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Posted By: Ben Taylor, PA-C, PhD, DFAAPA
April 21, 2020
Hepatitis C virus (HCV) is a contagious hepatic disease that lives in blood and bodily fluids, and can be passed from person to person through infected blood. It can also be transmitted through other bodily fluids, such as saliva or semen—but this is not as common. HCV can cause both acute and chronic hepatitis. The acute phase is self-limited and usually leads to chronic infection. The chronic disease is often progressive over many years and usually results in hepatic cirrhosis, hepatocellular carcinoma, and the need for liver transplantation. Reported cases of acute HCV infection have been increasing over the last decade because of increasing injection drug use as well as increased diagnosis secondary to improved surveillance.
The Centers for Disease Control and Prevention (CDC) and the US Preventive Services Task Force (USPSTF) had previously recommended that adults born between 1945 and 1965 (ages 55-75) should be tested once, without prior ascertainment of HCV risk factors. In March 2020, USPSTF revised this recommendation for one-time HCV screening to include all asymptomatic adults aged 18 to 79 years, including pregnant women, who do not have known liver disease. The previous testing regimen was thought to result in multiple missed diagnoses, hence the guideline revision. It is also recommended that individuals with ongoing, high-risk factors have repeat screening accomplished. The CDC is currently revising their guidelines.
The risk of HCV infection is increased if your patient:
- Is a healthcare worker who has been exposed to needle sticks, sharps, or mucosal contact to HCV-positive blood
- Has ever injected or inhaled illicit drugs
- Has HIV
- Has received a piercing or tattoo in an unclean environment using possibly unsterile equipment
- Has received a blood transfusion or organ transplant before the year 1992
- Has received clotting factor concentrates before 1987
- Has received long-term hemodialysis treatments
- Was born to a woman with HCV
- Was ever in prison
- Was born between 1945 and 1965, the age group with the highest incidence of HCV
- Chou R, Dana T, Fu R, et al. Screening for Hepatitis C virus infection in adolescents and adults: A systematic review update for the US Preventive Services Task Force. Evidence Synthesis No. 188. Rockville, MD: Agency for Healthcare Research and Quality; 2020.
- United States Preventive Services Task Force. Hepatitis C virus infection in adolescents and adults: Screening. www.uspreventiveservicestaskforce.org/uspstf/document/RecommendationStatementFinal/hepatitis-c-screening. Accessed April 9, 2020.