Unit 5 Discussion

Both the U.S.
Preventive Services Task Force and the Centers for Disease Control and Prevention (CDC)
recommend that all “baby boomers” – people born from 1945 through 1965 – get a hepatitis C test.
Discuss the change in these guidelines, who is at risk, and the ramifications for individuals that contract
hepatitis C. and are not identified and treated.
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In March 2020, the U.S. Preventive Services Task Force (USPSTF) issued restructured
recommendations concerning screening for HCV. The USPSTF now endorses routine screening
for all adults in the United States 18-79 years of age, as well as pregnant women. The 2020
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USPSTF recommendation for HCV screening was categorized as a grade B recommendation,
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which means that the USPSTF concludes with moderate certainty that screening for HCV in
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adults 18-79 years of age has considerable net benefit and that health care providers should offer
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this service[ CITATION RCh20 \l 1033 ]. The USPSTF explains that most adults will require
HCV screening only once, but those with ongoing risk of obtaining HCV will need intervallic
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screening. For people younger than 18 or older than 79 years of age, screening for HCV can be
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deliberated if the individual is considered at high risk for having acquired HCV. The 2020
USPSTF recommendations for HCV screening is clearly a major change from the prior 2013
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USPSTF recommendations to screen adults born during 1945-1965 and those with known
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risk[ CITATION USP20 \l 1033 ].

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Initial treatment of HCV infection consist of patients with chronic hepatitis C who have
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not been previously treated with interferon, peg interferon, ribavirin, or any HCV direct-acting
antiviral (DAA) agent, whether investigational, or US Food and Drug Administration (FDA)
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approved. Patients receiving antiviral therapy necessitate careful pretreatment assessment for
comorbidities that may affect treatment response or regimen selection[ CITATION AAS19 \l
1033 ]. All patients should have access to an HCV care provider throughout treatment, even
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though preset clinic visits and/or blood tests be contingent on the treatment regimen and may not
be mandatory for all regimens/patients. Patients getting ribavirin require supplementary
observing for anemia during treatment[ CITATION CDC20 \l 1033 ].
Hepatitis C can be treated with a combination of medicines that stop the virus multiplying
inside the body. These usually need to be taken for several months. The recommended treatment
for HCV included non-specific injectable immune-activating agent interferon and non-specific
antiviral, ribavirin. Guidelines now states that every patient with HCV should be treated
regardless of the stage of disease. Previous guidelines were based on toxic and less effective
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treatment. The cohort studies suggest that there is a greater benefit in treating patients of
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sustained virologic response (SVR) before significant fibrosis develops. As of October 2016,
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direct acting antiviral medication was approved for providers to prescribe for treatment of
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infected patients of HCV (Shaffer, & Ahuja, 2017).
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Per USPSTF, the highest risk factor for getting HCV is past or current IV drug use.
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Studies have proven that there is a 50% greater chance in this population. Other populations
identified by the USPSTF are people who have sex with IV drug users, have had a blood
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transfusion before 1992, long-term hemodialysis, born to an infected mother, incarcerated

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individuals, and getting unregulated tattoos. Other studies suggest that risky sexual practices and
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also place a patient at risk such as having multiple partners, unprotected sex, or sex with a known
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HCV partner. Patients that are also at a higher risk are those that were born between 1945 and
1965[ CITATION MSh17 \l 1033 ].

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There is serious consequence for those who have HCV and are not identified in time or
have proper and timely treatment. In the U.S, there was a reported 18,1513 certified deaths due
to HCV or essential causes. This is conservative approximation since evidence points to only
19% of decedent had HCV listed on the death certificate yet over 70% of decedents had evidence
of moderate to severe underlying liver disease; average age of death was 59. Patients that have
HCV progress other medical illness that are not limited to the liver such as diabetes mellitus,
glomerulonephritis, mixed cryoglobulinemia, porphyria, chronic fatigue, and non-Hodgkin’s
lymphoma. Even though some patients continue to be unaffected, the majority of patients with
HCV develop some degree of hepatic fibrosis and nearly 20% develop cirrhosis of the liver
within 20 years of their diagnosis (Shaffer, & Ahuja, 2017).
References:
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AASLD. (2019, November 6). Initial Treatment of Adults with HCV Infection. Retrieved from
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American Association for the Study of Liver Diseases and the Infectious Diseases Society
of America: https://www.hcvguidelines.org/treatment-naive
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CDC. (2020, January 13). Hepatitis C Questions and Answers for the Public. Retrieved from
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Centers for Disease Control and Prevention: https://www.cdc.gov/hepatitis/hcv/cfaq.htm
Chou, R., Dana, T., Fu, R., Zakher, B., Wagner, J., Ramirez, S., . . . Jou, J. (2020). Screening for
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Hepatitis C Virus Infection in Adolescents and Adults: Updated Evidence Report and
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Systematic Review for the US Preventive Services Task Force. JAMA, doi:
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10.1001/jama.2019.20788.
Force, U. P., Owens, D., Davidson, K., Krist, A., Barry, M., Cabana, M., . . . Wong, J. (2020).
Screening for Hepatitis C Virus Infection in Adolescents and Adults: US Preventive
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Services Task Force Recommendation Statement. JAMA, 1123.

