Hepatitis C virus is a leading cause of chronic liver disease. Worldwide, an estimated 180 million people are infected. In the U.S., approximately 4.1 million persons are positive for anti-HCV antibody and 80% of these are estimated to be viremic.
Screen patients who are at increased risk for hepatitis C.
Screen patients with test for anti-HCV antibody by ELISA; if positive, consider HCV RNA testing to confirm active infection.
Test patients with signs or symptoms of liver disease for hepatitis C using anti-HCV antibody by ELISA; if positive, consider HCV RNA testing to confirm active infection.
HCV RNA test should be performed if HCV infection is suspected but anti-HCV antibody test is negative in patients who are immunocompromised (e.g. chronic renal failure, HIV patients, and organ transplant recipients) or suspected of having acute HCV infection.
Consider other causes of acute or chronic liver disease when evaluating for HCV.
Consider other disease processes that may be complications of hepatitis C infection.
Consider an appropriate regimen of antiviral drug therapy for selected patients with chronic hepatitis C.
Antiviral drug treatment of HCV is contraindicated in certain patient groups.
Test for immunity to HAV and HBV infection, and vaccinate susceptible patients before initiating HCV treatment.
Consider not treating patients who seem to be at low risk of developing progressive disease, such as patients with long-duration (>30 years) disease with minimal histologic evidence of hepatic fibrosis.