Who Should Be Screened For Hepatitis C

What Do We Do If A Patient Does Not Have Health Insurance And Accepts The Offer Of The Hepatitis C Screening Test

There are a number of free hepatitis C test sites throughout the state. For a complete list of those sites, go to:

• or

Free hepatitis C rapid test kits are also available for providers through the NYSDOH Hepatitis C Rapid Testing Program. Providers wishing to provide hepatitis C rapid testing may be eligible to enroll in this program. These tests kits are available for use with persons that do not have health insurance coverage. For more information on the NYS Hepatitis C Rapid Testing Program, go to: or call 518-486-6806.

Are Local Health Department Std Clinics Mandated To Offer Hepatitis C Screening Under The New Law If The Patient Does Not Have A Primary Care Provider But Is Receiving Gynecological Services Only

Primary care is defined in the law as the medical fields of family medicine, general pediatrics, primary care, internal medicine, primary care obstetrics, or primary care gynecology, without regard to board certification. If primary care is being provided at the STD clinics, the hepatitis C screening test must be offered.

As A Patient Born Between 1945 And 1965 What Do I Do If When I’m Seeking Care I Am Not Offered A Hepatitis C Test

If you meet the criteria set out by the law and are not offered a hepatitis C test by a health care provider, you should bring it to the attention of that provider and ask for a test or an explanation for why the offer was not made. If you believe that your health care provider is not complying with the law, send us your name and contact information, the name of the provider, and whatever details you think would be helpful to and the situation will be reviewed.

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Pathogenetic Background Of Chronic Hepatitis C In Hemodialysis Patients

As already mentioned, in HD patients setting HCV-induced liver disease runs a more benign course showing a lower incidence of cirrhosis compared to non-uremic patients.

Histological findings are strongly supportive of a particularly mild chronic hepatitis type while the demonstration of minimal and mild necroinflammatory activity and lack of immune-related specific features such as lymphoid aggregates and hepatitic bile duct lesions, speak in favor of a deficient immune reaction.

Another possible pathogenetic mechanism explaining the milder disease profile of hepatitis C in HD patients is that hemodialysis procedure increases the levels of HGF. HGF is a potent mitogen for hepatocytes that promotes liver regeneration and restitution of liver cell loss. In a study by Rampino et al in 1999, a marked and sustained release of HGF was observed in HD compared to non-HD patients and this was further associated with milder histological findings and a lower degree of fibrosis. The low viral load as triggering factor of a weak immune reaction has also to be taken into consideration.

Retesting For Hcv In Dialysis Patients

In initially anti-HCV negative HD patients, retesting with EIA should be considered every 6-12 mo. Retesting with NAT is suggested in patients with unexplained elevation of aminotransferase levels, if there is suspicion of an outbreak of HCV in a HD unit, in patients on the waiting list for transplantation and for the monitoring of therapy in those who are treated.

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Limitations Of Using Only Risk

A prior study that analyzed effectiveness of risk-based HCV screening found that 45 to 85% of adults with chronic HCV infection in the United States were unaware of their HCV infection status. Problems with using risk-based screening were highlighted in the Chronic Hepatitis Cohort Study survey of 4,689 persons living with HCV infection who were asked about their choice of location and reason for their HCV testing. The study analyzed data from 2006-2010 that revealed that 60% of persons living with HCV had their initial testing ordered at a physician’s office and 45% underwent testing because of clinical indications related to liver disease fewer than 25% of the persons with HCV infection had identifiable risk factors for acquiring HCV that would have prompted testing using the 1998 CDC Risk-Based HCV Screening Recommendations. Notably, 78% of those diagnosed with HCV were born during the time period of 1945 to 1965.

Who Is Most At Risk Of Contracting Hepatitis C

You have a high risk of contracting hepatitis C if you:

• use or have used injection drugs even if it was just once or many years ago
• have received blood or blood products or an organ transplant before July 1990 in Canada
• have been in jail or
• have been injected or scratched during vaccination, surgery, blood transfusion or a religious/ceremonial ritual in regions where hepatitis C is common.

You have a high moderate risk of contracting hepatitis C if you:

• have tattoos or body piercing
• have multiple sexual partners
• have a sexually transmitted infection , including HIV or lymphogranuloma venereum
• have experienced traumatic sex or rough sex or have used sex toys or fisting that can tear body tissue
• have vaginal sex during menstruation
• have received a kidney treatment
• have received an accidental injury from a needle or syringe
• have another infectious disease
• were born to a hepatitis C infected mother or
• have a sexual partner infected with hepatitis C.

Hepatitis C is NOT passed from person to person by:

• coughing, sneezing
• breastfeeding unless your nipples are cracked and bleeding or
• oral sex, unless blood is present.

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Study Shows Viruses Are Potentially Curable

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Most people are never routinely screened for hepatitis B or C — partly because there’s a belief that there’s nothing you can do for them — but one doctor believes everyone should be screened because there seems to be a cure.

