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Physician groups promote CDC guide to HCV testing
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To mark Hepatitis Testing Day on May 19, two physicians’ organizations are directing clinicians to the CDC’s newest guide to hepatitis C virus testing.
The free guide — circulated by the American Academy of HIV Medicine (AAHIVM) and the American College of Physicians and available online — lists the types of patients for whom the CDC recommends testing, as well as resources for HCV information and referrals to specialists.
“We know there is widespread uncertainty out there among providers about whom to test and with what labs, and how to get reimbursed,” Margaret Hoffman-Terry, MD, FACP, AAHIVS, chair of the AAHIVM board of directors and director of the group’s Institute for Hepatitis C, said in a news release. “We hope this new resource will give clinicians the information they need to ramp up testing for hepatitis C. It is imperative that clinicians test indicated patient cohorts, and this guide will help them to do that.”
Among others, the CDC recommends HCV testing for patients who inject or have injected drugs, patients living with HIV, children born to women with HCV, and health care or public safety workers who may have been exposed to the virus.
It also recommends testing for “baby boomers” — those born between 1945 and 1965 — who are five times more likely to be infected as patients of other generations. Clinicians should also evaluate the extent of liver damage in patients with confirmed HCV, according to the CDC.
Patients with a positive HCV antibody test result who have not had confirmatory qualitative polymerase chain reaction (PCR) testing should do so, the guide reads, and quantitative PCR tests can signal viral load. Reflexive testing can determine the genotype and whether patients have HCV that is resistant to drugs.
Among other suggestions, the CDC recommends that all HCV patients be tested for hepatitis B virus, which can be reactivated by HCV treatment.
The guide also provides links to clinicians experienced with HCV, to whom doctors can refer patients, as well as additional information about the virus for both doctors and patients.
Hoffman-Terry said that now is an important time to be vigilant in screening, as baby boomers may begin noticing symptoms.
“Because HCV is usually a mild illness initially, it goes undiagnosed and typically stays quiet in the body for decades until clinical signs and symptoms of advancing disease develop,” she said. “We are in the midst of a perfect storm. We’re only now at the point at which many of those infected through the 1960s to the 1980s are developing symptoms.”
HCV is not usually evident in the general population either, Hoffman-Terry explained.
“Those with newly acquired HCV usually are asymptomatic, with only 20% to 30% developing symptoms within 1 to 3 months after exposure,” she said. “Most HCV–infected people have no symptoms or lab abnormalities with their chronic infection, even though they may be insidiously developing fibrosis, cirrhosis or liver cancer over several decades.”
That is a point clinicians should make to patients, she stressed, along with the appeal of effective medication.
“HCV is now curable with typically 8 to 12 weeks of daily oral medications, which have very few side effects and cure almost everyone who takes them,” she said. “Treatment will prevent possible development of fibrosis, cirrhosis and liver cancer.”
The CDC recently reported that the number of HCV infections nearly tripled in the United States since 2010. More than 2,400 cases were reported in 2015, compared with 850 in 2010. However, they estimated that the true number of HCV infections in 2015 reached about 34,000.
In addition, the agency reported, the incidence of HCV cases in pregnant women at the time of childbirth increased by 89% from 2009 to 2014, from 1.8 to 3.4 cases per 1,000 live births (P < .001). – by Joe Green
References:
Campbell CA, et al. MMWR Morb Mortal Wkly Rep. 2017;66:465-469.
CDC. Guide to Hepatitis C Testing. https://aahivm.org/wp-content/uploads/2017/04/FINAL-HCV-TESTING-GUIDE-PDF-ONLINE-DOWNLOAD-FILE-and-PRINTABLE.pdf. Accessed May 18, 2017.
Patrick SW, et al. MMWR Morb Mortal Wkly Rep. 2017;66:470-473.
Disclosure: Hoffman-Terry is chair of the AAHIVM board of directors and director of the group’s Institute for Hepatitis C. She reports holding speaking engagements for Gilead Sciences and ViiV Healthcare and conducting clinical research for Gilead Sciences, ViiV Healthcare and Merck.