Hepatitis C Virus Testing Guidelines

Many people with Hepatitis C virus (HCV) do not know they are infected. Since many people can live with HCV for decades without developing symptoms, testing is critical. HCV infection can progress to cirrhosis and hepatocellular carcinoma. Highly effective medications are now available that can cur HCV infection.

The Center for Disease Control and Prevention (CDC) recommends testing the following individuals for HCV infection:

  • Adults born from 1945 through 1965 should be tested at least once in their lifetime and more frequently if they are at ongoing risk
  • Persons who currently or previously inject drugs
  • Patients who have HIV infection
  • Patients with persistently abnormal alanine aminotransferase (ALT) levels
  • Patients treated with clotting factor concentrates produced before 1987
  • Patients who have ever received long-term hemodialysis
  • Patients who were recipients of either blood transfusions or organ transplants before July 1992, or who were notified their donor later tested positive for HCV
  • Children born to HCV-positive women
  • Healthcare, emergency medical, and public safety workers with exposure to HCV-positive blood through needle sticks, sharps, or mucosal exposures

CDC also suggests that HCV testing may benefit:

  • Recipients of transplanted tissues
  • Persons who inject drugs
  • Intranasal cocaine and other non-injecting illegal drug users
  • Persons with a history of tattooing or body piercing
  • Persons with a history of multiple sex partners or sexually transmitted infections
  • Long-term steady sex partners of HCV-positive persons
  • Persons who engage in high-risk sexual activity and with history of sexually transmitted infections

The initial test should be an immunoassay for HCV antibody. Individuals with reactive test results should be confirmed with quantitative real-time PCR for HCV RNA. Patients, who have confirmed positive results for HCV infection, should then have their HCV genotype determined. If an individual has HCV genotype 1a, they should be further tested for NS5a drug resistance.

All patients with chronic HCV infection should be tested for evidence of current or previous Hepatitis B (HBV) infection by measuring Hepatitis B surface antigen (HBsAg) and Hepatitis B core antibody (anti-HBc). This testing should be completed before initiating HCV treatment because HBV may be reactivated.

Reference:

CDC Testing Recommendations for Hepatitis C Virus Infection: http://www.cdc.gov/hepatitis/hcv/guidelinesc.htm

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