From the Guidelines
Hepatitis C (HCV) viral load testing is not part of standard Sexually Transmitted Infection (STI) screening, but rather is recommended for individuals with specific risk factors or clinical indications.
Key Risk Factors for HCV Infection
- Persons who have injected illicit drugs
- Persons with HIV infection
- Persons who have ever been on hemodialysis
- Persons with hemophilia who received clotting factor concentrates prior to 1987
- Persons who have received blood/blood products transfusions or organ transplants prior to screening program
- Children born to HCV-infected mothers
- Health care providers after a needle stick injury or mucosal exposure to HCV positive blood
- Current sexual partners of HCV-infected persons, although the prevalence of infection is low 1
HCV Screening Recommendations
The Centers for Disease Control and Prevention (CDC) recommends one-time testing without prior ascertainment of HCV risk for persons born during 1945–1965, a population with a disproportionately high prevalence of HCV infection and related disease 1.
Clinical Practice Guidelines
The American Gastroenterological Association recommends diagnostic testing for HCV infection among high-risk groups, including injection drug users, persons who received a transfusion before 1992, and persons with hemophilia who received clotting factors before 1987 1. In clinical practice, HCV viral load testing is primarily used for monitoring active Hepatitis C infection, rather than as a standard component of STI screening 1.
From the Research
Hepatitis C Viral Load Testing in STI Screening
- Hepatitis C viral load testing is not typically part of standard Sexually Transmitted Infection (STI) screening, but rather used for monitoring active Hepatitis C (HCV) infection 2.
- However, some studies suggest that routine HCV antibody testing should be introduced for certain high-risk groups, such as men who have sex with men (MSM) with a human immunodeficiency virus (HIV)-positive or unknown status, as it can result in earlier detection of HCV infection 3.
- The Centers for Disease Control and Prevention (CDC) recommends HCV testing for individuals with certain risk factors, including those with a history of injecting drugs, receiving a blood transfusion before 1992, or being born to an HCV-positive mother 4.
- In some cases, HCV testing and linkage to care have been integrated into STI clinics, with essential resources including reflex HCV RNA testing and a dedicated bridge counselor to provide test results and linkage-to-care assistance 5.
Monitoring Active Hepatitis C Infection
- Viral load measurements are clinically useful in predicting sustained virological response and lack of sustained virological response to treatment in individuals with chronic HCV infection on antiviral therapy 6.
- Absolute viral load and log decline in viral load from baseline can be used to predict treatment outcomes, with decision thresholds providing negative predictive values of >95% at certain time points 6.
- Early changes in viral load can be highly predictive of treatment outcomes, and can provide encouragement to patients who are in the early phases of treatment when side effects are frequent 6.