Universal Screening for Hepatitis C
SUMMARY:
USPSTF has reviewed available evidence and has updated its hepatitis C screening guidance. HCV is the most common chronic blood-borne pathogen in the US with potential for significant morbidity and mortality if left untreated.
- The incidence rate of acute hepatitis C has more than doubled since 2013, and increased 15% from 2019 to 2020,
- This increase is primarily due to increased testing and surveillance, as well as increased injection drug use
- The USPSTF recommends screening for HCV infection in adults aged 18 to 79 years
- Population: All asymptomatic adults aged 18 to 79 years without known liver disease
- B level recommendation
- Offer or provide this service
- There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial
The USPSTF concludes with moderate certainty that screening for HCV infection in adults aged 18 to 79 years has substantial net benefit
Risk Assessment
- Screen all adults ages 18 to 79 years
- Risk factors to consider
- Injection drug use: Consider screening adolescents <18 years or >79 years
- Young adults (ages 18 to 30): Approximately 30% are infected
- Older adults: 70% to 90% are infected
- Pregnancy
- Screen pregnant adults during each pregnancy
- Due to increasing prevalence of HCV in women aged 15 to 44 years and in infants born to HCV-infected mothers, clinicians may want to consider screening pregnant persons younger than 18 years
- Injection drug use: Consider screening adolescents <18 years or >79 years
Screening Test
- Anti-HCV antibody testing followed by polymerase chain reaction testing for HCV RNA
- HCV infection can be detected by anti-HCV screening tests (enzyme immunoassay) 4 to 10 weeks after infection
- Delayed seroconversion may occur in immunocompromised individuals (e.g., those with HIV infection)
- Consider addition of HCV RNA in these patients despite a negative antibody test
Screening Intervals
- “Most adults need to be screened only once”
- Consider more frequent screening for individuals with ongoing risk (e.g., ongoing injection drug use)
- See “Related Topics” below for further information
KEY POINTS:
Hepatitis C Overview
- Acute Hepatitis C occurs within the first 6 months after exposure to HCV
- Many individuals will remain asymptomatic
- 15% of patients will spontaneously clear the virus within 6 months
- Signs and symptoms of acute HCV infection
- Fever | Fatigue | Dark urine | Clay-colored stool | Abdominal pain | Loss of appetite | Nausea and vomiting | Joint pain | Jaundice
- Most individuals with newly acquired HCV infection will be asymptomatic | 20 to 30% will exhibit symptoms
- Symptoms will usually appear within 2 to 12 weeks (range: 2–26 weeks)
- Symptoms of chronic HCV infection
- Most people are asymptomatic or have non-specific symptoms (e.g., chronic fatigue and depression)
- Many eventually develop chronic liver disease, which can range from mild to severe, including cirrhosis and liver cancer
- Chronic HCV infection is typically not recognized until asymptomatic people are identified as HCV-positive when screened for blood donation or liver function tests return an abnormal result (e.g., elevated ALT), often during routine evaluation
Hepatitis C Treatment
Acute
- The same regimens recommended for chronic HCV infections are recommended for acute infection
Chronic
- Current antiviral therapies can result in sustained virologic response (SVR; absence of detectable virus 12 weeks after completion of treatment)
- SVR is indicative of a cure of HCV infection
- Over 90% of HCV infected persons can be cured of HCV infection regardless of HCV genotype with 8-12 weeks of oral therapy
- See “”Related Topics” below for information on HCV drug regimens
Other Considerations
- Advise abstinence from alcohol and acetaminophen during acute infection
- Evaluate for hepatitis B and HIV infection
- Vaccinate against Hepatitis A and Hepatitis B, as well as pneumococcal vaccine in patients with cirrhosis
- Evaluation for advanced hepatic fibrosis with
- Elastography or liver imaging (US or CT Scan)
- FIB-4 Score (see “Learn More” below)
- Lab tests: ALT | AST | Albumin | Bilirubin | INR | CBC
- Provide education on how to prevent HCV transmission to others
Other Professional Recommendations
- AASLD/IDSA
- One-time, routine, opt out HCV testing is recommended for all individuals aged 18 years and older
- One-time HCV testing should be performed for all persons less than 18 years old with behaviors, exposures, or conditions or circumstances associated with an increased risk of HCV infection
- Periodic repeat HCV testing should be offered to all persons with behaviors, exposures, or conditions or circumstances associated with an increased risk of HCV exposure
- Annual HCV testing is recommended for all persons who inject drugs and for HIV-infected men who have unprotected sex with men
- As part of prenatal care, all pregnant women should be tested for HCV infection, ideally at the initial visit, and test should be repeated with each pregnancy
- CDC
- All adults 18 years and older (except in settings where the prevalence is <0.1%)
- All pregnant persons should be screened for HCV during each pregnancy (except in settings where the prevalence of HCV infection is < 0.1%)
- All persons with risk factors (e.g., persons with HIV, prior recipients of blood transfusions, persons who ever injected drugs and shared needles, and persons who are born to an HCV-infected mother) should be tested for HCV, with periodic testing while risk factors persist
Learn More – Primary Sources:
AASLD / IDSA: HCV Testing and Linkage to Care
CDC Recommendations for Hepatitis C Screening Among Adults — United States, 2020
CDC Clinical Overview of Hepatitis C
Reported Prevalence of Maternal Hepatitis C Virus Infection in the United States
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