May 25, 2018
HCVguidelines.org — a website developed by the American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA) to provide up-to-date guidance on the management of hepatitis C (HCV) — has updated several sections of the website to reflect new testing and management recommendations for pregnant women, people who inject drugs, men who have sex with men and people who are incarcerated.
“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. We feel these recommendations are in alignment with the 2016 World Health Organization and National Academies of Sciences, Engineering and Medicine (NASEM) goals of eliminating HCV infection by 2030.”
Universal screening for pregnant women
Drawing from recent studies highlighting a sharp increase of HCV-infected women giving birth in the United States between 2011-2014, and a lack of evidence that risk-factor-based testing is effective in identifying chronic HCV infection, the updated HCV Guidance recommends all pregnant women be tested for HCV infection, ideally at the start of their prenatal care.
By screening all pregnant women at the beginning of prenatal care, physicians will increase opportunities for education and referral and allow early testing and treatment for exposed infants. Treatment of women post-pregnancy will improve the health of women and ultimately prevent future HCV transmission.
Men who have sex with men
Several outbreaks of sexually transmitted HCV infection among HIV-infected men who have sex with men have been reported since 2000. Additionally, HCV incidence is increasing among HIV infected men who have sex with men.
With these things in mind, the Panel has made new recommendations that focus on sexually active adult and adolescent men who have sex with men who are HIV-infected, who are initiating pre-exposure prophylaxis (PrEP) for HIV, or who have been successfully treated or spontaneously cleared HCV infection.
For these men, the Guidance recommends:
People who inject drugs
To address the growing number of cases of HCV infection due to the opioid epidemic, the updated Guidance recommends annual HCV testing for people who inject drugs and have never been tested for the virus. The guidance also recommends annual testing for people who have previously tested negative for the virus but continue to use injection drugs and treatment for those who test positive.
Additionally, the Guidance recommends:
People in correctional institutions
Research has shown that HCV infection disproportionately affects people in correctional institutions. The updated Guidance recommends that jails and prisons should implement opt-out testing for incarcerated individuals.
The Guidance also recommends:
Visit HCVguidelines.org for more information about these recommendations and to view other sections of the HCV Guidance.
AASLD is the leading organization of clinicians and researchers committed to preventing and curing liver disease. The work of our members has laid the foundation for the development of drugs used to treat patients with viral hepatitis. Access to care and support of liver disease research are at the center of AASLD’s advocacy efforts.
Visit aasld.org to view AASLD’s evidence-based practice guidelines and guidances.
The Infectious Diseases Society of America (IDSA) is an organization of physicians, scientists, and other health care professionals dedicated to promoting health through excellence in infectious diseases research, education, prevention, and patient care. The Society, which has over 10,000 members, was founded in 1963 and is based in Arlington, VA. For more information, see idsociety.org.
Visit idsociety.org/HCV/ to access IDSA’s extensive collection of resources on hepatitis C.