New US guidelines on hepatitis C testing and counselling

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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

Glossary

interferon alfa

A natural protein produced by the human body in response to infection. Manufactured interferon alfa is a treatment against hepatitis B, hepatitis C, genital warts and some cancers. See also ‘pegylated interferon’ – this is the form of the most commonly used drug.

alanine aminotransferase (ALT)

An enzyme found primarily in the liver. Alanine aminotransferase may be measured as part of a liver function test. Abnormally high blood levels of ALT are a sign of liver inflammation or damage from infection or drugs.

hepatitis A virus (HAV)

The hepatitis A virus is transmitted through contaminated food and water, as well as human faeces. It can be passed on during sex, particularly rimming (oral-anal contact). Symptoms usually last less than two months, although they continue in some people for up to six months. Drug treatment is not needed. A vaccine is available to prevent hepatitis A.

 

fibrosis

Thickening and scarring of connective tissue. Often refers to fibrosis of the liver, which can be caused by an inflammatory reaction to long-term hepatitis infection. See also ‘cirrhosis’, which is more severe scarring.

ribonucleic acid (RNA)

The chemical structure that carries genetic instructions for protein synthesis. Although DNA is the primary genetic material of cells, RNA is the genetic material for some viruses like HIV.

 

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).

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