PUBLIC HEALTH
0.1 percent and there is no current recommendation for
PEP (12).
o People in Ky. have acquired hepatitis C from manicures
and pedicures
o Children born to HCV-positive women
Please note that for persons who might have been exposed to HCV
within the past six months or with ongoing risk factors, testing for
HCV RNA or follow-up testing for HCV antibody is recommended.
Additional HCV screening guidelines can be found at:
» » CDC screening guidelines: https://bit.ly/RsajNk.
» » USPSTF screening guidelines: https://bit.ly/2NU5ptp.
LABORATORY TESTING:
Testing for HCV infection begins with a laboratory-conducted
assay for HCV antibody in blood. The KDPH recommends using
venipuncture to obtain a specimen for HCV Antibody (anti-HCV)
testing. Rapid HCV testing should only be used for offsite HCV
outreach programs or in Syringe Exchange programs (13).
HCV infection can be detected by anti-HCV screening tests (enzyme
immunoassay) four to 10 weeks after infection. Anti-HCV can be
detected in >97 percent of persons by six months after exposure.
(1, 14-17).
A nonreactive HCV antibody result indicates no HCV antibody
detected. People with early HCV infection might not yet have de-
veloped antibody levels high enough that the test can measure. In
addition, some people might lack the immune response necessary
for the test to work well. In high risk individuals with negative HCV
antibody testing, early repeat testing with HCV antibody testing
or further testing such as PCR for HCV RNA may be considered.
A reactive result indicates one of the following: 1) current HCV
infection, 2) past HCV infection that has resolved, or 3) false posi-
tivity. A reactive result should be followed by a HCV confirmation
test using HCV RNA Quantitative tests to detect amount (viral
load) of the virus. Automatically performed confirmation testing
(i.e., reflex testing) is recommended (13).
HCV RNA appears in blood and can be detected as early as two
to three weeks after infection. (1, 14-17). If HCV RNA is detected,
that indicates current HCV infection. If HCV RNA is not detected,
that indicates either a past, resolved HCV infection, or false positive
HCV antibody. A table on the interpretation of results of tests for
hepatitis C Virus (HCV) infection and further actions is available
at: https://bit.ly/2De6gRx. An algorithm for testing is also provided
by the CDC at: https://bit.ly/2ppbOih.
FIRMED HCV INFECTION?
HCV-positive persons should be evaluated (by referral or con-
sultation, if appropriate) for the presence of chronic liver disease,
including assessment of liver function tests, evaluation for severity
of liver disease and possible treatment, and determination of the
need for hepatitis A and hepatitis B vaccination.
Hepatitis A and hepatitis B vaccines are recommended for non-im-
mune persons with HCV infection to prevent additional damage to
the liver that infections from these other hepatitis viruses may cause.
COUNSELING PATIENTS
According to the Center for Disease Control and Prevention, indi-
viduals with HCV infection should be counseled about the following
topics (19):
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PATIENTS WITH HCV AND SUBSTANCE USE DIS-
ORDER:
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For more information about the CDC HCV recommendations,
see the “Testing for HCV infection: An Update of Guidance for
Clinicians and Laboratorians” https://bit.ly/1xN8Hea
REFERRAL FOR HCV MANAGEMENT AND TREAT-
MENT
Over 90 percent of HCV infected persons can be cured of HCV
infection regardless of HCV genotype, with eight to 12 weeks of oral
therapy (18). New treatment guidelines recommend no treatment
of acute hepatitis C. Patients with acute HCV infection should be
followed and only considered for treatment if HCV RNA persists
after six months. For more information, see http://www.hcvguide-
lines.org (18).
WHAT SHOULD BE DONE FOR A PATIENT WITH CON-
8
LOUISVILLE MEDICINE
Individuals should be informed about the risk for transmission
to sex partners.
Sharing personal items that might have blood on them, such as
toothbrushes, nail clippers or razors, can pose a risk to others.
Cuts and sores on the skin should be covered to keep from
spreading infectious blood or secretions.
Donating blood, organs, tissue or semen can spread HCV to
others.
Individuals may benefit from joining a local HCV support
group.
HCV-positive persons should be advised to avoid alcohol be-
cause it can accelerate cirrhosis and end-stage liver disease.
Likewise, viral hepatitis patients should also check with a health
professional before taking any new prescription pills, over-the
counter drugs (such as non-aspirin pain relievers), or supple-
ments, as these can potentially damage the liver.
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Perform Screening Brief Intervention and Referral to Treatment
(SBIRT). This is a comprehensive, integrated public health ap-
proach for early identification and intervention with patients
whose patterns of alcohol and/or drug use put their health at
risk. Multiple training options are available to providers in
Kentucky, including through the following websites:
o http://www.kafp.org/sbirt-training-2/
o https://bit.ly/2plGNMg
o http://passporthealthplan.com/providers/sbirt/
For individuals ready for substance use disorder treatment, a
current list of Kentucky Opioid Treatment programs can be
found at:
o https://bit.ly/2PNedyM or
o Substance misuse treatment assistance can also be found
at https://findhelpnowky.org/ or 1-833-8KY-HELP (1-
833-859-4357).
For those not yet ready for substance use disorder treatment,
consider harm reduction strategies. Counsel that sharing nee-
dles and syringes with injection drug use is highly likely to
spread the infection to others. A prompt referral to a syringe
exchange program in your area will help reduce infection risk
to others. Prescribe naloxone for overdose prevention.
The Louisville Metro Department of Public Health and Wellness
website lists addiction resources, including recovery centers
and syringe exchange information at https://bit.ly/2plo57F