Hepatitis C Virus (HCV) Information for Health Care Providers - Minnesota Dept. of Health

Hepatitis C Virus (HCV) Information for Health Care Providers

  • The number of new hepatitis C virus (HCV) infections per year in the U.S. declined from an average of 240,000 in the 1980’s to about 30,000 in 2003.
  • Most new infections are due to illegal injection drug use.
  • Transfusion-associated cases occurred prior to routine HCV screening of blood donors and now occurs at a rate of less than one case per million units of transfused blood.
  • An estimated 3.9 million (1.8 percent) persons in the U.S. have been infected with HCV, of whom 2.7 million have chronic infection.

On this page:
What should be reported?
What is the etiology of HCV?
What are signs and symptoms of HCV?
What are the long-term effects of HCV?
How is HCV transmitted?
Who is at risk for HCV?
How can HCV be prevented?
Who should be tested for HCV?
What is the treatment for HCV?
What should be done after a person is exposed to HCV?

Download PDF version formatted for print: Hepatitis C Virus (HCV) Information for Health Care Providers (PDF)

What should be reported?

  • Acute hepatitis C virus (HCV) infection (i.e., newly acquired symptomatic HCV infection).
  • Chronic and past HCV infection (i.e., persistent infection with HCV, characterized by detection of HCV RNA >6 months after newly acquired infection).
  • All available positive serology and nucleic testing results (i.e., EIA with signal-to-cutoff ratio, qualitative and quantitative PCR, genotype).

What is the etiology of HCV?

HCV is a small single-stranded RNA virus in the flavivirus family.

What are signs and symptoms of HCV?

  • 80 percent of patients are asymptomatic.
  • Symptoms may include fever, abdominal pain, loss of appetite, nausea, jaundice, or dark urine.
  • Jaundice occurs in 25 percent of patients; liver function test results generally are less pronounced than with HBV infection.
  • Acute disease tends to be mild and insidious in onset.
  • Average incubation period is 6-7 weeks (range: 2 weeks to 6 months).

What are the long-term effects of HCV?

  • Chronic infection (80 percent of patients are asymptomatic).
  • Chronic liver disease in 55 percent-85 percent of chronically HCV-infected persons.
  • Death from chronic liver disease in <5 percent.
  • HCV is the leading indication for liver transplant in the United States.

How is HCV transmitted?

All persons with HCV-RNA in their blood are considered infectious. The highest infection rates (60-90 percent) occur in persons with large or repeated, direct percutaneous exposure to blood or blood products, including:

  • Less than 10 percent of cases are sexually transmitted.
  • Perinatal transmission accounts for 5 percent of cases.

Who is at risk for HCV?

High risk:

  • Injection drug users
  • Recipients of clotting factors made before 1987

Intermediate risk:

  • Hemodialysis patients
  • Recipients of blood and/or solid organs donated before 1992
  • Persons with undiagnosed liver problems
  • Infants born to HCV-infected mothers

Low risk:

  • Health care/public safety workers
  • Persons who have sex with multiple partners
  • Persons who have sex with an HCV-infected steady partner

How can HCV be prevented?

Persons who use or inject illegal drugs should be advised to:

  • Stop using and injecting drugs;
  • Enter and complete substance abuse treatment, including relapse prevention programs; or
  • If continuing to inject drugs to:
    • Never reuse or share syringes, needles, water, or drug preparation equipment; if injection equipment has been used by other persons, clean with bleach and water;
    • Use only syringes obtained from a reliable source (e.g., pharmacy);
    • Use a new sterile syringe to prepare and inject drugs;
    • Use sterile water to prepare drugs, otherwise use clean water from a reliable source (e.g., tap water);
    • Use a new or disinfected container (“cooker”) and a new filter (“cotton”) to prepare drugs;
    • Clean the injection site with a new alcohol swab prior to injection; and
    • Safely dispose of syringes after one use.
  • Receive vaccination against hepatitis B virus (HBV) and hepatitis A (HAV).

Persons diagnosed with a sexually transmitted disease or who are sexually active should be advised to:

  • Have sex with only one partner or not at all;
  • Use latex condoms correctly during every sexual encounter; and
  • Get vaccinated against HBV (and, if risk factors are present, HAV).

Who should be tested for HCV?

  • Testing is recommended for all high- and intermediate-risk persons.
  • Testing is recommended for low-risk persons only after known exposure.
  • Testing is recommended after 12-18 months of age- for infants born to HCV-infected mothers.

What is the treatment for HCV?

  • Evaluate the patient for liver disease.
  • There are a number of drugs licensed for treatment of persons with chronic HCV infection. Please visit www.HCVguidelines.org for additional information on HCV treatment. Attention: Non-MDH link
  • Evaluate patient for HAV and HBV immunization status; vaccinate if indicated.
  • Advise against alcohol consumption and, if necessary, provide counseling for alcohol abuse.

What should be done after a person is exposed to HCV?

  • Follow-up of occupational HCV exposures:
    • Perform anti-HCV testing of source patient.
    • For the person exposed to an HCV-positive source:
      • Perform baseline testing for anti-HCV, ALT activity, with follow-up testing at 4-6 months (for earlier diagnosis, testing for HCV RNA may be performed at 4-6 weeks).
      • Confirm all positive anti-HCV results obtained by enzyme immunoassay using HCV RNA testing.
  • Immune globulin and antiviral agents are not recommended after exposure to HCV-positive blood. No guidelines exist for administration of antiviral therapy during HCV infection; however, limited data indicate that antiviral therapy may be beneficial if started early in HCV infection. When HCV infection is identified early, refer patient to a specialist for medical management.
  • Institutions should establish policies and procedures for HCV testing after percutaneous or mucosal exposures to blood and ensure that staff is familiar with them.
  • Clinicians who care for persons with occupational exposure to HCV should be familiar with the risk for HCV infection and recommendations for post-exposure counseling, testing, and follow-up.

Updated Wednesday, June 17, 2015 at 10:31AM