New US guidelines on hepatitis C testing and counselling

The US Centers for Disease Control have published expert

guidelines on hepatitis C testing and counselling, with the warning that

approximately 3.9 million Americans are already infected. Research published in

1994 by Dr Graham Alexander of Addenbrooke’s Hospital, Cambridge, suggested a UK

prevalence of 1.2 million (Journal of Hepatology 20 p768).

The guidelines can be downloaded from:

href="http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/00055154.htm">http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/00055154.htm

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Summary

Routine Hepatitis C testing is recommended for:

Persons who have ever injected drugs, even if they only ever injected once,

many years ago

Anyone who received a blood transfusion before 1992

Anyone who received an organ transplant before 1992

Anyone who received clotting factor concentrates produced before 1987

Anyone with persistently abnormal ALT levels

Anyone who has undergone long-term hemodialysis

Children born to HCV+ women

Professionals exposed to HCV-positive blood

Routine testing is not currently recommended for:

Persons with a history of tattooing or body-piercing

People with a history of multiple sex partners

Recipients of tissue transfers, corneal transplants

Sexual partners of HCV+ diagnosed people

Although interferon alpha manufacturer Schering-Plough has taken out full

page adverts in US newspapers giving the impression that anyone who has been

tattooed, had an ear pierced, shared a razor or toothbrush or ever snorted

cocaine is at risk of infection, the CDC states that there is no current

evidence to suggest that these are transmission routes.

The guidelines also contain detailed discussion of which tests should be

used, and the advice which should be given to people diagnosed HCV+ about the

avoidance of alcohol, vaccination against hepatitis A, the need for vigilance

against drug reactions and the risks of HCV transmission.

Treatment is currently recommended in the US for anyone with persistently

elevated ALT levels, detectable HCV RNA and a liver biopsy indicating either

portal or bridging fibrosis with moderate degrees of inflammation and necrosis.

However, the guidelines do not recommend what treatment should be utilised, and

acknowledge that 1997 US recommendations may now have been superseded by the

results of the International Hepatitis Interventional Therapy Group study of

interferon alpha 2b/ribavirin combination therapy (T Poynard et al, The Lancet

October 31, 1998; unavailable to non-subscribers on-line).