Hepatitis C screening: should I get tested?

What the guidelines recommend

The USPSTF recommends screening all adults 18 to 79 and says most adults need to be screened only once (USPSTF 2020). The CDC recommends testing every adult at least once in a lifetime and every pregnant woman during each pregnancy, except in settings where fewer than 1 in 1,000 people have the virus. It also says anyone who asks for a hepatitis C test should get one, without having to explain why (CDC 2020).

Risk factors that call for a test at any age

The CDC advises a one-time test, regardless of age, for (CDC 2020):

• People with HIV.
• Anyone who ever injected drugs and shared needles, syringes or other equipment, including once or a few times many years ago.
• Anyone who ever received maintenance hemodialysis, or who has persistently abnormal ALT liver test results.
• People who received clotting factor made before 1987, or a blood transfusion or organ transplant before July 1992, or who were told they received blood from a donor who later tested positive.
• Health care, emergency and public safety workers after a needle-stick, sharps or mucosal exposure to blood with hepatitis C.
• Children born to mothers with hepatitis C.

People who still inject drugs and share equipment, and people on maintenance hemodialysis, should be tested again from time to time while the risk lasts (CDC 2020). The USPSTF agrees that people with continued risk should be screened periodically, but notes there is little evidence on how often (USPSTF 2020).

Why it matters

Hepatitis C is the most common chronic blood-borne infection in the US and a leading cause of complications from chronic liver disease (USPSTF 2020). In 2013 to 2016 about 2.4 million people in the US, 1.0% of adults, were living with it (CDC 2020). The most important risk factor is past or current injection drug use (USPSTF 2020).

Treatment today is a course of pills, typically for 8 to 12 weeks (USPSTF 2020). Clearing the virus after treatment was linked with a lower risk of death, cirrhosis and liver cancer in the studies the USPSTF reviewed (USPSTF 2020).

How the test works

Screening starts with a blood test for hepatitis C antibodies. A positive antibody test is followed by a test for the virus itself (HCV RNA), because some people clear the infection on their own and still carry antibodies (CDC 2020). Antibodies can be found 4 to 10 weeks after infection and in about 97% of people by 6 months, so a very recent exposure may not show up yet (CDC 2020).

Common questions

At what age should you get tested for hepatitis C?

At 18 or older, at least once. The USPSTF recommendation covers ages 18 to 79 (USPSTF 2020); the CDC has no upper age limit (CDC 2020). Younger people with a risk factor should be tested too.

How often should you get a hepatitis C test?

Once for most adults. Test again during each pregnancy, and from time to time if you keep injecting drugs and sharing equipment or are on hemodialysis (CDC 2020).

Does Medicare cover hepatitis C screening?

Medicare Part B covers one lifetime screening if you were born from 1945 to 1965, used injection drugs in the past, or had a blood transfusion before 1992, and a yearly test if you keep using injection drugs. Your doctor must order it, and you pay nothing if your provider accepts assignment (Medicare).

I feel fine. Why test?

A new infection is usually silent or feels like a mild illness (CDC 2020), and the screening recommendations are for people without symptoms (USPSTF 2020). Treatment that clears the virus lowers the risk of cirrhosis, liver cancer and death (USPSTF 2020).

Also see all screening tests by age, the HIV screening check, the hepatitis B screening check, the FIB-4 liver fibrosis calculator, the AST/ALT ratio, the fatty liver disease guide and the alcohol screening (AUDIT-C).