HCV Screening, Transmission, and Treatment: A Test

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Welcome to the next edition in our ongoing series of Hepatitis C Quizzes. This month's questions cover mother-to-child transmission, screening of baby boomers, testing populations at risk, what sex partners of men with hepatitis C virus (HCV) need to know, and optimal treatment regimens for patients with decompensated cirrhosis.

What's your HCV IQ?

Question 1.

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Answer: C. Control of HIV coinfection

MCTC of HCV occurs in up to 15% of cases, and up to 5% of those progress to chronic infection, according to the American Association for the Study of Liver Diseases and the Infectious Diseases Society of America HCV guidelines. Antiviral treatment and mode of delivery have not been shown to reduce transmission. In contrast, women with well-controlled HIV disease may have lower rates of HCV MTCT than reported in other coinfected populations, according to an analysis by Checa Cabot and colleagues. The guidelines advise against fetal scalp monitors and forceps delivery due to the potential associated risk of MTCT.

Question 2.

A 35-year-old heterosexual male is diagnosed with HCV. He is otherwise healthy and reports no sexual partners other than his wife of 10 years.

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Answer: A. Discuss transmission risk with partner

According to guidelines from the Centers for Disease Control and Prevention (CDC), there is no need for individuals with HCV infection who have one steady, long-term sex partner to change sexual practices. However, they should discuss the low risk of transmission and need for testing with their partner. The guidelines further state that condom use may not be needed in heterosexual couples since incident HCV has not been demonstrated in such couples followed over time.

Question 3.

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Answer: A. Less than 15%

In 2012, the CDC recommended a one-time HCV screening for individuals born between 1945 and 1965 (baby boomers) due to the high prevalence of infection in that group. Soon after, the US Preventive Services Task Force issued a similar recommendation. Despite the clear guidance, only 11.5% to 12.8% of baby boomers report ever having a blood test for HCV, according to a recent analysis of data from the 2013-2015 National Health Interview Surveys years 2013-2015. Statistical analysis showed that the prevalence of HCV screening was improving modestly over time, suggesting substantial room for improvement.

Question 4. 

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Answer: C. Injection drug use once or twice, years ago

HCV testing is of uncertain need in recipients of transplanted tissue, intranasal cocaine users, persons with a history of tattooing or body piercing, and persons with a history of multiple sex partners or sexually transmitted diseases, according to the CDC testing guidelines. In contrast, HCV testing is recommended for all individuals who have ever reported injecting drugs, even if they injected very infrequently in the distant past.

Question 5.

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Answer: D. Ledipasvir/sofosbuvir + ribavirin

A 12-week course of ledipasvir/sofosbuvir and ribavirin is appropriate for patients with decompensated cirrhosis and HCV genotype 1 or 4 infection, according to current AASLD/IDSA  treatment guidelines. In contrast, paritaprevir/ritonavir/ombitasvir ± dasabuvir is contraindicated in patients with decompensated cirrhosis due to potential hepatotoxicity.

Glecaprevir/pibrentasvir has not been studied in these patients and is not recommended until further data are available. Likewise, sofosbuvir/velpatasvir/voxilaprevir is not recommended in this patient population pending additional data.

References:

1. AASLD-IDSA. HCV in pregnancy. Recommendations for testing, managing, and treating hepatitis C. https://www.hcvguidelines.org/unique-populations/pregnancy. Accessed April 23, 2018.

2. Checa Cabot CA, Stoszek SK, Quarleri J, et al, for the NICHD International Site Development Initiative Perinatal/Longitudinal Study in Latin American Countries Study Group. Mother-to-Child Transmission of Hepatitis C Virus (HCV) Among HIV/HCV-Coinfected Women.  J Pediatric Infect Dis Soc. 2013;2:126–135.
Published online 2012 Oct 11. doi:  10.1093/jpids/pis091

3. CDC. Hepatitis C. 2015 Sexually Transmitted Diseases Treatment Guidelines. https://www.cdc.gov/std/tg2015/emerging.htm#hepc. Accessed April 23, 2018.

4. Kasting ML, Giuliano AR, Reich RR, et al. Hepatitis C virus screening trends: serial cross sectional analysis of the National Health Interview Survey population, 2013–2015. Cancer Epidemiol Biomarkers Prev. 2018;27:1–11.

5. CDC. Viral hepatitis. Testing recommendations for hepatitis C virus infection. https://www.cdc.gov/hepatitis/hcv/guidelinesc.htm. Accessed April 23, 2018.

6. AASLD-IDSA. Patients with decompensated cirrhosis. Recommendations for testing, managing, and treating hepatitis C. https://www.hcvguidelines.org/unique-populations/decompensated-cirrhosis. Accessed April 23, 2018.