HCV Screening Decision Tool

HCV SCREENING DECISION TOOL
The initial screening tool for HCV infection is an HCV antibody test. A positive anti-HCV antibody result can signify either current or resolved infection, followed with an HCV ribonucleic acid (RNA) test to determine if active infection is present. Screening should be offered to all individuals falling within one or more of the following at-risk categories or behaviors.^1-4

HIGH-RISK INDIVIDUALS HAVE/ARE…
• Been born between 1945 and 1965, regardless of other risk factors; should be screened one time
• Currently or formerly used injection drugs, including injecting only once many years ago; current injection drug users should be screened annually
• Received clotting factor concentrates made before 1987 (before more advanced methods for manufacturing those products were developed)
• Received blood transfusions or solid organ transplants before July 1992 (before better testing of blood donors became available)
• Born to HCV-positive mothers (If diagnosis is required for children younger than 18 months, use the HCV ribonucleic acid (RNA) test at 1 to 2 months.)
• Ever received long-term hemodialysis
• Human immunodeficiency virus (HIV) infection
• Known exposures to HCV
• Health care workers after needle stick injuries involving HCV-positive blood
• Recipients of blood or organs from donors who tested positive for HCV
• HIV-positive men who have sex with men; should be screened annually
• Signs and symptoms of liver disease (elevated transaminase levels)

LOWER-RISK INDIVIDUALS HAVE...
• Heterosexual intercourse with an HCV-infected person or multiple sexual partners
• Shared personal items that may contain blood, such as razors and toothbrushes
• Other invasive health care procedures, such as injections
• Cosmetic procedures, such as tattoos and piercings, where infection control is substandard
• Used intranasal drugs, cocaine, or marijuana

The following HCV screening algorithm, which includes the points at which referrals to specialists are indicated, is useful for determining the right test to use for a specific risk group.

Because of the potentially serious consequences of untreated chronic HCV, it is critical that primary care clinicians identify and screen patients who are at risk for having or acquiring the disease.

Read Sturm D, Gurevitz SL, Davidson D, Fritchley A, Wagaman A. Chronic hepatitis C infection: Bane of baby boomers. 2014;24(11):24-32 to earn 1 hour AAPA Category 1 CME credit, expires November 31, 2015.

URL: http://www.clinicianreviews.com/articles/cecme-activities/article/chronic-hepatitis-c-infection-bane-of-baby-boomers/73b211cce27d01b93463584dd2c44083.html

REFERENCES
4. [1.] The World Health Organization. Guidelines for the screening, care and treatment of persons with hepatitis C infection. www.who.int/hiv/pub/hepatitis/hepatitis-c-guidelines/en/. Accessed January 7, 2015.
8. [2.] CDC. Testing for HCV infection: an update of guidance for clinicians and laboratorians. MMWR. 2013;62(18):362-365.
9. [3.] Moyer VA, on behalf of the U.S. Preventive Services Task Force. Screening for hepatitis C virus infection in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2013;159(5):349-357.
10. [4.] American Association for the Study of Liver Diseases and Infectious Diseases Society of America. Recommendations for testing, managing, and treating hepatitis C. www.hcvguidelines.org/sites/default/files/full_report.pdf. Accessed January 7, 2015.