HEPATITIS C testing remains a major challenge in high-risk populations despite major advances in antiviral therapy, according to experts speaking during a Meet-the-Experts session at EASL 2026. Discussions focused on acute infection, reinfection monitoring, and the growing importance of point-of-care diagnostics in reducing transmission and improving access to care.
Hepatitis C Testing and Acute Infection
Speakers highlighted ongoing variation in approaches to diagnosing and treating acute hepatitis C infection. While many clinicians now initiate direct acting antiviral treatment following a single positive hepatitis C RNA result, historical reimbursement criteria in some healthcare systems have required confirmation of persistent infection over 6 months before treatment approval.
Ashley Brown, Consultant Hepatologist, St Mary’s and Hammersmith Hospitals; Professor of Practice, Imperial College London, UK, noted that delaying treatment may increase opportunities for onward transmission, particularly in individuals continuing high-risk behaviours such as injecting drug use or high-risk sexual exposure. Experts explained that earlier studies during the interferon era supported delaying therapy because spontaneous viral clearance occurred in a substantial proportion of patients and treatment carried significant toxicity. However, modern direct acting antivirals are considerably safer and easier to administer.
The panel also discussed the importance of frequent hepatitis C testing in populations at ongoing risk of exposure. Men who have sex with men receiving HIV pre-exposure prophylaxis and people attending drug treatment services were identified as groups in whom regular monitoring may facilitate earlier detection of acute infection and reinfection.
Point-of-Care Hepatitis C Testing Expands
Point-of-care hepatitis C testing technologies generated significant discussion during the session. Experts highlighted the potential role of dry blood spot testing and rapid molecular diagnostics, particularly in community settings where conventional laboratory access remains limited.
Delegates from Catalonia described the use of dry blood spot collection networks linked to central laboratories, allowing simplified hepatitis C RNA testing in vulnerable populations. The discussion also explored the growing role of core antigen testing as a potentially faster and lower cost alternative to molecular diagnostics in some settings.
However, concerns were raised regarding sensitivity differences between dry blood spot samples and standard plasma or serum testing platforms. Experts also noted that core antigen testing may still require reflex molecular confirmation in certain clinical scenarios.
Reinfection Monitoring Remains Complex
The session additionally addressed the clinical challenge of distinguishing hepatitis C relapse from reinfection following successful treatment. Although phylogenetic analysis may help differentiate these scenarios, speakers acknowledged that such testing is not routinely available in most clinical settings.
Ultimately, experts agreed that improving hepatitis C testing pathways will require broader access to rapid diagnostics, greater clinician awareness, and more integrated community-based approaches to screening and follow up.
Reference:
Brown A, Mangia A. Meet-the-Experts: Barriers or opportunities in HCV: point-of-care diagnosis, acute infection, reinfection and pregnancy. Presentation. EASL Congress 2026, Barcelona, Spain. 28 May 2026.
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