Clinical and cost effective testing for HCV
Recommendations for who should be tested or offered a test for HCV and an overview of the supporting evidence.
Clinical and cost-effective testing for HCV
National and international guidelines recommend that individuals who have an excess risk of being infected and might benefit from knowing their HCV status should be offered an HCV test. 5, 11-13 This recommendation is based primarily on the need to diagnose an often silent infection, allowing the initiation of prompt antiviral treatment if appropriate. 14 Since treatment cannot be offered unless a diagnosis of chronic HCV infection is made, the offering, and uptake, of testing among populations at risk of HCV will convey a degree of clinical benefit. 4
Further benefits of diagnosing people infected with HCV include the opportunity to convey information aimed at slowing the rate of HCV disease progression (such as advice about the dangers of excess alcohol consumption) and reducing the chances of infection being transmitted to others. No robust, consistent evidence to indicate the effectiveness of these interventions was identified.
UK guidelines consistently recommend that people who may convey an HCV risk to patients in the healthcare setting should undergo HCV testing. 5, 11-13 Several instances of healthcare worker to patient and blood/organ donor to recipient transmission of HCV have been recorded. 15, 16 4
Controlled trials or cohort studies to gauge the cost effectiveness of offering an HCV test to different population groups have not been undertaken. Limited evidence from economic modelling work, indicates that offering an HCV test to former injecting drug users in drug treatment and perhaps other settings would convey cost-effective clinical benefits. 17 Former IDU are more likely to have a higher prevalence of HCV and comply with therapy than current IDU. Models of best practice for the identification and testing of former IDU have not been developed and evaluated. Expert opinion suggests that general practices, particularly those that serve areas with a high prevalence of drug use, may constitute environments where focused, well supported testing initiatives might be successful. Prisons may also offer similar opportunities. 18 Targeted and generalised HCV awareness/testing campaigns have been conducted but no evaluations of their success in encouraging people (including former IDU) at high risk of HCV to engage with services have been reported. 4
In populations where the prevalence of HCV is low (eg genitourinary medicine clinic attendees), economic modelling indicates that universal testing does not convey cost-effective clinical benefit. 17 4
The following groups should be tested for HCV:
- blood/tissue donors
- patients on haemodialysis
- healthcare workers who intend to pursue a career in a specialty that requires them to perform exposure prone procedures.
The following groups should be offered an HCV test:
- patients with an otherwise unexplained persistently elevated alanine aminotransferase
- people with a history of injecting drug use
- people who are human immunodeficiency virus (HIV) positive
- recipients of blood clotting factor concentrates prior to 1987
- recipients of blood and blood components before September 1991 and organ/tissue transplants in the UK before 1992
- children whose mother is known to be infected with HCV
- healthcare workers following percutaneous or mucous membrane exposure to blood which is, or is suspected to be, infected with HCV
- people who have received medical or dental treatment in countries where HCV is common and infection control may be poor
- people who have had tattoos or body piercing in circumstances where infection control procedure is, or is suspected to be, suboptimal
- people who have had a sexual partner/household contact who is HCV infected.
