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{{Hepatitis C}}
{{Hepatitis C}}
{{CMG}} '''Associate Editor(s)-In-Chief:''' [[User:YazanDaaboul|Yazan Daaboul]]; [[User:Sergekorjian|Serge Korjian]]
{{CMG}}; '''Associate Editor(s)-In-Chief:''' [[User:YazanDaaboul|Yazan Daaboul]], [[User:Sergekorjian|Serge Korjian]]


==Overview==
==Overview==
Persons living in regions highly prevalent with HCV and who have engaged in high risk should be screened. Screening by [[serological testing]], confirmed by [[nucleic acid amplification]] (NAT) for [[HCV RNA]] is required.  Additionally, screening for other [[bloodborne infections]], such as [[HBV]] and [[HIV]], is required once diagnosis is made. The frequency of testing in these patients is unclear and should be individualized according to frequency of exposure to risk.
People living in regions with high HCV prevalence and who have engaged in high-risk activities should be screened. Screening by [[serological testing]], confirmed by [[nucleic acid amplification]] (NAT) for [[HCV RNA]], is required.  Additionally, screening for other [[bloodborne infections]], such as [[HBV]] and [[HIV]], is required once the diagnosis is made. The ideal frequency of testing in these patients is unclear and should be individualized according to the frequency of exposure to risk.


==Screening==
==Screening==
===Initial Testing===
===Initial Testing===
Screening for HCV is performed by HCV [[serological testing]].<ref name=WHO>{{cite web |url=http://apps.who.int/iris/bitstream/10665/111747/1/9789241548755_eng.pdf?ua=1 |title=World Health Organization (WHO) Guidelines for the Screening, Care, and Treatment of Persons with Hepatitis C Infection|date=April 2014 |website=World Health Organization|publisher=WHO |accessdate=July 27 2014}}</ref> In cases who test positive, a confirmation for chronic HCV status is required by [[nucleic acid amplification]] (NAT) or [[HCV RNA]]. HCV RNA may be directly tested in cases of immunocompromised states or in patients who already had spontaneous or treatment-related clearance.<ref name=WHO>{{cite web |url=http://apps.who.int/iris/bitstream/10665/111747/1/9789241548755_eng.pdf?ua=1 |title=World Health Organization (WHO) Guidelines for the Screening, Care, and Treatment of Persons with Hepatitis C Infection|date=April 2014 |website=World Health Organization|publisher=WHO |accessdate=July 27 2014}}</ref>  
Screening for HCV is performed by HCV [[serological testing]].<ref name=WHO>{{cite web |url=http://apps.who.int/iris/bitstream/10665/111747/1/9789241548755_eng.pdf?ua=1 |title=World Health Organization (WHO) Guidelines for the Screening, Care, and Treatment of Persons with Hepatitis C Infection|date=April 2014 |website=World Health Organization|publisher=WHO |accessdate=July 27, 2014}}</ref> In patients who test positive, a confirmation for chronic HCV status is required by [[nucleic acid amplification]] (NAT) or [[HCV RNA]]. HCV RNA may be directly tested in [[immunocompromised]] patients or patients who already had spontaneous or treatment-related clearance.<ref name=WHO>{{cite web |url=http://apps.who.int/iris/bitstream/10665/111747/1/9789241548755_eng.pdf?ua=1 |title=World Health Organization (WHO) Guidelines for the Screening, Care, and Treatment of Persons with Hepatitis C Infection|date=April 2014 |website=World Health Organization|publisher=WHO |accessdate=July 27, 2014}}</ref>  


Screening for other infections, such as [[HBV]] and [[HIV]], is also indicated when patients are found to be HCV-positive. In some endemic areas and high risk populations, screening for [[tuberculosis]] ([[TB]]) is also warranted.<ref name=AASLD<ref name=WHO>{{cite web |url=http://apps.who.int/iris/bitstream/10665/111747/1/9789241548755_eng.pdf?ua=1 |title=World Health Organization (WHO) Guidelines for the Screening, Care, and Treatment of Persons with Hepatitis C Infection|date=April 2014 |website=World Health Organization|publisher=WHO |accessdate=July 27 2014}}</ref> <ref name=WHO>{{cite web |url=http://apps.who.int/iris/bitstream/10665/111747/1/9789241548755_eng.pdf?ua=1 |title=World Health Organization (WHO) Guidelines for the Screening, Care, and Treatment of Persons with Hepatitis C Infection|date=April 2014 |website=World Health Organization|publisher=WHO |accessdate=July 27 2014}}</ref>
Screening for other infections, such as [[HBV]] and [[HIV]], is also indicated when patients are identified as HCV-positive. In some endemic areas and high-risk populations, screening for [[tuberculosis]] ([[TB]]) is also warranted.<ref name=AASLD<ref name=WHO>{{cite web |url=http://apps.who.int/iris/bitstream/10665/111747/1/9789241548755_eng.pdf?ua=1 |title=World Health Organization (WHO) Guidelines for the Screening, Care, and Treatment of Persons with Hepatitis C Infection|date=April 2014 |website=World Health Organization|publisher=WHO |accessdate=July 27, 2014}}</ref>


