Researchers say current hep C testing guidelines overlook many cases

Up to a quarter of all cases of hepatitis C virus infection cases may be overlooked due to overly lax federal screening guidelines, a new Clinical Infectious Diseases study suggests.

Current CDC recommendations state that those born between 1945 and 1965 and those with risk factors like injection drug use be tested for the virus at least once. But when Johns Hopkins Hospital's emergency department ran the number of cases it detected using its expanded screening protocol, which tests all adults over 18 for HCV, against federal guidelines, it found nearly a third of those who tested positive were unaware they were infected. These patients would not have been tested had the hospital only followed the federal guidelines.

"Hepatitis C has a very long clinical arc, so if you get infected, you may not have obvious signs of illness for five to 10 years," Thomas C. Quinn, MD, senior study author and professor at the Johns Hopkins University School of medicine, said in a statement. "This is an infection that can now be cured if detected early, rendering people noninfectious and thereby preventing the dire consequences that are associated with the virus. However, we found a large proportion of undocumented, undiagnosed hepatitis C infection in the population attending this ED."

Universal testing is advantageous because many people with risk factors, such as those from injection drug use, don't readily disclose their risk to clinicians, according to the authors. They concluded that had they not expanded their ED guidelines beyond those recommended by the CDC, 51 HCV-positive patients would have gone undocumented. 

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