New US guidelines recommend screening of all adults for hepatitis C

Simplified treatment initiation recommended for the majority of people with hepatitis C

Keith Alcorn
Published:
12 December 2019

All adults in the United States should be screened for hepatitis C by healthcare providers as part of routine medical care, updated guidelines from the American Association for the Study of Liver Diseases and the Infectious Diseases Society of America recommend.

“Our Panel has always recommended screening high-risk populations, but several studies now demonstrate that routine, one-time HCV [hepatitis C virus] testing among all adults in the U.S. would likely identify a substantial number of HCV cases that are currently being missed, and that doing so would be cost-effective. This is why we now recommend universal screening of adults,” said HCV Guidance Co-Chairs, Drs Marc G. Ghany, Kristen M. Marks, Timothy R. Morgan, and David L. Wyles.

“The good news is that once new HCV cases are identified, there are safe and effective treatments that can cure more than 95% of people. We believe that the improved testing and treatment strategies described in the Guidance will bring us closer to achieving the World Health Organization’s goal of eliminating HCV infection as a public health threat by 2030,” they added.

Glossary

compensated cirrhosis

The earlier stage of cirrhosis, during which the liver is damaged but still able to perform most of its functions. See also ‘cirrhosis’ and ‘decompensated cirrhosis’.

US Preventive Services Taskforce guidance recommends one-time screening of all adults born between 1945 and 1965 and screening of all people with high risks for acquiring hepatitis C, including anyone who received a blood transfusion prior to 1992, and anyone with a history of injecting drugs.

The new guidelines also recommend repeat testing for people with behaviours, exposures or conditions associated with an increased risk of hepatitis C, and annual testing for people who inject drugs and for men who have condomless sex with men.

The new US guidelines also follow guidance issued in France earlier this year, recommending a simplified treatment protocol for people with hepatitis C who do not have cirrhosis. The new recommendation is designed to encourage primary care physicians to initiate treatment in previously untreated non-complicated patients.

“Simplification of the treatment regimen may expand the number of healthcare professionals who prescribe antiviral therapy and increase the number of persons treated,” the new guidance states.

People with cirrhosis, chronic kidney disease, HIV or hepatitis B co-infection and pregnant women should be treated by a liver specialist, as should people with a previous history of hepatitis C treatment.

The guidelines recommend two regimens, either glecaprevir/pibrentasvir (Maviret) or sofosbuvir/velpatasvir (Epclusa) as suitable for all patients.

For patients with compensated cirrhosis (Child-Pugh A, FIB-4 score > 3.25) and no complicating factors (such as HIV, pregnancy, chronic kidney disease or a previous history of hepatitis C treatment), an eight-week course of treatment with glecaprevir/pibrentasvir (Maviret) can be initiated by any physician. No genotyping is needed before starting treatment with glecaprevir/pibrentasvir.

As an alternative, people with genotypes 1, 2, 4, 5, or 6 can undergo a 12-week course of treatment with sofosbuvir/velpatasvir (Epclusa)

For people who have recently acquired hepatitis C – acute infection – the guidelines have been updated to recommend immediate treatment. Previous guidance counselled physicians to wait and see whether patients cleared the virus spontaneously. The new guidance recommends immediate treatment to avoid further HCV transmission.

Further information