Screening for chronic hepatitis C virus infection
- Norah A Terrault, MD, MPH
Norah A Terrault, MD, MPH
- Professor of Medicine
- University of California San Francisco
- Sanjiv Chopra, MD, MACP
Sanjiv Chopra, MD, MACP
- Editor-in-Chief — Gastroenterology/Hepatology
- Section Editor — General Hepatology; Gallbladder and Biliary Tract Disease
- Professor of Medicine
- Harvard Medical School
- Senior Consultant in Hepatology
- James Tullis Firm Chief
- Beth Israel Deaconess Medical Center
Screening for hepatitis C virus (HCV) infection is an important component of successful control of HCV for the infected individual and for public health purposes. Screening strategies are recommended by various expert and public health organizations worldwide.
This topic will review the rationale behind screening for HCV infection in addition to recommendations on whom and how to screen.
Tests and algorithms used for the diagnosis and evaluation of HCV infection are discussed in detail elsewhere. (See "Diagnosis and evaluation of chronic hepatitis C virus infection".)
Other issues related to HCV infection are also discussed in detail elsewhere. (See "Epidemiology and transmission of hepatitis C virus infection" and "Clinical manifestations and natural history of chronic hepatitis C virus infection" and "Overview of the management of chronic hepatitis C virus infection".)
RATIONALE FOR SCREENING
HCV infection is a global health problem that can progress to cirrhosis and end stage liver disease in a substantial proportion of patients. In resource-rich settings, increasingly effective and better tolerated agents are becoming available to treat infection and reduce complications. However, because it is frequently asymptomatic, many individuals do not know they have chronic HCV infection (see "Clinical manifestations and natural history of chronic hepatitis C virus infection"). As an example, in the United States, an estimated 50 percent of individuals with chronic HCV infection are unaware of their diagnosis . Failure to identify infected individuals is a major bottleneck to linkage to care and successful control of HCV . Thus, screening asymptomatic patients who may have an increased likelihood of being infected with HCV is an important step toward improving the detection and ultimately treatment of infected individuals.
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- RATIONALE FOR SCREENING
- Benefit of early detection
- Risk for exposure
- Elevated transaminases
- High-prevalence groups
- - 1945 to 1965 birth cohort
- - HIV-infected individuals
- - Dialysis patients
- - Incarcerated individuals
- PATIENT SELECTION
- Our approach
- Recommendations from expert groups in the United States
- - Centers for Disease Control and Prevention
- - AASLD/IDSA
- - United States Preventive Services Task Force
- - National Institutes of Health
- Recommendations from groups outside of the United States
- SCREENING METHOD
- SCREENING FREQUENCY
- BLOOD DONOR SCREENING
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS