♦ The Centers for Disease Control and Prevention (CDC) and the U.S. Preventive Services Task Force (USPSTF) recommend that adults born during 1945– 1965 should receive one time testing for hepatitis C virus (HCV) without prior ascertainment of HCV risk (Strong Recommendation, Moderate Quality of Evidence).
♦ Full implementation of the hepatitis C testing recommendations in primary care would help identify more individuals with hepatitis C, allowing them to get into care and treatment sooner.

Background and Rationale

High Prevalence of HCV Infection in People Born 1945–1965

Of the estimated 3 million people with chronic hepatitis C in the U.S., 75% were born during 1945–1965. National prevalence data show that people born during these years have a five times higher prevalence of hepatitis C than other adults.

Increasing HCV-Associated Morbidity and Mortality

Hepatitis C is a leading cause of liver transplants and liver cancer. Annual HCV-associated mortality in the U.S. increased more than 50% from 1999 to 2007. People born during 1945–1965 account for 73% of all HCV-associated deaths.

Limited Effectiveness of Current Testing Strategies

About 50% of persons with chronic hepatitis C do not know that they are infected. Testing based solely on elevated alanine aminotransferase (ALT) levels is estimated to miss 50% of chronic infections.

Benefits of HCV Testing and Care

Clinical preventive services including regular medical monitoring, hepatitis A and B vaccination, and behavior changes like alcohol reduction/cessation, and achieving and maintaining a healthy BMI can improve health outcomes for persons with HCV infection.

Benefits of HCV Treatment

New therapies, including interferon-free regimens, can halt disease progression
and provide a virologic cure in most HCV-infected persons. These treatment
options increase the effectiveness and reduce the duration of therapy for many

Resource Implications

Studies of HCV testing of people born from 1945 to 1965, and linking them to care and treatment, have found this strategy to be cost effective. One-time testing is estimated to identify 800,000 infections and, with linkage to care and treatment, to avert more than 120,000 HCV-related deaths and to save $1.5–$7.1 billion in liver-disease-related costs.

Source: Centers for Disease Control and Prevention (CDC). Recommendations for the Identification of Chronic Hepatitis C Virus Infection Among Persons Born During 1945 1965 (MMWR 2012;61(RR04);1-18).

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