Hepatitis C Screening for High Risk Patients

April 5, 2017

Patients can be identified at earlier stages of disease, before serious liver damage, and have improved clinical outcomes.

Screening tests can accurately identify patients with chronic hepatitis C virus (HCV) infection, most of whom do not know they have it. Screening can identify patients at earlier stages of disease, before serious liver damage develops, and lead to treatment for improved clinical outcomes.

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Recommendations for screening certain populations for HCV have been put forth by the United States Preventive Services Task Force (USPSTF), CDC, Infectious Diseases Society of America (IDSA), and American Association for the Study of Liver Diseases (AASLD). The organizations’ recommendations are essentially identical and are summarized below. The patient populations are at high risk for HCV but, unless screened, may not be aware of their status.

The frequency of HCV testing/screening is based on various demographics and risk factors. The USPSTF/CDC/IDSA/AASLD recommend screening for the following:

• Adults who were born between 1945 and 1965 should undergo 1-time HCV testing without prior ascertainment of risk. The “baby boomer” population has been found to have high rates of HCV; the reason is not completely understood. It may be related to the high rate of blood transfusions given in the 1950s and 1960s. Blood used for transfusions in that era was not screened for HCV.

• Other persons with certain risk behaviors

► Injection drug users (current or prior users, even those who may have injected only once). About one-third of injection drug users aged 18 to 30 years are infected with HCV, according to the CDC.

► Intranasal illicit drug users.

• Other persons with certain exposures

► Recipients of clotting factor concentrates produced before 1987. Screening of clotting factor concentrates for HCV became a requirement in 1987.

► Persons who were notified that they were recipients of blood transfusion from a donor who later tested positive for HCV.

► Recipients of blood or blood components or organ transplants before July 1992. Specific blood tests have been used since 1992 to screen for all donated blood and organs.

Next: More Screening Recommendations

► Long-term hemodialysis patients. Investigations regarding the increased number of reports of acute HCV infection among hemodialysis patients are ongoing. According to the CDC, “lapses in infection control (such as injection safety, environmental disinfection, and hand hygiene)” were identified as common factors in facilities that reported HCV infection.

► Children born to HCV-infected mothers.

► Persons with a history of incarceration. According to the CDC, 1 in 3 persons incarcerated in jails and prisons tests positive for HCV infection. The most common way HCV is transmitted among inmates is through sharing of equipment used for piercing, performing tattoos, and injecting drugs.

► Persons getting an unregulated tattoo or other percutaneous or parenteral exposures in an unregulated setting.

► Health care, emergency medical, and public safety workers after needle sticks, sharps, or mucosal exposures to HCV-positive blood.

• Persons with certain medical conditions

► HIV infection.

► Unexplained persistently elevated alanine aminotransferase levels.

Miscellaneous

► Solid organ donors.

Periodic HCV testing is recommended in:

► Injection drug users.

► HIV seropositive men who have unprotected sex with men.

► Persons with ongoing risk factors for exposure to HCV.

Mandatory Age-based HCV Screening

Of note, age-based HCV screening became mandatory in 1 state when the New York State Hepatitis C Testing Law went into effect on January 1, 2014. The law states that HCV screening must be offered by health care providers to every person who was born between 1945 and 1965 regardless of whether he or she is receiving health services in an outpatient or inpatient setting. If a patient consents to the hepatitis C screening test and is found to be “reactive,” the health care provider must then offer the patient follow-up care or referral to a provider who can provide follow-up care.

 

Coming soon, the next part of this Special Report on Hepatitis C and Primary Care will focus on what tests to order for HCV. Watch your email for eNewsletters from Patient Care and visit our homepage at www.patientcareonline.com to check for updates.

References:

U.S. Preventive Services Task ForceFinal Recommendation Statement Hepatitis C: Screening

CDC:Persons for Whom HCV Testing Is Recommended

HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C

NYS Hepatitis C Testing Law