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Last Updated: 4/21/2014  

Screening for Hepatitis C

  • Understand that HCV is the most common blood-borne infection in the U.S., with with an estimated 2.7 million people infected, making it a major public health concern.

  • Recognize that as many as 75% of persons chronically infected with HCV are unaware of their infection.

  • Understand that chronic HCV infection in the U.S. is most prevalent among persons born between 1945 and 1965.

  • Recognize that most cases of HCV infection become chronic (75% to 85%). Patients with undiagnosed chronic HCV can have an insidious course over decades, presenting with symptoms only after their disease has resulted in significant liver damage.

  • Understand that the medical sequelae of undiagnosed, untreated HCV include cirrhosis, liver cancer, and liver transplantation. Chronic HCV accounts for 8000 to 10,000 deaths per year and is the leading indication for liver transplants in the U.S.

  • Screen for HCV in persons at risk to identify early those individuals who may benefit from antiviral therapy and counseling to reduce HCV-related liver injury, especially in light of direct-acting antiviral treatment options and improved rates of sustained virologic response.

  • Perform one-time screening for HCV in adults born from 1945 to 1965 and perform targeting screening in adults with one or more risk factors for HCV.

  • Note that testing for HCV should be done on most individuals with abnormal liver tests.

  • Recognize that individuals with chronic HCV infection can have normal LFTs, which alone should not be used to exclude persons from HCV screening.

  • Screen individuals for HCV exposure by doing a single EIA for HCV antibodies (most recent generation assay, at least second or third).

  • Use a rapid test (oral fluid or fingerstick) to screen for HCV when available.

  • Follow a positive EIA (standard or rapid test) with HCV RNA PCR testing (HCV RNA “viral load”) to determine if a patient has been exposed to, and cleared, HCV infection (negative RNA PCR) or has a chronic HCV infection (positive viral load).

  • Repeat the HCV RNA PCR test 4 to 6 months after the first negative viral load in patients with a positive EIA to confirm the absence of chronic HCV infection.

  • Recognize that a confirmed negative HCV RNA assay in a patient with a positive EIA indicates that either the infection has resolved or the initial EIA was a false-positive.

DOI: 10.7326/s390
The information included herein should never be used as a substitute for clinical judgment and does not represent an official position of ACP.
Disclosures:
William D. Carey, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Mazen Albeldawi, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Ernesto Ruiz-Rodriguez, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Katherine Krauskopf, MD, MPH is key personnel for a Mt. Sinai project funded by Kadmon Pharmaceuticals to develop a psychosocial assessment website for patients considering Hepatitis C treatment. Donald Gardenier, DNP, FNP-BC has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
Deborah Korenstein, MD, FACP, Editor in Chief, ACP Smart Medicine, has no relationships with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. Richard B. Lynn, MD, FACP, Editor, ACP Smart Medicine, has no relationships with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.
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