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Shaffer, M., & Ahuja, D. (2017). Hepatitis C: Screening changes, treatment advances. The
Journal of Family Practice, 136-144.
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Melissa, done
There is no vaccine to prevent hepatitis C. The best way to prevent HCV is to avoid
contact with contaminated blood. Acute HCV infection is rarely symptomatic, but results in
chronic infection approximately 75% of the time. While some chronically infected individuals
remain unaffected, most develop some degree of hepatic fibrosis, and 20% will develop cirrhosis
within 20 years of diagnosis. The CDC estimates that half of people with chronic HCV are
unaware of their infection. The only way to find out if you have a hepatitis C infection is to get
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an HCV test (CDC, 2020).
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Hepatitis C can be treated with a combination of medicines that stop the virus multiplying
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inside the body. These usually need to be taken for several months. Most people will take 2 main
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medications called pegylated interferon (a weekly injection) and ribavirin (a capsule or tablet),
although newer tablet-only treatments are likely to replace the interferon injections for most
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people in the near future. These newer hepatitis C medications have been found to make
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treatment more effective. They include simeprevir, sofosbuvir and daclatasvir (AASLD, 2019).
Using the latest medications, up to 90% or more of people with hepatitis C may be cured.
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However, it's important to be aware that you won't be immune to the infection and should take
steps to reduce your risk of becoming infected again (Force, et al., 2020).
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References:
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AASLD. (2019, November 6). Initial Treatment of Adults with HCV Infection. Retrieved from
American Association for the Study of Liver Diseases and the Infectious Diseases Society
of America: https://www.hcvguidelines.org/treatment-naive
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Mary
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Melissa,
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There is no vaccine to prevent hepatitis C. The best way to prevent HCV is to avoid
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contact with contaminated blood. Acute HCV infection is rarely symptomatic, but results in
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chronic infection approximately 75% of the time. While some chronically infected individuals
remain unaffected, most develop some degree of hepatic fibrosis, and 20% will develop cirrhosis
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within 20 years of diagnosis. The CDC estimates that half of the people with chronic HCV are
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unaware of their infection. The only way to find out if you have a hepatitis C infection is to get
an HCV test (CDC, 2020).

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Hepatitis C can be treated with a combination of medicines that stop the virus from
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multiplying inside the body. These usually need to be taken for several months. Most people will
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take 2 main medications called pegylated interferon (a weekly injection) and ribavirin (a capsule
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or tablet), although newer tablet-only treatments are likely to replace the interferon injections for
most people in the close future. These newer hepatitis C medications have been found to make
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treatment more effective. They include simeprevir, sofosbuvir, and daclatasvir[ CITATION
AAS19 \l 1033 ].
Using the latest medications, up to 90% or more of people with hepatitis C may be cured.
However, it's important to be aware that you won't be immune to the infection and should take
steps to reduce your risk of becoming infected again (Force, et al., 2020).
References:
Mary
m
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sh
Arielle, Done
According to various estimates, anywhere from 3 to 10 million people in the United
States are carriers of the virus. One reason for this is because the virus wasn't even diagnosed
until the late 1980s. In fact, a majority of carriers are still unaware of their HCV status. In 2017,
a total of 3,216 cases of acute hepatitis C were reported to CDC. Since many people may not
have symptoms or don’t know they are infected, their illness is often not diagnosed or reported
and therefore can’t be counted. CDC estimates the actual number of acute hepatitis C cases was
closer to 44,700 in 2017 (CDC, 2020).
References:
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Mary
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Both the U.S.

risk[ CITATION USP20 \l 1033 ].

be mandatory for all regimens/patients. Patients getting ribavirin require supplementary

observing for anemia during treatment[ CITATION CDC20 \l 1033 ].

transfusion before 1992, long-term hemodialysis, born to an infected mother, incarcerated

1965[ CITATION MSh17 \l 1033 ].

glomerulonephritis, mixed cryoglobulinemia, porphyria, chronic fatigue, and non-Hodgkin’s

within 20 years of their diagnosis (Shaffer, & Ahuja, 2017).

Services Task Force Recommendation Statement. JAMA, 1123.

an HCV test (CDC, 2020).

closer to 44,700 in 2017 (CDC, 2020).

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