Hepatitis C screening

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Yazan Daaboul, Serge Korjian

Overview

People living in regions with high HCV prevalence and who have engaged in high-risk activities should be screened. Screening by serological testing, confirmed by nucleic acid amplification (NAT) for HCV RNA, is required. Additionally, screening for other bloodborne infections, such as HBV and HIV, is required once the diagnosis is made. The ideal frequency of testing in these patients is unclear and should be individualized according to the frequency of exposure to risk.

Screening

Initial Testing

Screening for HCV is performed by HCV serological testing. In patients who test positive, a confirmation for chronic HCV status is required by nucleic acid amplification (NAT) or HCV RNA. HCV RNA may be directly tested in immunocompromised patients or patients who already had spontaneous or treatment-related clearance.

Screening for other infections, such as HBV and HIV, is also indicated when patients are identified as HCV-positive. In some endemic areas and high-risk populations, screening for tuberculosis (TB) is also warranted.

Interpretation of Screening Results

• If an anti-HCV test is negative and patients are suspected to have liver disease, a follow-up HCV antibody or HCV RNA test is recommended if HCV exposure occurs within 6 months.

• If an anti-HCV test is positive but HCV RNA is negative, patients have no evidence of active infection.

• If an anti-HCV test is positive and HCV RNA is positive, a diagnosis of HCV infection is made. Quantitative HCV RNA tests should be performed before initiation of antiviral therapy to document baseline levels of viremia. Additionally, HCV genotyping is recommended to guide therapy.

Frequency of Screening

The ideal frequency of testing in patients is unclear and should be individualized according to frequency of exposure to risk. In patients who use intravenous drugs or HIV-positive men who have unprotected sex with men, annual screening may be considered.

Summary of Screening Recommendations

American Association for the Study of Liver Disease (AASLD) - Infectious Diseases Society of America (IDSA) "Recommendations for Testing, Managing, and Treating Hepatitis C": 2014

According to the AASLD - IDSA recommendations in 2014, the following patients should be screened for HCV:

• People born between 1945 and 1965

Risk Behaviors

• Injection-drug use (current or ever, including those who injected once)
• Intranasal illicit drug use

Risk Exposures

• Long-term hemodialysis (ever)
• Getting a tattoo in an unregulated setting
• Healthcare, emergency medical, and public safety workers after needle sticks, sharps, or mucosal exposures to HCV-infected blood
• Children born to HCV-infected women
• Prior recipients of transfusions or organ transplants, including persons who:
  • were notified that they received blood from a donor who later tested positive for HCV infection
• received a transfusion of blood or blood components or underwent an organ transplant before July 1992
• received clotting factor concentrates produced before 1987
• were ever incarcerated

Other Medical Conditions

• HIV infection
• Unexplained chronic liver disease and chronic hepatitis including elevated alanine aminotransferase levels

World Health Organization "Guidelines for the Screening, Care, and Treatment of Persons with HCV": 2014

Generally, the World Health Organization (WHO) Guidelines for the Screening, Care, and Treatment of Persons with Hepatitis C Infection published on April 2014 recommends HCV screening for all people living in regions of high HCV prevalence with positive history for risk exposure and behavior.

Screening includes:

• Persons who received medical or dental interventions in health-care settings where infection control practices are substandard
• Persons who received blood transfusions prior to the time when serological testing of blood donors for HCV was initiated
• Persons who received blood transfusions in countries where serological testing of blood donations for HCV is not routinely performed
• Persons who inject drugs (PWID)
• Persons who have had tattoos, body piercings, or scarification procedures are done where infection control practices are substandard
• Persons with HIV infection
• Persons who have used intranasal drugs
• Prisoners and previously incarcerated persons