Summary: HCV Testing and Linkage to Care

Recommendations for One-Time Hepatitis C Testing

One-time hepatitis C testing is recommended for persons borna from 1945 through 1965 without prior ascertainment of risk. I, B

Other persons should be screened for HCV infection risk factors. One-time testing should be performed for all persons with behaviors, exposures, and conditions or circumstances associated with an increased risk of HCV infection.

Risk Behaviors

  • Injection-drug use (current or ever, including those who injected only once)
  • Intranasal illicit drug use

Risk Exposures

  • Persons on long-term hemodialysis (ever)
  • Persons with percutaneous/parenteral exposures in an unregulated setting
  • Healthcare, emergency medical, and public safety workers after needle-stick, sharps, or mucosal exposures to HCV-infected blood
  • Children born to HCV-infected women
  • Prior recipients of transfusions or organ transplants, including persons who:
    • Were notified that they received blood from a donor who later tested positive for HCV
    • Received a transfusion of blood or blood components, or underwent an organ transplant before July 1992
    • Received clotting factor concentrates produced before 1987
  • Persons who were ever incarcerated

Other Conditions and Circumstances

  • HIV infection
  • Sexually-active persons about to start pre-exposure prophylaxis (PreP) for HIV
  • Unexplained chronic liver disease and/or chronic hepatitis, including elevated alanine aminotransferase (ALT) levels
  • Solid organ donors (deceased and living)
I, B
a Regardless of country of birth

HCV Testing for Persons With Ongoing Risk Factors

Recommendation for HCV Testing for Persons With Ongoing Risk Factors

Annual HCV testing is recommended for persons who inject drugs and for HIV-infected men who have unprotected sex with men. Periodic testing should be offered to other persons with ongoing risk factors for HCV exposure. IIa, C

Initial HCV Testing and Follow-Up

Recommendations for Initial HCV Testing and Follow-Up

An HCV-antibody test is recommended for initial HCV testing. If the result is positive, current infection should be confirmed by a sensitive HCV-RNA test. I, A
Among persons with a negative HCV-antibody test who are suspected of having liver disease, testing for HCV RNA or follow-up testing for HCV antibody is recommended if exposure to HCV occurred within the past 6 months; testing for HCV RNA can also be considered for persons who are immunocompromised. I, C
Among persons at risk of reinfection after previous spontaneous or treatment-related viral clearance, initial HCV-RNA testing is recommended because an HCV-antibody test is expected to be positive. I, C
Quantitative HCV-RNA testing is recommended prior to initiation of antiviral therapy to document the baseline level of viremia (ie, baseline viral load). I, A
HCV genotype testing is recommended to guide selection of the most appropriate antiviral regimen. I, A
Persons found to have a positive HCV-antibody test and negative results for HCV RNA by polymerase chain reaction (PCR) should be informed that they do not have evidence of current (active) HCV infection. I, A


Counseling Persons With Active HCV Infection

Recommendations for Counseling Persons With Active HCV Infection

Persons with current HCV infection should receive education and interventions aimed at reducing liver disease progression and preventing HCV transmission. IIa, B
Abstinence from alcohol and, when appropriate, interventions to facilitate cessation of alcohol consumption should be advised for all persons with HCV infection. IIa, B
Evaluation for other conditions that may accelerate liver fibrosis, including hepatitis B and HIV infections, is recommended for all persons with active HCV infection. IIb, B
Evaluation for advanced fibrosis using liver biopsy, imaging, and/or noninvasive markers is recommended for all persons with HCV infection to facilitate an appropriate decision regarding HCV treatment strategy, and to determine the need for initiating additional measures for cirrhosis management (eg, hepatocellular carcinoma screening) (see Monitoring section). I, A
Vaccination against hepatitis A and hepatitis B is recommended for all susceptible persons with HCV infection. IIa, C
Vaccination against pneumococcal infection is recommended for all patients with cirrhosis. IIa, C
All persons with HCV infection should be provided education about how to avoid HCV transmission to others. I, C



Linkage to Care

Recommendation for Linkage to Care

All persons with active HCV infection should be linked to a clinician who is prepared to provide comprehensive management. IIa, C


Last update: 
May 24, 2018