There Are New Guidelines for Hep C. Should You Get Tested?
One of the most common infectious diseases in the U.S., the hepatitis C virus is spread by blood and can wreak havoc on your liver. The condition is also highly curable—new medications can snuff out the virus in over 95% of cases. Recently, the U.S. Preventive Services Task Force and the Centers for Disease Control and Prevention released new testing guidelines for the disease, including the recommendation that every adult between 18 to 79 should be screened once in their lifetime. Here’s what you should know about hep C—and what else the new guidelines say.
How Common Is Hepatitis C?
Some 4 million people in the U.S. have been infected with the hepatitis C virus, and these numbers are increasing. Hep C used to be thought of as a problem for baby boomers, but that’s no longer the case. “We’re starting to see more infections in younger people,” says Roger Chou, M.D, director of the Evidence Based Practice Center at Oregon Health & Science University in Portland and lead author of the medical review that informed the new screening guidelines.
Does Everyone With Hep C Get Sick?
When the virus enters your body, it heads straight to the liver. While some people can get rid of an infection without treatment, in most cases the virus sticks around and causes long-term damage to the organ, including scarring, liver failure, and liver cancer, in addition to nonspecific symptoms like fatigue and weight loss. Researchers estimate that 1% of U.S. adults live with chronic hep C infections, many unaware of an infection because symptoms often take years or decades to emerge.
Who’s Most at Risk of Infection?
The hep C virus is transmitted through blood; consequently, one of the most significant risk factors in the U.S. is actively injecting drugs with shared needles or syringes. Even if you don’t use drugs anymore, just one shared needle, many years ago, is enough to cause infection. “The exposure might have been ancient history,” says Michael Barry, M.D., a professor of medicine at Harvard Medical School in Cambridge, MA, and a member of the U.S. Preventive Services Task Force.
But What If I Never Used Drugs?
Just because you never shared needles with someone doesn’t exempt you from getting hep C. There are a number of other risk factors for a hep C infection, including getting tattoos from someone who did not use a sterile needle. Also, doctors only identified the virus in the last few decades, so anyone who had a blood transfusion or organ transplant before July 1992 could have been exposed to the virus, along with people who received clotting factors before 1987, and chronic hemodialysis patients.
Why Does Everyone Need Screening?
Because the disease can be symptomless, the only way to know for sure who has it is through testing. Maybe you picked up the virus from sharing a razor or toothbrush with someone who’s infected, or maybe you got stuck by a needle when you volunteered to clean up a nearby park. If you have it and don’t know it, you run the risk of infecting others. Testing is easy and treatment is highly effective (especially if you catch an infection early), so there’s not much to lose by getting tested.
What About People Under 18 or Over 79?
There’s little evidence available on whether treatments for hep C are effective in children, teenagers, or the elderly. For that reason, the new guidelines don’t suggest the same blanket testing among these age groups. But because the medications work well for large segments of the population, public health experts still recommend that if you’re at high risk of exposure to the virus, particularly from past or current injection drug use, you should be screened for hep C regardless of age.
Should I Get Screened if I’m Pregnant?
Doctors often recommend that pregnant people be tested, even if you are under 18 years old, since the number of hepatitis C infections has doubled in women between the ages of 15 to 44 in recent years. And because mothers can pass hep C on to their infants, “screening at this level may produce benefits for two people,” Dr. Barry says. The test is simple (more on that in the next slide), minimally invasive, and takes virtually no time.
What Does a Hep C Test Involve?
Any primary care doctor can order a hep C screening test. It’s a simple blood test that looks for the presence of an antibody against the virus. Not everyone who has been exposed to the virus will still have an ongoing infection, so if the antibody test is positive, labs will run another test to look for the presence of the virus itself. This second test can be done using the same blood sample, so there’s usually no need to go back.
Why Did Screening Recommendations Change?
A lot of it has to do with the treatment for hep C itself. Only a decade ago, treatment options for the disease weren’t that effective and caused significant side effects. Now, with the development of medications called direct-acting antiviral regimens, treatments for hep C destroy the virus in more than nine out of 10 people. These meds are also easier to tolerate and typically require only 8 to 12 weeks of therapy. “That’s been a really remarkable change,” Dr. Chou says.
Are There Other Reasons for the New Recs?
Yes. A big reason for the re-think is that the number of hep C cases has risen dramatically in recent years, in part due to the opioid epidemic. Public health experts estimate that about one in three people who inject drugs under the age of 30 are infected with hep C, while the majority of older injection drug users are also likely to be infected. These factors convinced infectious disease experts that screening should be widespread and reach a broad age demographic.
Are There Barriers to Hep C Screening?
Despite the recommendation that all adults be screened, less than one in five people is currently tested for the disease, according to several large studies. One issue is access to primary care, particularly for the uninsured. Another has been the reluctance to be labeled in a high-risk group, because people don’t remember or want to admit to experimenting with intravenous drugs. The new guidelines aim to ease the stigma, saying every adult should have access to screening without being questioned as to why they want the test.
Updated Screening Guidelines: U.S. Preventive Services Task Force. (2020). “Hepatitis C Virus Infection in Adolescents and Adults: Screening.” uspreventiveservicestaskforce.org/uspstf/recommendation/hepatitis-c-screening
Evidence Report: JAMA. (2020). “Screening for Hepatitis C Virus Infection in Adolescents and Adults.” jamanetwork.com/journals/jama/fullarticle/2762185
CDC Hep C Guidelines: Centers for Disease Control and Prevention. (2020). “CDC Recommendations for Hepatitis C Screening Among Adults — United States, 2020.” cdc.gov/mmwr/volumes/69/rr/rr6902a1.htm
Prevalence of Hep C: Hepatology. (2018). “Estimating Prevalence of Hepatitis C Virus Infection in the United States, 2013‐2016.” aasldpubs.onlinelibrary.wiley.com/doi/full/10.1002/hep.30297
Direct-acting Antivirals: JAMA. (2019). “Management of Hepatitis C in 2019.” jamanetwork.com/journals/jama/article-abstract/2734262