Recommendations for Prevention and Control of Hepatitis C Virus (HCV) Infection and HCV-Related Chronic Disease

Rationale

Reducing the burden of HCV infection and HCV-related disease in the United States requires implementation of primary prevention activities that reduce risks for contracting HCV infection and secondary prevention activities that reduce risks for liver and other chronic diseases in HCV-infected persons. In addition, surveillance and evaluation activities are required to determine the effectiveness of prevention programs in reducing incidence of disease, identifying persons infected with HCV, providing appropriate medical follow-up, and promoting healthy lifestyles and behaviors.

Primary prevention activities can reduce or eliminate potential risk for HCV transmission from a) blood, blood components, and plasma derivatives; b) such high-risk activities as injecting-drug use and sex with multiple partners; and c) percutaneous exposures to blood in health care and other (i.e., tattooing and body piercing) settings. Immunization against HCV is not available; therefore, identifying persons at risk but not infected with HCV provides opportunity for counseling on how to reduce their risk for becoming infected.

Secondary prevention activities can reduce risks for chronic disease by identifying HCV-infected persons through diagnostic testing and by providing appropriate medical management and antiviral therapy. Because of the number of persons with chronic HCV infection, identification of these persons must be a major focus of current prevention programs. Identification of persons at risk for HCV infection provides opportunity for testing to determine their infection status, medical evaluation to determine their disease status if infected, and antiviral therapy, if appropriate. Identification also provides infected persons opportunity to obtain information concerning how they can prevent further harm to their liver and prevent transmitting HCV to others.

Factors for consideration when making decisions regarding development and implementation of preventive services for a particular disease include the public health importance of the disease, the availability of appropriate diagnostic tests, and the effectiveness of available preventive and therapeutic interventions. However, identification of persons at risk for HCV infection must take into account not only the benefits but also the limitations and drawbacks associated with such efforts. Hepatitis C is a disease of major public health importance, and suitable and accurate diagnostic tests as well as behavioral and therapeutic interventions are available. Counseling and testing can prevent disease transmission and progression through reducing high-risk practices (e.g., injecting-drug use and alcohol intake). However, the degree to which persons will change their high-risk practices based on knowing their test results is not known, and possible adverse consequences of testing exist, including disclosure of test results to others that might result in disrupted personal relationships and possible discriminatory action (e.g., loss of employment, insurance, and educational opportunities). Antiviral treatment is also available, and treatment guidelines have been developed. Such treatment is beneficial for many patients, although sustained response rates and mode of delivery are currently less than ideal.

Persons at risk for HCV infection who receive health-care services in the public and private sectors should have access to counseling and testing. Facilities that provide counseling and testing should include services or referrals for medical evaluation and management of persons identified as infected with HCV. Priorities for implementing new counseling and testing programs should be based on providing access to persons who are most likely to be infected or who practice high-risk behaviors.