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Hepatitis C Test Recommendations

Hepatitis C Virus (HCV) persists as a chronic infection in 75 to 85% of individuals. Approximately 20% of infected persons will progress to cirrhosis within 20 years and up to 5% will die from HCV-related liver disease. Today, HCV infection is the leading indication for liver transplantation.

In 1998, CDC recommended HCV testing for individuals at high risk for HCV transmission, including those who had injected drugs, been hemodialysed, transfused or transplanted before July 1992, or received clotting factor concentrates produced before 1987. Screening also was recommended for persons with occupational sharps exposures, children born to HCV-infected mothers and individuals with persistently elevated ALT levels and individuals infected with HIV.

Unfortunately, this risk-based testing strategy has had limited success, as evidenced by the substantial number of HCV-infected persons who remain unaware of their infection. Of the estimated 2.7–3.9 million persons infected with HCV in the United States, 45%–85% are unaware of their status.

A recent analysis of NHANES data determined that the prevalence of HCV antibody among persons in the 1945–1965 birth cohort was 3.25%, compared to 1.0 – 1.5% in the general population.People within this age cohort account for approximately three fourths of all chronic HCV infections.

CDC recently published new birth-year based recommendations that target the baby boomer generation (MMWR August 17, 2012 / 61:1-18). These birth-year-based recommendations are intended to augment, not replace, the 1998 HCV testing guidelines. In addition to testing adults of all ages at risk, CDC now recommends that all adults born during 1945–1965 should be tested one-time with an HCV antibody test (anti-HCV).

An immunocompetent person without risk factors who tests anti-HCV negative is not HCV-infected and does not require additional testing. Repeat testing should be considered for persons with ongoing risk behaviors. A person whose anti-HCV test is reactive should be tested for HCV RNA to distinguish active from cleared infection.

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