Guidelines for the management of hepatitis C virus (HCV) infection have been updated to include testing and treatment recommendations for pregnant women, men who have sex with men (MSM), individuals who inject drugs and people who are incarcerated. The guidelines were developed by the American Association for the Study of Liver Diseases and the Infectious Diseases Society of America.
“Today, hepatitis C is curable for over 95 percent of people who undergo treatment,” explain HCV Guidance Co-Chairs, Marc G. Ghany, MD, MHSc; Arthur Y. Kim, MD; Kristen M. Marks, MD; and Hugo E. Vargas, MD. “With the success of HCV treatments, the medical community must now shift our focus toward eliminating HCV as a public health problem. As a first step, our Panel has made new recommendations to re-emphasize the importance of testing key populations and treating virtually all patients with the virus.”
The updated recommendations include:
- Universal screening for pregnant women, ideally at the start of prenatal care
- For MSM infected with HIV or initiating pre-exposure prophylaxis for HIV, annual testing for HCV antibody (or more often based on risk) for those who have never been exposed to HCV and HCV RNA testing for those who have been successfully treated or spontaneously cleared HCV infection
- Annual HCV testing for people who inject drugs and have never been tested for HCV as well as for people who have previously tested negative but continue to use injection drugs; those who test positive should be treated
- Substance use disorder treatment programs and needle/syringe exchange programs should offer routine, opt-out HCV antibody testing with reflexive or immediate confirmatory RNA testing and connection to care for those who are infected
- Counseling and connection to harm reduction services for people who inject drugs to reduce the risk of HCV transmission
- Jails/prisons should implement opt-out testing for incarcerated indivduals
- In jail settings, chronically infected individuals should receive counseling and be connected to follow-up care for evaluation of liver disease and treatment upon release
- For those with jail sentences sufficiently long enough to complete antiviral therapy, individuals should receive treatment while incarcerated with connection to community care upon release to monitor for HCV-related complications
- Prisons should provide harm reduction and treatment for underlying substance use disorders in order to prevent the risk of re-infection and reduce the risk of HCV-associated liver disease progression
- Jails/prisons should facilitate continuation of treatment for those on HCV therapy at the time of incarceration
The entire HCV guidance can be found here.