All Manitoba Ordering Practitioners

Beginning in late October 2025, Cadham Provincial Laboratory (CPL) will be changing the provincial HCV laboratory screening protocol, with significant improvements. Other bloodborne testing, such as for HIV, HBV or syphilis, is not affected by these changes in lab protocol.

Practitioners should continue to order HCV antibody as the screen test for HCV infection. Where possible, submitting sites are asked to spin down serum specimens prior to shipping to CPL.

Effective the date above, screen positive results for HCV antibody (HCV Ab) will be confirmed by nucleic acid testing (NAT) to detect circulating HCV RNA. Prior to this, serum specimens were unable to be tested for HCV RNA, requiring a subsequent separate plasma specimen. Detection of HCV RNA in patient serum confirms active HCV infection.

For those who have previously cleared or been previously treated for HCV and achieved SVR (sustained viral response), HCV RNA detection will be the only reliable method remaining to diagnose reinfection, as HCV Ab typically remains positive for life. HCV RNA to assess for reinfection should only be requested in high risk cases with suggestive laboratory or clinical findings.

As a reminder, HCV genotyping is generally not available nor indicated and requests will require direct consultation with laboratory staff. HCV antigen testing is no longer available.

This change simplifies the diagnosis of active Hepatitis C for clinicians and public health practitioners. Serum specimens subsequently determined to be HCV RNA(+) will result in patients being more readily eligible for curative HCV treatment. If you have any questions about testing for HCV, or the interpretation of HCV test results, please contact CPL or the CPL physician on-call to discuss.

References/Resources:
Please refer to the CPL Guide to Services (G2S) for collection and submission information.

More Information:
Manitoba Hepatitis C Protocol

Contact Information:
Paul Van Caeseele, MD
Medical Director, Cadham Provincial Laboratory | Shared Health
204-945-6456 or

Changes to Hepatitis C Virus Antibody Confirmation and Reporting Memo

Submitted by: Tamara Burnham, Collaborative Practice Lead