===Interpretation of Screening Results<ref name=WHO>{{cite web |url=http://apps.who.int/iris/bitstream/10665/111747/1/9789241548755_eng.pdf?ua=1 |title=World Health Organization (WHO) Guidelines for the Screening, Care, and Treatment of Persons with Hepatitis C Infection|date=April 2014 |website=World Health Organization|publisher=WHO |accessdate=July 27 2014}}</ref>===
===Interpretation of Screening Results===
*If anti-HCV test is negative and patients are suspected to have liver disease, a follow-up HCV antibody or HCV RNA is recommended if HCV exposure occurs within 6 months.
*If an anti-HCV test is negative and patients are suspected to have [[liver disease]], a follow-up HCV antibody or HCV RNA test is recommended if HCV exposure occurs within 6 months.<ref name=WHO>{{cite web |url=http://apps.who.int/iris/bitstream/10665/111747/1/9789241548755_eng.pdf?ua=1 |title=World Health Organization (WHO) Guidelines for the Screening, Care, and Treatment of Persons with Hepatitis C Infection|date=April 2014 |website=World Health Organization|publisher=WHO |accessdate=July 27, 2014}}</ref>


*If anti-HCV test is positive but HCV RNA is negative, patients have no evidence of active infection.
*If an anti-HCV test is positive but HCV RNA is negative, patients have no evidence of active infection.<ref name=WHO>{{cite web |url=http://apps.who.int/iris/bitstream/10665/111747/1/9789241548755_eng.pdf?ua=1 |title=World Health Organization (WHO) Guidelines for the Screening, Care, and Treatment of Persons with Hepatitis C Infection|date=April 2014 |website=World Health Organization|publisher=WHO |accessdate=July 27, 2014}}</ref>


*If anti-HCV test is positive and HCV RNA is positive, diagnosis of HCV infection is made. Quantitative HCV RNA should be performed before initiation of antiviral therapy to document baseline levels of viremia. Additionally, HCV genotyping is recommended to guide therapy.
*If an anti-HCV test is positive and HCV RNA is positive, a diagnosis of HCV infection is made. Quantitative HCV RNA tests should be performed before initiation of [[antiviral therapy]] to document baseline levels of [[viremia]]. Additionally, HCV genotyping is recommended to guide therapy.<ref name=WHO>{{cite web |url=http://apps.who.int/iris/bitstream/10665/111747/1/9789241548755_eng.pdf?ua=1 |title=World Health Organization (WHO) Guidelines for the Screening, Care, and Treatment of Persons with Hepatitis C Infection|date=April 2014 |website=World Health Organization|publisher=WHO |accessdate=July 27, 2014}}</ref>


===Frequency of Screening===
===Frequency of Screening===
The frequency of testing in patients is unclear and should be individualized according to frequency of exposure to risk. In patients who are inject drug users or HIV-positive men who have unprotected sex with men, annual screening may be considered.<ref name="pmid24343580">{{cite journal| author=Aberg JA, Gallant JE, Ghanem KG, Emmanuel P, Zingman BS, Horberg MA| title=Primary care guidelines for the management of persons infected with HIV: 2013 update by the HIV Medicine Association of the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2014 | volume= 58 | issue= 1 | pages= 1-10 | pmid=24343580 | doi=10.1093/cid/cit757 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24343580  }} </ref>
The ideal frequency of testing in patients is unclear and should be individualized according to frequency of exposure to risk. In patients who use [[intravenous drug use (recreational)|intravenous drugs]] or [[HIV]]-positive men who have unprotected sex with men, annual screening may be considered.<ref name="pmid24343580">{{cite journal| author=Aberg JA, Gallant JE, Ghanem KG, Emmanuel P, Zingman BS, Horberg MA| title=Primary care guidelines for the management of persons infected with HIV: 2013 update by the HIV Medicine Association of the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2014 | volume= 58 | issue= 1 | pages= 1-10 | pmid=24343580 | doi=10.1093/cid/cit757 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24343580  }} </ref>


