In the Journals

New HCV guidelines recommend universal testing for all adults

New guidelines from the CDC that were published in MMWR recommend that all adults aged 18 years and older be screened for hepatitis C virus at least once in their lifetime.

The universal testing recommendation comes as “rapid increases in acute HCV infections among young adults, including reproductive-aged persons, have put multiple U.S. generations at risk for chronic HCV infection,” Carolyn Wester, MD, MPH, director of CDC’s Division of Viral Hepatitis, and colleagues wrote. These increases are “concurrent with the nation’s opioid crisis,” they noted.

Screening for HCV has historically focused on patients born between 1945 and 1965 — a birth cohort that, traditionally, has a much higher prevalence of HCV infection.

“The hepatitis C epidemic has changed and so should the nation’s testing guidelines,” Jonathan Mermin, MD, MPH, director of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, said in a news release. “CDC wants all of us to get tested and get cured.”

The guidelines also recommend that all women are screened for the virus during pregnancy. However, the recommendations for screening all adults and all pregnant women do not apply to individuals in settings where the prevalence of HCV infections are below 0.1%.

“To stop hepatitis C, we must radically transform the way we screen for this disease,” Wester told Healio. “We must expand testing to all adults, increase the proportion of hepatitis C diagnoses among people with the disease, and help people to access treatment — which can cure hepatitis C and ultimately prevent further transmission.”

The new recommendations from the CDC align with testing guidelines from the United States Preventive Services Task Force, which also call for screening all U.S. adults for HCV infection.

Results published in MMWR show that millennials accounted for 36.5% of all newly reported HCV infections in 2018, whereas baby boomers accounted for 36.3% of new infections and generation X accounted for 23.1%.

In addition to the guidance that all adults be screened for HCV and the recommendations regarding pregnant women, the CDC’s new HCV screening recommendations call for continued testing of people with known risk factors for, or exposure to, HCV regardless of age or setting. Risk factors for HCV infection include, among other things, HIV infection and injection drug use.

The report also outlines three settings that can be used for testing and prevention services, including comprehensive syringe services programs, substance use disorder programs, including medication-assisted treatment programs, and health care settings like primary care clinics and EDs.

“Simply put, test every adult and all pregnant women during every pregnancy for hepatitis C, and offer access to treatment for people diagnosed with the disease,” Wester said. “CDC recommends that clinicians perform routine periodic testing for people with ongoing risk factors (such as injection drug use).”

Mermin emphasized the fact that HCV infection is now curable.

“The opioid crisis shifted the course of the hepatitis C epidemic in less than a decade,” Mermin said. “There are nearly 1 million Americans with hepatitis C who don’t know they have it. This is a curable disease — no one should have to look back knowing something as simple as a blood test could have changed their life or the life of their loved one.” – by Eamon Dreisbach

Disclosures: The authors and Mermin report no relevant financial disclosures.

Editor’s note: This story was updated on April 14, 2020, to include disclosure information and comments from Wester.

New guidelines from the CDC that were published in MMWR recommend that all adults aged 18 years and older be screened for hepatitis C virus at least once in their lifetime.

The universal testing recommendation comes as “rapid increases in acute HCV infections among young adults, including reproductive-aged persons, have put multiple U.S. generations at risk for chronic HCV infection,” Carolyn Wester, MD, MPH, director of CDC’s Division of Viral Hepatitis, and colleagues wrote. These increases are “concurrent with the nation’s opioid crisis,” they noted.

Screening for HCV has historically focused on patients born between 1945 and 1965 — a birth cohort that, traditionally, has a much higher prevalence of HCV infection.

“The hepatitis C epidemic has changed and so should the nation’s testing guidelines,” Jonathan Mermin, MD, MPH, director of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, said in a news release. “CDC wants all of us to get tested and get cured.”

The guidelines also recommend that all women are screened for the virus during pregnancy. However, the recommendations for screening all adults and all pregnant women do not apply to individuals in settings where the prevalence of HCV infections are below 0.1%.

“To stop hepatitis C, we must radically transform the way we screen for this disease,” Wester told Healio. “We must expand testing to all adults, increase the proportion of hepatitis C diagnoses among people with the disease, and help people to access treatment — which can cure hepatitis C and ultimately prevent further transmission.”

The new recommendations from the CDC align with testing guidelines from the United States Preventive Services Task Force, which also call for screening all U.S. adults for HCV infection.

Results published in MMWR show that millennials accounted for 36.5% of all newly reported HCV infections in 2018, whereas baby boomers accounted for 36.3% of new infections and generation X accounted for 23.1%.

In addition to the guidance that all adults be screened for HCV and the recommendations regarding pregnant women, the CDC’s new HCV screening recommendations call for continued testing of people with known risk factors for, or exposure to, HCV regardless of age or setting. Risk factors for HCV infection include, among other things, HIV infection and injection drug use.

The report also outlines three settings that can be used for testing and prevention services, including comprehensive syringe services programs, substance use disorder programs, including medication-assisted treatment programs, and health care settings like primary care clinics and EDs.

“Simply put, test every adult and all pregnant women during every pregnancy for hepatitis C, and offer access to treatment for people diagnosed with the disease,” Wester said. “CDC recommends that clinicians perform routine periodic testing for people with ongoing risk factors (such as injection drug use).”

Mermin emphasized the fact that HCV infection is now curable.

“The opioid crisis shifted the course of the hepatitis C epidemic in less than a decade,” Mermin said. “There are nearly 1 million Americans with hepatitis C who don’t know they have it. This is a curable disease — no one should have to look back knowing something as simple as a blood test could have changed their life or the life of their loved one.” – by Eamon Dreisbach

Disclosures: The authors and Mermin report no relevant financial disclosures.

Editor’s note: This story was updated on April 14, 2020, to include disclosure information and comments from Wester.