CDC Guidance on HCV Screening: 5 Questions

February 21, 2019

CDC guidance on hepatitis C screening is mandatory primary care reading. Test your recall with these 5 questions on CDC recommendations.

Question 1. The CDC recommends that all of the above should be tested for hepatitis C, except which one?

Answer: A. People born after 1970. The CDC recommends that anyone born between 1945-1965 (“baby boomers’’) should be tested for HCV, without the need for identifying other risk factors for HCV. The prevalence of HCV is 5X higher in baby boomers, compared with other adults. One-time testing in this group is estimated to identify 800,000 more people with HCV, and linking them to care may prevent 120,000 HCV-related deaths.

Question 2. Testing for hepatitis C using just ALT levels catches approximately what percentage of people with chronic hepatitis C?

Answer: B. 50%. According to the CDC, testing for hepatitis C using only ALT levels misses about 50% of people with chronic infections.

3. What percentage of people who become infected with HCV develop chronic HCV infection?

Answer: A. 75%-85%. According to the CDC, about 75-85% of people who become infected with HCV go on to develop chronic HCV. Only about 15-25% of people clear the virus without treatment. Newer treatments, ie, highly active direct-acting antiviral medications that do not require use of interferon, can stop disease progression and lead to virologic cure in most people.

Question 4. Approximately what percentage of Americans with chronic HCV do not know they are infected?

Answer: D. ~50%. The CDC reports that ~50% of Americans with chronic HCV do not know they are infected. Chronic HCV affects 3 million Americans and ranks as the country’s top chronic blood-borne infection. About 60-70% of people with chronic HCV develop liver disease, and about 1-5% will develop liver cancer.

Question 5. A 40-year old woman who received a blood transfusion in 1990 has never been checked for HCV, so you review her labs. Her HCV antibody comes back reactive. What is the next step in the workup?

Answer: D. Order HCV RNA. The CDC recommends HCV screening for people who received blood transfusions/components or organ transplants before July 1992. Those who test positive for HCV antibodies should be checked for HCV RNA. In the case of a positive antibody, negative RNA test, and a recent exposure or other clinical signs of HCV infection (eg, abnormal ALT), follow-up with repeat HCV RNA testing may be warranted.

Source: Centers for Disease Control and Prevention. A guide to comprehensive hepatitis C counseling and testing. https://www.cdc.gov/hepatitis/resources/professionals/pdfs/CounselingandTestingPC.pdf. Accessed February 18, 2019.