Testing and Linkage to Care Box: Summary of Recommendations for Testing and Linkage to Care

Summary of Recommendations for HCV Testing and Linkage to Care


Recommendations for One-time HCV Testing

  • One-time HCV testing is recommended for persons born between 1945 and 1965,* without prior ascertainment of risk.
    Rating: Class I, Level B
  • Other persons should be screened for risk factors for HCV infection, and one-time testing should be performed for all persons with behaviors, exposures, and conditions associated with an increased risk of HCV infection.
  1. Risk behaviors
    • Injection-drug use (current or ever, including those who injected once)
    • Intranasal illicit drug use
  2. Risk exposures
    • Persons on long-term hemodialysis (ever)
    • Persons with percutaneous/parenteral exposures in an unregulated setting
    • Healthcare, emergency medical, and public safety workers after needlesticks, 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
    • Persons who were ever incarcerated


  3. Other considerations
    • HIV infection
    • Sexually active persons about to start pre-exposure prophylaxis (PreP) for HIV
    • Unexplained chronic liver disease and/or chronic hepatitis including elevated alanine aminotransferase levels
    • Solid organ donors (deceased and living)

Rating: Class I, Level B

*Regardless of country of birth


Recommendation for HCV Testing Those with Ongoing Risk Factors

  • Annual HCV testing is recommended for persons who inject drugs and for HIV-seropositive men who have unprotected sex with men. Periodic testing should be offered to other persons with ongoing risk factors for exposure to HCV.
    Rating: Class IIA, Level C 

Recommendations for Follow-up of Initial Testing

  • An anti-HCV test is recommended for HCV testing, and if the result is positive, current infection should be confirmed by a sensitive HCV RNA test.
    Rating: Class I, Level A
  • Among persons with a negative anti-HCV test who are suspected of having liver disease, testing for HCV RNA or follow-up testing for HCV antibody is recommended if exposure to HCV occurred within the past six months; testing for HCV RNA can also be considered in persons who are immunocompromised.
    Rating: Class I, Level C
  • Among persons at risk of reinfection after previous spontaneous or treatment-related viral clearance, initial HCV-RNA testing is recommended because an anti-HCV test is expected to be positive. 
    Rating: Class I, Level C
  • Quantitative HCV-RNA testing is recommended prior to the initiation of antiviral therapy to document the baseline level of viremia (ie, baseline viral load).
    Rating: Class I, Level A
  • Testing for HCV genotype is recommended to guide selection of the most appropriate antiviral regimen.
    Rating: Class I, Level A
  • If found to have positive results for anti-HCV test and negative results for HCV RNA by polymerase chain reaction (PCR), persons should be informed that they do not have evidence of current (active) HCV infection.
    Rating: Class I, Level A 

Recommendations for Counseling Those with Current (Active) HCV Infection

  • Persons with current (active) HCV infection should receive education and interventions aimed at reducing progression of liver disease and preventing transmission of HCV.
    Rating: Class IIa, Level B
  1. Abstinence from alcohol and, when appropriate, interventions to facilitate cessation of alcohol consumption should be advised for all persons with HCV infection.
    Rating: Class IIa, Level B
  2. Evaluation for other conditions that may accelerate liver fibrosis, including HBV and HIV infections, is recommended for all persons with HCV infection.
    Rating: Class IIb, Level B
  3. Evaluation for advanced fibrosis using liver biopsy, imaging, and/or noninvasive markers is recommended for all persons with HCV infection, to facilitate an appropriate decision regarding HCV treatment strategy and to determine the need for initiating additional measures for the management of cirrhosis (eg, hepatocellular carcinoma screening). (see When and in Whom to Initiate HCV Therapy)
    Rating: Class I, Level A
  4. Vaccination against hepatitis A and hepatitis B is recommended for all susceptible persons with HCV infection.
    Rating: Class IIa, Level C
  5. Vaccination against pneumococcal infection is recommended to all patients with cirrhosis. (Marrie, 2011)
    Rating: Class IIa, Level C
  6. All persons with HCV infection should be provided education on how to avoid HCV transmission to others.
    Rating: Class I, Level C


Recommendation for Linkage to Care

  • All persons with current active HCV infection should be linked to a practitioner who is prepared to provide comprehensive management.
    Rating: Class IIa, Level C

Changes made July 6, 2016.

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