Prevention of Hepatitis C Virus Infection

Agency or organization

Recommendation (screening, transfer of care, treatment), evidence grading,^a year of recommendation

USPSTF

Screening:

Screening for HCV infection in persons at high risk for infection (B recommendation, 2013).

Offering one-time screening for HCV infection to adults born between 1945 and 1965 (B recommendation, 2013).

CDC

Screening:

One-time testing without prior ascertainment of HCV risk for persons born during 1945-1965 (strong recommendation, moderate quality of evidence, 2012).

Transfer of care:

Early detection and treatment of asymptomatic individuals. Treatment decisions should be made by the patient and provider after several factors are considered, including stage of disease, hepatitis C genotype, comorbidities, therapy-related adverse events, and benefits of treatment.

ALF

Screening:

HCV testing at least once for persons born between 1945 and 1965. Rating: Class I, Level B (2014).

Other persons should be screened for risk factors for HCV infection, and one-time testing should be performed for all persons with behaviors, exposures, and conditions associated with an increased risk of HCV infection.

Rating: Class I, Level B (2014).

IOM

Screening:

Risk factor screening for hepatitis C should be included as a core component of preventive care (2010).

Canadian Liver Foundation

Screening:

All adults born between 1945 and 1975 undergo a test for hepatitis C (2014).

AASLD/IDSA/IAS- USA

Screening (2014):

HCV testing at least once for persons born between 1945 and 1965 without ascertainment of risk. Rating: Class I, level B.

Other persons should be screened for risk factors for HCV infection, and one-time testing should be performed for all persons with behaviors, exposures, and conditions associated with an increased risk of HCV infection.

Rating: Class I, level B.

Annual HCV testing for persons who inject drugs and for HIV-seropositive men who have unprotected sex with men. Periodic testing should be offered to other persons with ongoing risk factors for exposure to HCV. Rating: Class IIA, Level C.

Transfer of care (2014):

Evaluation by a practitioner who is prepared to provide comprehensive management, including consideration of antiviral therapy, is recommended for all persons with current (active) HCV infection.

Rating: Class IIa, level C.

Persons with current (active) HCV infection should receive education and interventions aimed at reducing progression of liver disease and preventing transmission of HCV.

Rating: Class IIa, Level B.

Treatment (2015):

Treatment for all patients with chronic HCV infection is recommended, except those with short life expectancies that cannot be remediated by treating HCV, by transplantation, or by other directed therapy. Rating: Class I, Level A.

2. Pretreatment assessment of a patient’s understanding of treatment goals and provision of education on adherence and follow-up are essential. A well-established therapeutic relationship between practitioner and patient remains crucial for optimal outcomes with new direct-acting antiviral therapies.