1998 CDC Risk-Based HCV Screening Recommendations
In 1998, the Centers for Disease Control and Prevention (CDC) issued recommendations for risk-based hepatitis C testing as part of an overall strategy to prevent and control HCV infection and HCV-related disease. These recommendations categorize groups of persons who should undergo routine testing for hepatitis C virus (HCV) infection based on their risk for infection and based on a recognized exposure (Figure 1).
2002 NIH Guidelines for HCV High-Risk Testing
In 2002, the National Institutes of Health (NIH) recommended testing for HCV in persons considered at high risk of acquiring HCV infection (Figure 2).
Limitations of use of Risk-Based HCV Screening Alone
Despite the well-publicized CDC and NIH recommendations for risk-based screening, at least 50% of persons with HCV infection remain unaware of their HCV infection status. In addition, surveys of primary care medical providers revealed that more than 40% were not familiar with the 1998 CDC recommendations for risk-based HCV screening. Further, many persons who only experimented with injection drugs or occasionally used intranasal cocaine do not report this information to their medical provider. Thus, using risk-based screening alone is problematic
Chronic Hepatitis Cohort Study
The Chronic Hepatitis Cohort Study involved 4,689 HCV-infected persons who completed a survey regarding the location and reason for their HCV testing. The study analyzed data from 2006 to 2010 and revealed that 60% of HCV-infected persons had their initial testing ordered at a physician's office and 45% underwent testing because of clinical indications related to liver disease. Fewer than 25% of the HCV-infected had identifiable risk factors for hepatitis C infection that would have prompted testing using the 1998 CDC Risk-Based HCV Screening Recommendations. In contrast, 78% of those identified as HCV-infected were born during the time period of 1945 to 1965. Findings from this study illustrate the limitations for using the 1998 CDC Risk-Based HCV Screening Recommendations.