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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:
• At least annual (or more often, based on risk) testing for HCV antibody for those who have never been exposed to the virus.
• HCV RNA testing for those who were treated or spontaneously cleared HCV infection.
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:
• Substance use disorder treatment programs and needle/syringe exchange programs should offer routine, opt-out HCV antibody testing with reflexive or immediate confirmatory RNA testing and connection to care for those who are infected.
• People who inject drugs should be counseled on measures to reduce risk of HCV transmission to others.
• People who inject drugs should be connected to harm reduction services when available, including needle/syringe service programs and substance use disorder treatment programs.
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:
• Chronically infected people in jail settings should receive counseling about HCV infection and be connected to follow-up community health care for evaluation of liver disease and treatment upon release.
• Chronically infected people in prisons - and those whose jail sentences are sufficiently long enough to complete a total course of antiviral therapy - should receive antiviral therapy according to AASLD/IDSA Guidance while incarcerated. Upon release, these patients should be connected to community healthcare to monitor for HCV-related complications.
• To prevent HCV re-infection and reduce the risk of progression of HCV-associated liver disease, prisons should provide harm reduction and evidence-based treatment for underlying substance use disorders.
• Jails and prisons should facilitate continuation of HCV therapy for individuals on treatment at the time of incarceration.
Visit HCVguidelines.org for more information about these recommendations and to view other sections of the HCV Guidance.
Source: AASLD and IDSA