Screen All Patients for Hepatitis C

As of April 2020, the Centers for Disease Control and Prevention (CDC) recommends that primary care providers screen all patients 18 years and older at least once in their lifetime for hepatitis C, a liver infection caused by the hepatitis C virus (HCV). Routine periodic testing is also recommended for people with ongoing risk factors.  Chronic HCV infection does not cause symptoms in most people but can lead to cirrhosis and liver cancer.  Without treatment, HCV infection can lead to severe liver disease, liver cancer, and even death. Hepatitis C can be cured; testing is the first step.

Why Test All Your Adult Patients?

• 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.

What are CDC’s Hepatitis C Screening Recommendations?

All patients 18 years and older should be screened for hepatitis C at least once in their lifetime, except in settings where the prevalence of HCV infection (HCV RNA-positivity) is <0.1%.[i]

Patients with recognized exposures (such as use of injection drugs) should be tested for hepatitis C regardless of age or setting prevalence, and regular periodic testing should continue as long as risk persists.

Additional Resources

• CDC Recommendations for Hepatitis C Screening Among Adults — United States, 2020
• Overview of Viral Hepatitis for Health Care Professionals
• Algorithm for testing and follow-up of HCV-exposed healthcare personnel [PDF – 2 pages]
• Interpretation of Results of Tests for Hepatitis C Virus (HCV) Infection and Further Actions [PDF – 1 page]
• Recommended Testing Sequence for Identifying Current Hepatitis C Virus (HCV) Infection [PDF – 1 page]
• Hepatitis C Virus in Pregnancy: Are We Ready for Test and Treat?
• University of Washington Hepatitis C Online—up-to-date comprehensive educational website (offers CMEs) for diagnosing, monitoring, and managing HCV infection.
• CDC’s Know More Hepatitis website—resources to help educate your pregnant patients about hepatitis C.

[i] Breastfeeding is not considered a route of transmission if nipples are not cracked and bleeding.