What are the indications for hepatitis C screening on hospital admission?

Indications for Hepatitis C Screening on Hospital Admission

Hepatitis C screening should be performed on hospital admission for high-risk populations including persons with history of injection drug use, recipients of blood transfusions or organ transplants before 1992, hemodialysis patients, HIV-infected individuals, and those with persistently abnormal liver enzymes. 1

High-Risk Groups Requiring Screening

• Current or past injection drug users - This group represents the primary risk factor for HCV transmission in current epidemiology 1, 2
• Recipients of blood transfusions or organ transplants before 1992 - Prior to implementation of donor screening, transfusion-associated HCV was common 1
• Hemodialysis patients - These patients have higher prevalence of HCV infection due to potential exposure during treatment 1
• HIV-infected individuals - Co-infection with HIV accelerates HCV disease progression and increases risk of complications 1
• Persons with hemophilia - Particularly those who received clotting factor concentrates before 1987 1
• Children born to HCV-infected mothers - Vertical transmission is an important route of infection 1
• Healthcare providers after needle stick injury or mucosal exposure to HCV-positive blood - Occupational exposure requires prompt testing 1
• Persons with persistently abnormal liver enzymes - Unexplained liver enzyme elevations may indicate underlying HCV infection 1

Additional Considerations for Hospital-Based Screening

• Birth cohort screening - The CDC recommends one-time screening for all adults born between 1945-1965 (baby boomers) regardless of risk factors, as this population has higher prevalence of undiagnosed HCV 3
• Patients with clinical or biochemical evidence of chronic liver disease - These patients should be screened even if asymptomatic 1
• Sexual contacts of HCV-infected persons - Though sexual transmission is less efficient than bloodborne routes, screening is recommended for current sexual partners of HCV-infected individuals 1

Screening Approach

• Initial testing should use HCV-antibody testing with reflex HCV RNA PCR testing to confirm active infection 3
• For patients with suspected acute infection or immunocompromised status, direct HCV RNA testing may be more appropriate 3
• Confirmatory testing with HCV RNA is essential as antibody tests alone cannot distinguish between resolved and active infection 3

Clinical Implications of Early Detection

• Early identification allows for interventions that can reduce liver injury, including counseling to avoid alcohol misuse 1
• Patients identified through screening can receive immunization against hepatitis A and B to prevent additional liver damage 1
• Timely treatment with current direct-acting antivirals can achieve sustained virologic response in most patients, preventing progression to cirrhosis and hepatocellular carcinoma 1

Common Pitfalls to Avoid

• Relying solely on elevated liver enzymes - Many HCV-infected patients have normal ALT/AST levels 3
• Missing diagnosis in immunocompromised patients - These patients may have delayed or inadequate antibody production 3
• Failure to implement reflex RNA testing - This can lead to patients being lost to follow-up between antibody and confirmatory testing 3
• Overlooking reinfection risk - Using only antibody testing in previously infected patients will miss reinfection 3

Hospital admission provides an important opportunity to identify undiagnosed HCV infection in high-risk populations, potentially improving long-term outcomes through early intervention and treatment.