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Hepatitis C

In 2018, there were 3,621 cases of acute hepatitis C in the United States reported to the CDC.1

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Hepatitis C by the numbers1

 

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~50,300


An estimated 50,300 acute hepatitis C cases occurred in 2018

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~2.4M


An estimated 2.4 million people in the US were living with hepatitis C from 2013–2016

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~5-25%

Approximately 5–25% of people with chronic hepatitis C will develop cirrhosis over the next ten to twenty years

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1–4%

People with hepatitis C and cirrhosis have a 1–4% annual risk for hepatocellular carcinoma

The importance of screening

New cases of hepatitis C are on the rise, particularly among reproductive age adults. 

Rates of new HCV infections increased by more than 60% from 2015 to 2019. And in 2019, more than 63% of HCV infections occurred among adults 20-39 years of age. 

Your patients aren’t aware of their risk. 

Almost half of people with hepatitis C are unaware of their infection. Testing is the first step to accessing curative treatment. Without treatment, approximately 15-20% of adults with chronic HCV infection will develop progressive liver fibrosis and cirrhosis. 

Hepatitis C can be cured. 

Over 90 percent of people infected with HCV can be cured with 8-12 weeks of oral therapy. Treatment of hepatitis C is associated with reductions in mortality among persons with chronic hepatitis C.

The Centers for Disease Control and Prevention (CDC) and the U.S. Preventive Services Task Force recommend that primary care providers test all adult patients for hepatitis C.2

Screening & Medical Management3 

Screening your patients for chronic illnesses like hepatitis C, we know, is of utmost importance. According to the CDC, the following is recommended:

Universal hepatitis C screening (new recommendations)

  • Hepatitis C screening at least once in a lifetime for all adults aged ≥18 years, except in settings where the prevalence of HCV infection (HCV RNA-positivity) is <0.1%
  • Hepatitis C screening for all pregnant women during each pregnancy, except in settings where the prevalence of HCV infection (HCV RNA-positivity) is <0.1%

One-time hepatitis C testing regardless of age or setting prevalence among persons with recognized conditions or exposures (existing recommendations)

  • Persons with HIV Persons who ever injected drugs and shared needles, syringes or other drug preparation equipment, including those who injected once or a few times many years ago
  • Persons with selected medical conditions, including persons who ever received maintenance hemodialysis and persons with persistently abnormal ALT levels
  • Prior recipients of transfusions or organ transplants, including persons who received clotting factor concentrates produced before 1987, persons who received a transfusion of blood or blood components before July 1992, persons who received an organ transplant before July 1992 and persons who were notified that they received blood from a donor who later tested positive for HCV infection
  • Health care, emergency medical and public safety personnel after needle sticks, sharps or mucosal exposures to HCV-positive blood
  • Children born to mothers with HCV infection

Routine periodic testing for persons with ongoing risk factors, while risk factors persist

  • Persons who inject drugs and share needles, syringes or other drug preparation equipment
  • Persons with selected medical conditions, including persons who ever received maintenance hemodialysis

Any person who requests hepatitis C testing should receive it, regardless of disclosure of risk, because many persons might be reluctant to disclose stigmatizing risks.

Consult the following algorithm from the CDC for identifying HCV and HCV infection
 

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Patient Follow-Up3

Based on your patients’ screening results, the CDC recommends the following:

  • Negative anti-HCV results: they should be informed and reassured that they are not infected unless recently exposed through prior risk behaviors (e.g.: intravenous drug use (IDU)).
  • Positive anti-HCV/negative HCV RNA results: they should be informed that they do not have a current HCV infection. This is either a resolved past infection or a false-positive. Additional testing may be necessary.
  • Positive anti-HCV/positive HCV RNA results: they should be informed that they have an active HCV infection and likely need curative treatment. They should be provided treatment options information as well as educational materials and resources on how to prevent transmission.

The patient’s level of alcohol and drug use may need to be evaluated in case a brief alcohol or drug use intervention is clinically indicated.

Additional resources
 

References: 

  1. U.S. Department of Health and Human Services; Centers for Disease Control and Prevention (CDC). The ABCs of Hepatitis – for Health Professionals.  Accessed May 9, 2022. 
  2. Centers for Disease Control and Prevention (CDC). Screen All Patients for Hepatitis C; Updated Recommendation.  Accessed, May 9, 2022.
  3. Centers for Disease Control and Prevention (CDC). Morbidity and Mortality Weekly Report (MMWR); CDC recommendations for Hepatitis C Screening Among Adults – United States, 2020.  Accessed May 9, 2022.