==Summary of Screening Recommendations==
==Summary of Screening Recommendations==
===American Association for the Study of Liver Disease (AASLD) - Infectious Diseases Society of America (IDSA) "Recommendations for Testing, Managing, and Treating Hepatitis C": 2014<ref name=WHO>{{cite web |url=http://apps.who.int/iris/bitstream/10665/111747/1/9789241548755_eng.pdf?ua=1 |title=World Health Organization (WHO) Guidelines for the Screening, Care, and Treatment of Persons with Hepatitis C Infection|date=April 2014 |website=World Health Organization|publisher=WHO |accessdate=July 27 2014}}</ref>===
===American Association for the Study of Liver Disease (AASLD) - Infectious Diseases Society of America (IDSA) "Recommendations for Testing, Managing, and Treating Hepatitis C": 2014<ref name=WHO>{{cite web |url=http://apps.who.int/iris/bitstream/10665/111747/1/9789241548755_eng.pdf?ua=1 |title=World Health Organization (WHO) Guidelines for the Screening, Care, and Treatment of Persons with Hepatitis C Infection|date=April 2014 |website=World Health Organization|publisher=WHO |accessdate=July 27, 2014}}</ref>===
According to the AASLD - IDSA recommendations in 2014, the following patients should be screened for HCV:
According to the AASLD - IDSA recommendations in 2014, the following patients should be screened for HCV:
*Persons born between 1945 and 1965
*People born between 1945 and 1965
====Risk Behaviors====
====Risk Behaviors====
*[[Injection-drug use]] (current or ever, including those who injected once)
*[[Injection-drug use]] (current or ever, including those who injected once)
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===World Health Organization "Guidelines for the Screening, Care, and Treatment of Persons with HCV": 2014===
===World Health Organization "Guidelines for the Screening, Care, and Treatment of Persons with HCV": 2014===
Generally, the [[World Health Organization]] (WHO) Guidelines for the Screening, Care, and Treatment of Persons with Hepatitis C Infection<ref name=WHO>{{cite web |url=http://apps.who.int/iris/bitstream/10665/111747/1/9789241548755_eng.pdf?ua=1 |title=World Health Organization (WHO) Guidelines for the Screening, Care, and Treatment of Persons with Hepatitis C Infection|date=April 2014 |website=World Health Organization|publisher=WHO |accessdate=July 27 2014}}</ref> published on April 2014 recommends HCV screening for all persons living in regions of high HCV prevalence with positive history for risk exposure and behavior.
Generally, the [[World Health Organization]] (WHO) Guidelines for the Screening, Care, and Treatment of Persons with Hepatitis C Infection<ref name=WHO>{{cite web |url=http://apps.who.int/iris/bitstream/10665/111747/1/9789241548755_eng.pdf?ua=1 |title=World Health Organization (WHO) Guidelines for the Screening, Care, and Treatment of Persons with Hepatitis C Infection|date=April 2014 |website=World Health Organization|publisher=WHO |accessdate=July 27, 2014}}</ref> published on April 2014 recommends HCV screening for all people living in regions of high HCV prevalence with positive history for risk exposure and behavior.<ref name=WHO>{{cite web |url=http://apps.who.int/iris/bitstream/10665/111747/1/9789241548755_eng.pdf?ua=1 |title=World Health Organization (WHO) Guidelines for the Screening, Care, and Treatment of Persons with Hepatitis C Infection|date=April 2014 |website=World Health Organization|publisher=WHO |accessdate=July 27, 2014}}</ref>


Screening includes:
Screening includes:<ref name=WHO>{{cite web |url=http://apps.who.int/iris/bitstream/10665/111747/1/9789241548755_eng.pdf?ua=1 |title=World Health Organization (WHO) Guidelines for the Screening, Care, and Treatment of Persons with Hepatitis C Infection|date=April 2014 |website=World Health Organization|publisher=WHO |accessdate=July 27, 2014}}</ref>
*Persons who received medical or dental interventions in health-care settings where infection control practices are substandard
*Persons who received medical or dental interventions in health-care settings where infection control practices are substandard
*Persons who received [[blood transfusions]] prior to the time when serological testing of blood donors for HCV was initiated
*Persons who received [[blood transfusions]] prior to the time when serological testing of blood donors for HCV was initiated
*Persons who received [[blood transfusions]] in countries where serological testing of blood donations for HCV is not routinely performed
*Persons who received [[blood transfusions]] in countries where serological testing of blood donations for HCV is not routinely performed
*Persons who inject drugs (PWID)
*Persons who inject drugs (PWID)
*Persons who have had tattoos, body piercings, or scarification procedures done where infection control practices are substandard
*Persons who have had tattoos, body piercings, or scarification procedures are done where infection control practices are substandard
*Persons with [[HIV]] infection
*Persons with [[HIV]] infection
*Persons who have used intranasal drugs
*Persons who have used intranasal drugs
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{{Reflist|2}}
{{Reflist|2}}


