Hepatitis C screening

USPSTF2020Grade B

Screen all adults 18 to 79 for HCV, one time. Test with anti-HCV antibody, confirm positives by RNA PCR. Periodic rescreening if ongoing risk (eg, injection drug use). May screen those under 18 or over 79 with high-risk factors.

CDC2020

HCV test all adults 18 and older at least once, and during each pregnancy. Exception: settings with HCV prevalence under 0.1%. Test anyone with ongoing risk periodically regardless of age, and anyone who requests it.

AASLD/IDSA2022Grade Class I, A / IIa, C

Test with HCV antibody plus automatic reflex HCV RNA PCR on the same blood draw (I, A). Beyond one-time testing of all adults and testing in each pregnancy, test annually people who inject drugs, men with HIV who have unprotected sex with men, and men who have sex with men taking HIV PrEP (IIa, C); offer periodic retesting to anyone with ongoing risk.

AASLD/IDSA2023

Simplified treatment for treatment-naive adults without cirrhosis (FIB-4 ≤3.25 and no other evidence of cirrhosis; any genotype; not for HBsAg positive, pregnancy, HCC, or prior transplant): glecaprevir/pibrentasvir 8 weeks with food, or sofosbuvir/velpatasvir 12 weeks. Before starting: CBC, hepatic panel, eGFR, HCV RNA, HIV and HBsAg tests, drug-interaction check. Confirm cure with HCV RNA and hepatic panel 12 or more weeks after therapy.