Around 600 million people around the world have hepatitis B or C, and thousands of people die from the viruses, according to statistics.

Needle Sharing And Opioids

The most common way hepatitis C is transmitted today is through needle sharing for drug use. When people become addicted to prescription opiates and then lose access to those drugs, they may turn to heroin, and sharing needles for heroin use is linked to hepatitis C infection. If you have a history of drug use, that could pose a risk of infection. Visit opioid-help.org

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Preparing Clients For Screening

Once clients are comfortable talking about viral , they might be more willing to undergo screening. However, clients might be anxious about the test itself a reassurance that testing is a simple procedure can help allay these concerns. Many substance use treatment facilities do not offer screening, and clients might need to be referred elsewhere. The following strategies can enhance the discussion of the hepatitis screening process and hepatitis prevention:

Should You Be Screened For Hepatitis C And Hiv

Q. My doctor recently suggested that I get screened for hepatitis C and HIV. Whyand should I?

A. Sounds like your doctor is following the latest recommendations from the U.S. Preventive Services Task Force, an independent group that recently advocated screening all baby boomers for hepatitis C, a virus that attacks the liver, and everyone age 15 to 65 for HIV, the virus that causes AIDS. And yes, our experts think those are good ideas.

Getting tested is the only way you can know for certain if youre infected. Then you can take steps to minimize the risk of infecting others, and weigh your treatment options. Hepatitis C medications can sometimes eliminate the virus from the body and prevent liver damage, cirrhosis, and even liver cancer. HIV drugs can reduce the risk of developing AIDS or delay its onset, helping people with HIV live longer than ever before. Plus, under the new health care law, most insurance plans must cover the task forces recommended hepatitis C and HIV screenings at no cost to you when conducted by a network provider, so check with your insurer for details. Have a question? Ask our health care experts.

Doug Podolsky

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Screening And Treating Patients

Screening for the hepatitis C virus, or HCV, involves an inexpensive blood test. Most people exposed to the virus are able to clear the infection.

“As the landscape has evolved such that everyone can access therapy we felt much more strongly that then everyone who is at risk should be tested,” said Feld’s co-lead author, Dr. Hemant Shah, a liver specialist and clinical practice director of the Francis Family Liver Clinic at Toronto’s University Health Network.

Joe Camara learned he contracted hepatitis C in 1993 after using intravenous drugs. The Toronto man was sent to the U.S. for treatment.

“I was throwing up. I would turn all yellow. Just sick,” he recalled. Since Camara started receiving direct-acting antiviral medication, he says his energy has returned and he feels great.

Who Should Get Tested For Hepatitis C

The CDC recommends that you get tested at least once no matter what. Definitely get screened if any of these things apply to you:

• You were born between 1945 and 1965.
• You use or inject drugs.
• You have ever injected drugs — even if it was just once or a long time ago.
• Youâre on kidney dialysis.
• You have abnormal alanine aminotransferase levels .
• You had a blood transfusion, blood components, or an organ transplant before July 1992.
• Youâve ever gotten clotting factor concentrates made before 1987.
• You received blood from a donor who later tested positive for hepatitis C virus.
• Youâre a health care worker, first responder, or have another job that exposes you to HCV-infected needles.
• You were born to a mother with HCV.

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Educating Clients About Viral Hepatitis

Clients may believe they know about viral , but their understanding of the disease may not be accurate. It is easy to confuse the three main types of viral , B, and C. Clients may have formed impressions based on limited or incorrect information. Counselors should briefly describe hepatitis A, B, and C, including their prevalence, , and relationship to drug use, as well as to other infections, such as HIV and sexually transmitted diseases. Specific strategies for speaking with clients include:

• Speak clearly and keep the message simple, focused, and brief.
• Use language, examples, and concepts that the client understands.
• Use appropriate visual aids.
• Frame numerical statements in terms that are easy to visualize. Say 5 out of 100 people rather than 5 percent of the population say more than half instead of the majority.
• Repeat the information at different times in different ways. The average client retains only approximately one-third of what he or she is told. Summarize essential points.
• Pay attention to a clients response to the information. For example, if a client stiffens his or her posture, consider saying, I notice that this topic seems to make you uncomfortable. It does for a lot of people. Please tell me what youre feeling right now. Id really like to help you with this.
• Use the opportunity to describe the potential detrimental effects of alcohol and other substance use on the liver of a person who is infected with HCV.

What Are The Key Provisions Of The Law

• A hepatitis C screening test must be offered to every individual born between 1945 and 1965 receiving health services as an inpatient or a hospital, or receiving primary care services in the outpatient department of hospital, or in a freestanding diagnostic and treatment center or from a physician, physician assistant, or nurse practitioner providing primary care.
• If an individual accepts the offer of the hepatitis C screening test and the screening test is reactive, the health care provider must offer the individual follow-up health care or refer the individual to a health care provider who can provide follow-up health care. The follow-up health care must include a hepatitis C diagnostic test.
• The offer of testing must be culturally and linguistically appropriate.

