How often should one be tested for Hep C?

[iana5252]

How often should one be testing for it. Are there guidelines to suggest the optimal frequency of testing? We test at baseline and in "high risk patients" (in quotations, because this is so subjective, on an annual basis), but is there a better set of guidelines to follow somewhere? -- From Joshua on Facebook

Question was posted after reading this story...
HCV Testing, Diagnosis Being Overlooked in People With HIV
http://www.hepmag.com/articles/hiv_hepatitis_diagnosis_2501_22128.shtml

[Tim Horn]

Joshua:

At present, the CDC -- in collaboration with the American Association for the Study of Liver Diseases (AASLD) -- recommends hepatitis C testing only for those considered to be at risk for HCV infection. According to AASLD guidelines, "at risk" is defined as:

● Persons who have injected illicit drugs in the recent and remote past, including those who injected only once and do not consider themselves to be drug users.
● Persons with conditions associated with a high prevalence of HCV infection
including:
● Persons with HIV infection
● Persons with hemophilia who received clotting factor concentrates prior to 1987
● Persons who have ever been on hemodialysis
● Persons with unexplained abnormal aminotransferase levels
● Prior recipients of transfusions or organ transplants prior to July 1992 including:
● Persons who were notified that they had received blood from a donor who later tested positive for HCV infection
● Persons who received a transfusion of blood or blood products
● Persons who received an organ transplant
● Children born to HCV-infected mothers
● Health care, emergency medical and public safety workers after a needle stick injury or mucosal exposure to HCV-positive blood
● Current sexual partners of HCV-infected persons

But here's the problem: Given that a huge percentage (75 percent) of people living with hepatitis C don't know it, were likely infected decades ago (two thirds of people living with the virus are baby boomers and infected in the 60s, 70s or 80s) and wouldn't think to discuss often isolated behaviors of their distant past with their current health care providers (especially if they don't have any obvious symptoms) -- a lot of folks are falling through the current testing recommendation cracks.

Of interest, then, are two recent studies:

http://www.hepmag.com/articles/One_Time_Screening_2501_22124.shtml
http://www.hepmag.com/articles/universal_hcv_testing_2501_21438.shtml


Whether or not the CDC follows these study conclusions isn't clear, but it is expected that expanded testing will be recommended as plans in support of the National Viral Hepatitis Action Plan are rolled out (in conjunction with health care reform).

The issue of frequency hasn't been addressed, but future recommendations may end up calling for one antibody test as a component of routine medical care for all people within a specified age bracket with, perhaps, annual or semi-annual testing recommended for those who continue to engage in high-risk activities.

Tim Horn

 

[Altmed]

The frequency of testing would depend on weather for screening or ongoing care.

There are MANY of us who, when we were young, were given injections with glass, reusable syringes that had reusable needles that were sharpened, usually by nurses. How many of us had surgeries where we were given blood before 1992? (AND after, as hepatitis testing was VERY expensive in those days, and there were MANY reports of hospitals getting tainted blood from prison populations after 1992, some that even made the news back then.)

Then add the dentists using non-disposable, not properly sterilized equipment, endoscopy equipment not being properly sterilized and so on.

Add those sharing needles for abusing drugs, sharing toenail clippers and all the other possible routes of potentially catching this virus, and everyone should be screened on a regular basis.

If we could get at least a screening added to basic chem panels usually done annually (along with HSV and perhaps other viral antibody testing), I think a lot more cases would be caught, treated early on and much suffering avoided.

I had asked for testing when I was in my 20's and my doctor ignored me, despite my having a "fatty liver" & elevated enzymes at the time. He figured I was a college student & therefore must be drinking too much, and to "cut back on the alcohol".

Ironically, I never was a "drinker", as I never tolerated alcohol well at all when I tried it several times. I felt awful after, and never liked how it made me feel, and although I had few drinks in my lifetime, that doctor, and a couple of others over the years, ignored my request to be tested, even after vomiting for a year with blood in my stools occasionally since childhood, very light colored, almost white stools at other times.

Years later with nerve damage, RA and on a test by a very through rheumatologist, sure enough I'm positive.

It would be nice to have nation-wide screening, both young and old, as there were kids born to my generation as well, and while the transmission rate in birth is low, a chance of exposure still exists. I imagine chances go way up if a mother tears or has an episiotomy and bleeds or worse, hemorrhages during birth, or has a C-Section.
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As for those that are HCV positive, obviously one has been through at least a screening and should have a PCR test for typing and a viral load, biopsy, as well as having an endoscopy and colonoscopy with portal pressures tested before starting any treatment, then labs at 2 week intervals for at least 12 weeks while on treatment, then follow-ups after that.
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I'm sure testing protocols will change as treatments change, yet my hope is that HCV testing will become part of an annual physical, along with other screening tests. There is no excuse not to, as the cost of treatment is expensive, and there is no price you can put on human suffering, families and friends taking what little time they have these days to take care of a sick relative or friend, assuming they even can.

The only reason I can see for resistance to this is that it may be another hospital,medical procedure or dental source that would have to be dealt with and might be embarrassing to the health care community.

At any rate, the sources for the transmission of this virus need to be tracked down, and treatment needs to be done sooner than 10, 20 or 30+ years later.