vaccines for hepatitis A and B if you are not immune.
• Suggest limiting alcohol to protect your liver.

After treatment, an RNA test confirms whether you are cured. People with advanced scarring still need regular liver cancer checks after cure.

Lowering your risk

You can lower the chance of getting or passing on hepatitis C:

• Do not share needles, straws, pipes, or other drug-use equipment.
• Do not share razors, toothbrushes, or nail clippers.
• Choose licensed tattoo and piercing shops.

Questions to ask your clinician

• Should I be tested for hepatitis C, based on my age and history?
• Will the lab check for active virus if my antibody test is positive?
• What does my result mean for my liver health?
• If I have hepatitis C, how much scarring do I have?
• Which treatment would I take, and is it covered for me?
• Should my partner or family members be tested?

When to get care quickly

Go to the emergency department if you have yellow skin or eyes with confusion, severe drowsiness, vomiting blood, black stools, or a rapidly swelling belly. These can be signs of serious liver disease.

Bottom line

Hepatitis C is a common, silent, and curable infection. In the US, one test is recommended for all adults. In Canada, national preventive guidance focused on risk factors, while a Canadian liver specialist guideline also supports testing many adults born from 1945 to 1975. A positive antibody test needs an RNA test. If you have active infection, modern treatment cures most people.

Primary AI can show you the guideline and study sources behind this topic in plain language, so you can bring better questions to your appointment.