Hepatitis C

Offer one-time HCV screening to all adults and screen all pregnant patients during each pregnancy, except in settings where HCV prevalence is less than 0.1%. Risk-based testing alone misses a substantial proportion of infections. CDC+1CDCAdvancing Hepatitis C Elimination through Opt-Out Universal Screening and Treatment in Carceral Settings, United States - Volume 30, Supplement—March 2024 - Emerging Infectious Diseases journal - CDCCDCCDC Recommendations for Hepatitis C Screening Among ...

Use an FDA-approved anti-HCV immunoassay as the initial test. A reactive antibody result requires nucleic-acid testing for HCV RNA to establish current infection; treatment decisions should be based on detectable RNA rather than antibody status. clinicalinfo hiv+1clinicalinfo hivHepatitis C Virus Infection: Adult and Adolescent OIs | NIHCDCCDC Recommendations for Hepatitis C Testing Among Perinatally Exposed Infants and Children — United States, 2023 | MMWR

For persons with HIV, perform routine HCV screening at entry into HIV care. Repeat anti-HCV testing at least annually for HCV-seronegative men who have sex with men and persons who inject drugs, or sooner after a compatible exposure, risk activity, or clinical presentation. clinicalinfo hivclinicalinfo hivHepatitis C Virus Infection: Adult and Adolescent OIs | NIH

For occupational exposure, test the exposed health care personnel as soon as possible, preferably within 48 hours, concurrently with source-patient testing. If the source has detectable HCV RNA, link the source patient to evaluation and treatment; CDC guidance incorporates early HCV viral dynamics and treatment of acute infection. CDCCDCGuidelines for Health Care Personnel Exposed to Hepatitis C Virus | Hepatitis C | CDC

Calculate FIB-4 from age, AST, ALT, and platelet count, and consider APRI, which is based on AST and platelets, as accessible blood-based fibrosis assessment. These tests are most useful for identifying advanced disease rather than finely discriminating fibrosis stages; indeterminate results require a second noninvasive modality when it will change management. Wolters Kluwer+1Wolters KluwerRelationship of FIB-4 index with transient elastography in... : Journal of Family Medicine and Primary CareWolters KluwerAPRI and FIB-4 performance to assess liver fibrosis against ... : Journal of Family Medicine and Primary Care

Use vibration-controlled transient elastography, shear-wave elastography, or magnetic resonance elastography when available to refine fibrosis assessment. Transient elastography measures liver stiffness and has reported sensitivity and specificity near 90% for advanced fibrosis in chronic HCV, but obesity and acute hepatitis can impair interpretation. Wolters Kluwer+1Wolters KluwerRelationship of FIB-4 index with transient elastography in... : Journal of Family Medicine and Primary Careclinicalinfo hivHepatitis C Virus Infection

Do not perform liver biopsy solely to stage HCV-related fibrosis in routine care. Reserve biopsy for another diagnostic indication, such as a competing liver disease requiring histology; do not delay antiviral therapy because elastography or additional staging is inaccessible. clinicalinfo hivclinicalinfo hivHepatitis C Virus Infection

Treat fibrosis assessment as a management triage tool: advanced fibrosis or cirrhosis changes the need for cirrhosis-focused evaluation and follow-up, whereas absence of cirrhosis supports a simplified treatment pathway in otherwise eligible patients. HIV infection does not itself preclude simplified treatment, but antiretroviral interactions and specified clinical exclusions require individualized selection. clinicalinfo hiv+1clinicalinfo hivHepatitis C Virus Infectionclinicalinfo hivHepatitis C Virus Infection: Adult and Adolescent OIs | NIH

Treat nonpregnant patients with detectable HCV RNA using oral DAA therapy rather than interferon-based treatment. CDC recommends treatment without waiting for spontaneous resolution, and contemporary oral regimens cure more than 95% of patients within 8-12 weeks. CDCCDCClinical Care of Hepatitis C

Use a pangenotypic, highly efficacious, well-tolerated DAA regimen for most patients, selected through current AASLD/IDSA guidance for the patient’s prior-treatment status and liver disease stage. Two pangenotypic regimens are described as preferred therapy for almost all persons with HIV/HCV coinfection; regimen and monitoring principles are otherwise similar to those for HCV monoinfection. clinicalinfo hiv+1clinicalinfo hivHepatitis C Virus Infectionclinicalinfo hivHepatitis C Virus Infection: Adult and Adolescent OIs | NIH

Do not use ribavirin with interferon or peginterferon for routine HCV treatment; these regimens are no longer recommended because of poor efficacy and high adverse-effect burden compared with DAAs. CDCCDCClinical Care of Hepatitis C

Before prescribing DAAs in HIV/HCV coinfection, screen every antiretroviral regimen for clinically significant interactions. Certain antiretroviral regimens or interaction-prone clinical circumstances exclude simplified treatment, so coordinate any antiretroviral modification with the HIV clinician rather than interrupting effective HIV therapy without a plan. clinicalinfo hivclinicalinfo hivHepatitis C Virus Infection: Adult and Adolescent OIs | NIH

Order quantitative or qualitative HCV RNA 12 weeks after completion of DAA therapy. Undetectable RNA at that point defines sustained virologic response and is the clinical cure endpoint. CDCCDCClinical Care of Hepatitis C

Explain that cure does not prevent reinfection. Reinforce practices that prevent HCV transmission during treatment and reinfection after cure, particularly for patients with ongoing exposure risk; repeat testing should be driven by risk activity or new compatible clinical presentation. CDC+1CDCClinical Care of Hepatitis Cclinicalinfo hivHepatitis C Virus Infection: Adult and Adolescent OIs | NIH

Continue liver-risk modification after cure. Alcohol accelerates HCV-associated liver disease progression, so counsel complete avoidance, especially when fibrosis assessment suggests advanced disease. clinicalinfo hivclinicalinfo hivHepatitis C Virus Infection

DAA-induced HCV eradication is associated with lower risk of all-cause mortality, end-stage liver disease, and hepatocellular carcinoma in observational Medicare data, but patients with advanced fibrosis or cirrhosis require ongoing liver-directed management rather than discharge solely on the basis of SVR. CDCCDCAdvancing Hepatitis C Elimination through Opt-Out Universal Screening and Treatment in Carceral Settings, United States - Volume 30, Supplement—March 2024 - Emerging Infectious Diseases journal - CDC

In HIV/HCV coinfection, noninvasive ultrasound-based or imaging-based elastography is recommended when available, and liver biopsy is not recommended solely for HCV staging. Treating HCV should not be withheld because additional staging is unavailable, but DAA selection must account for antiretroviral interactions. clinicalinfo hiv+1clinicalinfo hivHepatitis C Virus Infectionclinicalinfo hivHepatitis C Virus Infection: Adult and Adolescent OIs | NIH

For perinatally exposed children, CDC recommends HCV RNA NAT to identify current infection, with expert pediatric follow-up for children with detectable RNA at or after age 2 months. Retest RNA before treatment because spontaneous clearance can occur in childhood; DAA therapy may begin at age 3 years. CDCCDCCDC Recommendations for Hepatitis C Testing Among Perinatally Exposed Infants and Children — United States, 2023 | MMWR

For health care personnel after exposure, conduct prompt baseline testing and follow the CDC source-patient and exposed-person algorithm rather than using HCV antibody testing alone to determine current source infectivity. A source with detectable HCV RNA should be referred for evaluation and treatment. CDCCDCGuidelines for Health Care Personnel Exposed to Hepatitis C Virus | Hepatitis C | CDC