Hepatitis C Testing and Guidelines

Question 1

Who should be tested for HCV?

Answer 1

Baby boomers
IV drug use
Intranasal illegal drug use
Suspected exposure
HIV infection
Clotting factors before 1987
Dialysis
Tattoo in a sketchy setting
Persistently abnormal ALT or unexplained liver disease
Going to prison
Organ transplant or blood recipient before 1992
Needlestick or mucosal exposure
Children born to HCV positive mothers

Question 2

Initial test for HCV

Answer 2

Antibody test

Question 3

If the HCV Ab test is nonreactive, what happens?

Answer 3

Person doesn’t have HCV, no treatment/further action needed

Question 4

If the HCV Ab test is reactive, what happens?

Answer 4

Test for HCV RNA

Question 5

If HCV RNA isn’t detected, what happens?

Answer 5

No current HCV infection, but further testing is needed

Question 6

If HCV RNA IS detected, what happens?

Answer 6

Patient is currently infected with HCV and treatment is needed

Question 7

HCV treatment goals

Answer 7

Reduce all-cause mortality and liver-related health adverse consequences including end-stage liver disease and hepatocellular carcinoma by keeping SVR as low as possible

Question 8

Goal of HCV treatment with SVR

Answer 8

Get it to an undetectable level in 12 weeks post-treatment

Question 9

Who should be treated for HCV?

Answer 9

All patients with chronic HCV infection except for patients with short life expectancies due to comorbid conditions

Question 10

Highest priority patients to treat for HCV

Answer 10

Advanced fibrosis or compensated cirrhosis
Organ transplant
Type 2 or 3 cryoglobulinemia with end-organ manifestations such as vasculitis
Proteinuria, nephrotic syndrome, or membranoproliferative glomerulonephritis

Question 11

Patients with elevated risk to treat for HCV

Answer 11

MSM
Active illegal IVDU
People in prison
Long-term dialysis
HCV-infected women who want to get pregnant
HCV-infected HCPs who perform exposure-prone procedures

Question 12

Patient-specific treatment considerations for HCV

Answer 12

Previous treatment, degree of liver fibrosis, genomics, comorbidities, co-infection, DDI potential, adherence, access to therapy

Question 13

HCV therapy counseling points

Answer 13

HCV is slowly progressive
Don't donate blood, tissues, organs, semen
Barrier contraception
Breastfeeding isn't contraindicated
Don't share razors or toothbrushes
Universal precautions
Consider needle exchange programs
Avoid IV drug administration
Avoid alcohol