[[Category:Hepatitis|C]]
[[Category:Gastroenterology]]
[[Category:Gastroenterology]]
[[Category:FinalQCRequired]]
[[Category:Emergency mdicine]]
[[Category:Disease]]
[[Category:Up-To-Date]]
[[Category:Infectious disease]]
[[Category:Infectious disease]]
[[Category:Disease]]
[[Category:Hepatology]]
{{WH}}
{{WS}}

Latest revision as of 03:34, 11 June 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Yazan Daaboul, Serge Korjian

Overview

People living in regions with high HCV prevalence and who have engaged in high-risk activities should be screened. Screening by serological testing, confirmed by nucleic acid amplification (NAT) for HCV RNA, is required. Additionally, screening for other bloodborne infections, such as HBV and HIV, is required once the diagnosis is made. The ideal frequency of testing in these patients is unclear and should be individualized according to the frequency of exposure to risk.

Screening

Initial Testing

Screening for HCV is performed by HCV serological testing.[1] In patients who test positive, a confirmation for chronic HCV status is required by nucleic acid amplification (NAT) or HCV RNA. HCV RNA may be directly tested in immunocompromised patients or patients who already had spontaneous or treatment-related clearance.[1]

Screening for other infections, such as HBV and HIV, is also indicated when patients are identified as HCV-positive. In some endemic areas and high-risk populations, screening for tuberculosis (TB) is also warranted.[1]

Interpretation of Screening Results

  • If an anti-HCV test is negative and patients are suspected to have liver disease, a follow-up HCV antibody or HCV RNA test is recommended if HCV exposure occurs within 6 months.[1]
  • If an anti-HCV test is positive but HCV RNA is negative, patients have no evidence of active infection.[1]
  • If an anti-HCV test is positive and HCV RNA is positive, a diagnosis of HCV infection is made. Quantitative HCV RNA tests should be performed before initiation of antiviral therapy to document baseline levels of viremia. Additionally, HCV genotyping is recommended to guide therapy.[1]

Frequency of Screening

The ideal frequency of testing in patients is unclear and should be individualized according to frequency of exposure to risk. In patients who use intravenous drugs or HIV-positive men who have unprotected sex with men, annual screening may be considered.[2]

Summary of Screening Recommendations

American Association for the Study of Liver Disease (AASLD) - Infectious Diseases Society of America (IDSA) "Recommendations for Testing, Managing, and Treating Hepatitis C": 2014[1]

According to the AASLD - IDSA recommendations in 2014, the following patients should be screened for HCV:

  • People born between 1945 and 1965

Risk Behaviors

Risk Exposures

  • Long-term hemodialysis (ever)
  • Getting a tattoo in an unregulated setting
  • Healthcare, emergency medical, and public safety workers after needle sticks, sharps, or mucosal exposures to HCV-infected blood
  • Children born to HCV-infected women
  • Prior recipients of transfusions or organ transplants, including persons who:
    • were notified that they received blood from a donor who later tested positive for HCV infection
  • received a transfusion of blood or blood components or underwent an organ transplant before July 1992
  • received clotting factor concentrates produced before 1987
  • were ever incarcerated

Other Medical Conditions

World Health Organization "Guidelines for the Screening, Care, and Treatment of Persons with HCV": 2014

Generally, the World Health Organization (WHO) Guidelines for the Screening, Care, and Treatment of Persons with Hepatitis C Infection[1] published on April 2014 recommends HCV screening for all people living in regions of high HCV prevalence with positive history for risk exposure and behavior.[1]

Screening includes:[1]

  • Persons who received medical or dental interventions in health-care settings where infection control practices are substandard
  • Persons who received blood transfusions prior to the time when serological testing of blood donors for HCV was initiated
  • Persons who received blood transfusions in countries where serological testing of blood donations for HCV is not routinely performed
  • Persons who inject drugs (PWID)
  • Persons who have had tattoos, body piercings, or scarification procedures are done where infection control practices are substandard
  • Persons with HIV infection
  • Persons who have used intranasal drugs
  • Prisoners and previously incarcerated persons

References

  1. 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 "World Health Organization (WHO) Guidelines for the Screening, Care, and Treatment of Persons with Hepatitis C Infection" (PDF). World Health Organization. WHO. April 2014. Retrieved July 27, 2014.
  2. Aberg JA, Gallant JE, Ghanem KG, Emmanuel P, Zingman BS, Horberg MA (2014). "Primary care guidelines for the management of persons infected with HIV: 2013 update by the HIV Medicine Association of the Infectious Diseases Society of America". Clin Infect Dis. 58 (1): 1–10. doi:10.1093/cid/cit757. PMID 24343580.