A 30-year-old pregnant woman in her first trimester tests anti-HCV positive on screening. The next appropriate step to confirm active infection is:

• A Repeat anti-HCV ELISA in 3 months
• B HCV core antigen ELISA
• C HCV RNA PCR (NAAT) to detect active viraemia ✓
• D Liver biopsy for staging fibrosis

Explanation

Anti-HCV antibody only indicates exposure; it cannot distinguish active infection from a resolved infection or false-positive result. Confirming active HCV infection requires HCV RNA PCR (qualitative or quantitative), which detects current viraemia. HCV core antigen testing is an alternative when PCR is unavailable but is less sensitive for low viral loads. Liver biopsy is for staging, not confirmation of active infection, and is deferred in pregnancy. About 15–25% of HCV-infected individuals spontaneously clear the virus, leaving anti-HCV positive but RNA negative.

Reference: Ananthanarayan & Paniker's Textbook of Microbiology, 11th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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