Screening

Screening practices may be different between countries, and, in particular, developed countries may have different practices from developing countries with limited medical facilities. Local guidance should be followed.

In the US, the American Association for the Study of Liver Diseases (AASLD) recommends universal one-time, routine, opt-out screening in all adults ages 18 years and older, followed by periodic testing for people with ongoing risk activities, exposures, or other conditions and circumstances associated with an increased risk of hepatitis C infection (see below). One-time screening is also recommended in patients younger than 18 years with activities, exposures, or other conditions and circumstances associated with an increased risk of hepatitis C infection. Annual testing is recommended for all people who inject drugs, HIV-infected men who have unprotected sex with men, and men who have sex with men taking pre-exposure prophylaxis. All pregnant women should be tested, ideally at the initiation of prenatal care with each pregnancy.[66]

Risk activities

  • Injection drug use (current or past history, including those who injected only once)

  • Intranasal illicit drug use

  • Use of glass crack pipes

  • Engagement in chem sex

  • Men who have sex with men.

Risk exposures

  • People on long-term hemodialysis (ever)

  • People with percutaneous/parenteral exposures in an unregulated setting

  • Healthcare, emergency medical, and public safety workers after needlestick, sharps, or mucosal exposure to hepatitis C virus (HCV)-infected blood

  • Children born to HCV-infected women

  • Recipients of a prior transfusion or organ transplant, including people who:

    • Were notified that they received blood from a donor who later tested positive for HCV

    • Received a transfusion of blood or blood components, or underwent an organ transplant before July 1992

    • Received clotting factor concentrates produced before 1987

  • People who were ever incarcerated.

Other conditions and circumstances

  • HIV infection

  • Sexually active people about to start pre-exposure prophylaxis (PrEP) for HIV

  • Chronic liver disease and/or chronic hepatitis, including unexplained elevated alanine aminotransferase levels

  • Solid organ donors (living and deceased) and solid organ transplant recipients.

Opt-out, universal screening in emergency departments can identify a large number of previously unrecognized infections, especially among people born after 1965. A retrospective study from four urban academic emergency departments in the US found a high prevalence of previously unrecognized HCV infections (5.7% of adults tested overall, compared with the estimated overall US prevalence rate of 0.95%). Nearly half of infections were among people born after 1965.[78]

The US Preventive Services Task Force (USPSTF) also recommends that all adults ages 18-79 years be screened once for HCV infection, including pregnant women. Screening may be considered in patients outside of this age range if they are considered high risk.[79]

The Centers for Disease Control and Prevention (CDC) recommends that all adults ages 18 years and older be screened at least once, and that all pregnant women be screened during each pregnancy (except in settings where the prevalence of HCV infection is <0.1%). It also recommends one-time testing, regardless of age or setting prevalence, among people with recognized conditions or exposures (e.g., HIV infection, people who inject drugs, people with certain medical conditions, prior recipients of transfusions or organ transplants), as well as routine periodic testing for people with ongoing risk factors.[80]

The CDC recommends routine universal screening of all newly arrived adult refugees ages 18 years and older. Screening is not routinely recommended for children <18 years old but is recommended for unaccompanied refugee minors. Testing is also recommended in children with risk factors, and children born to HCV-positive mothers. Screening is recommended in all pregnant women during each pregnancy.[81]

The American College of Obstetricians and Gynecologists (ACOG) strongly recommends that all patients be screened for hepatitis C virus antibodies at each pregnancy. ACOG also strongly recommends prepregnancy screening for hepatitis C virus infection and treatment before pregnancy, when possible.[56]

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