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Why Is It Important To Test Persons Born Between 1945 And 1965

• According to the Centers for Disease Control and Prevention , more than 75% of adults infected with hepatitis C are people born from 1945 through 1965 .
• The reason that baby boomers have high rates of hepatitis C is not completely understood. However, it is believed that most baby boomers became infected in the 1970’s and 1980’s when rates of hepatitis C and drug use were highest. Since people with hepatitis C can live for decades without symptoms, many baby boomers are unknowingly living with an infection they got many years ago that can lead to liver disease, liver failure and cancer.
• Hepatitis C is primarily spread through contact with blood from an infected person. Many baby boomers could have gotten infected from contaminated blood and blood products before widespread screening of the blood supply began in 1992 and universal precautions were adopted. Still, many baby boomers do not know or remember how or when they were infected.

Current Hepatitis C Testing Recommendations

Recently, several organizations have issued hepatitis C virus screening recommendations. In general, major guidelines now recommend routine one-time universal HCV testing for adults 18 years of age and older, routine HCV screening of pregnant individuals, screening younger persons at risk of acquiring HCV, and repeat screening for those with ongoing risk for HCV acquisition.

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If A Person Does Not Want Any Out Of Pocket Expenses Or To Have His Insurance Company Know He Was Tested For Hepatitis C Can I Refer Him To A State Local Or Community Provider That Conducts Free Hepatitis C Testing

Yes. If a patient would otherwise refuse a hepatitis C test, it is appropriate to make this kind of referral. Patients who would like information about free testing sites may call 1-800-522-5006. For a complete list of free hepatitis C testing sites, go to:

Does The Referral For Follow

The law does not specify the clinician specialty but does specify that the referral must be for follow-up hepatitis C care. The patientâs medical record should reflect the name of the provider/facility to whom the referral appointment was made. The Departmentâs website includes contact information for providers of hepatitis C care and treatment.

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Discussing Screening Results With Clients

The medical personnel who ordered or arranged the screening test, not counselors, usually explain the results. Hepatitis screening should be part of the intake physical examination in an opioid treatment program, and medical personnel may report the results. However, the client may want to discuss the results with the counselor or ask the counselor questions.

Anxiety might interfere with some clients ability to comprehend or retain information, which might need to be repeated.

Suggestions for conversations with clients when the test results are negative include the following:

• Explain results clearly and simply: So the HCV screening result was negative? This means that, as of 6 months ago, you did not have .
• Emphasize that a negative result to an HCV test does not indicate to and that the client should take precautions to avoid . If a relapse to drug use occurs, advise clients to avoid sharing any drug paraphernalia or equipment. Specify that this includes cookers, cotton, water, needles, syringes, pipes, and straws.
• Emphasize the importance of getting HAV and HBV vaccinations. Provide information about the availability of low- or no-cost vaccinations.

Clients whose screening test results are positive for will need additional tests and examinationsusually with doctors who specialize in diseases of the liver to get accurate diagnoses and to determine their health status and the extent of liver damage. These tests are described in .

Will Nysdoh Require Any Data To Be Reported From Health Care Facilities Or Private Practitioners With Regard To Activities Mandated Under This Law

No. There are no new reporting requirements included in the Law. However, reporting of acute and chronic hepatitis C cases is mandated under the New York State Sanitary Code . Cases are required to be reported to the local health department in the county where the patient resides.

For questions on cases residing outside of NYC, call NYSDOH at 518-473-4439 or go to:

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Treatment Of Hepatitis C In Hd Patient

Although difficult to establish, there is a true impact of HCV infection on mortality in HD patients. The principal goal of HCV treatment is to decrease liver related mortality. In most studies surrogate endpoint of therapeutic success is virological response. Among virological responses, the most important is SVR defined as undetectable HCV-RNA, measured by a sensitive assay after the completion of 24 wk of therapy.

The currently recommended therapy for CHC in the general population is a combination of pegylated interferon- and ribavirin for 24 wk and 48 wk with achievement of SVR in about 50% of patients.

Unfortunately, treatment-related toxicity with IFN- and with RBV represent a major barrier to successful therapy. Even in the general population a need for dose reduction has been reported in 35%-42% of patients and treatment discontinuation in about 30%.

Initial Testing For Hcv

According to the KDIGO hepatitis C guidelilnes of 2009, it is recommended that patients on haemodialysis should be tested when they first start haemodialysis or when they transfer from another haemodialysis facility while for predialysis patients with chronic kidney disease the recommendation to test for hepatitis C is weak. Especially dialysis patients who are candidates for kidney transplantation should be screened, evaluated and if necessary treated for hepatitis C before entering the waiting list.

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