Testing Recommendations for Hepatitis C Virus Infection

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CDC Recommendations for Hepatitis C Screening Among Adults in the United States

  • Universal hepatitis C screening:
    • Hepatitis C screening at least once in a lifetime for all adults aged 18 years and older, except in settings where the prevalence of HCV infection (HCV RNA‑positivity) is less than 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 less than 0.1%*
  • One‑time hepatitis C testing regardless of age or setting prevalence among people with recognized conditions or exposures:
    • People with HIV
    • People 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
    • People with selected medical conditions, including:
      • people who ever received maintenance hemodialysis
      • people with persistently abnormal ALT levels
    • Prior recipients of transfusions or organ transplants, including:
      • people who received clotting factor concentrates produced before 1987
      • people who received a transfusion of blood or blood components before July 1992
      • people who received an organ transplant before July 1992
      • people 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 [PDF – 177 KB]
    • Children born to mothers with HCV infection
  • Routine periodic testing for people with ongoing risk factors, while risk factors persist:
    • People who currently inject drugs and share needles, syringes, or other drug preparation equipment
    • People with selected medical conditions, including:
      • people who ever received maintenance hemodialysis
  • Any person who requests hepatitis C testing should receive it, regardless of disclosure of risk, because many persons may be reluctant to disclose stigmatizing risks
*Determining prevalence: In the absence of existing data for hepatitis C prevalence, health care providers should initiate universal hepatitis C screening until they establish that the prevalence of HCV RNA positivity in their population is less than 0.1%, at which point universal screening is no longer explicitly recommended but may occur at the provider’s discretion.
Source: CDC Recommendations for Hepatitis C Screening Among Adults – United States, 2020
MMWR 2020 (RR 69)

Operational Guidance for Complete Hepatitis C Testing

CDC recommends that all samples needed to diagnose hepatitis C be collected in a single visit and HCV RNA testing be performed automatically when the HCV antibody is reactive.

“Automatic” testing happens in the laboratory without additional action on the part of the patient or the healthcare provider.

Automatic testing is critical to increase the number of people diagnosed with current HCV infection who can then be linked to care and curative antiviral therapy.  See complete Updated Operational Guidance for Implementing CDC’s Recommendations on Testing for HCV Infection.

Testing Sequence

Hepatitis C testing should be initiated with a Food and Drug Administration (FDA)‑approved anti‑HCV test. People testing anti‑HCV positive/reactive should be automatically tested with an FDA‑approved nucleic acid test (NAT) for detection of HCV RNA. See complete Recommended Testing Sequence for Identifying Current Hepatitis C Virus (HCV) Infection. People testing anti-HCV positive/reactive and have detectable HCV RNA have current HCV infection and should be linked to care.

USPSTF Recommendations

U.S. Preventive Services Task Force – Screening for Hepatitis C Virus Infection
The USPSTF recommends screening for hepatitis C virus (HCV) infection in adults aged 18 to 79 years. Grade: B Recommendation.

Resources

CDC recommends testing all adult patients for hepatitis C.

Hepatitis C Campaign for Health Care Providers