Who to test?
- Test patients who are at higher risk of having hepatitis C, with or without symptoms.
- Symptoms or signs in patients with chronic hepatitis C may indicate severe liver disease, possibly complicating treatment and worsening cure rates.
- Opportunistic testing for a patient at risk of hepatitis C is allowable under the Medicare Benefits Schedule.
Around 90% of new infections occur in people who inject drugs (PWID). Increasing numbers of Australians are also from high prevalence countries.
Patient groups who should be offered testing for HCV infection include:
- People who have ever injected drugs (even once)
- People who are, or have ever been, in prison
- People who received "backyard" or prison tattoos or skin piercings or scarification
- Aboriginal and Torres Strait Islander Australians
- People who received organs, tissues, blood or blood products in Australia before February 1990
- People who received organs, tissues, blood or blood products overseas before mandatory screening. Some countries still do not screen.
- Sexual partners of people with HCV. Transmission risk through vaginal sex in heterosexual couples is extremely low but risk increases for men who have sex with men, especially for HIV positive men.
- Children born to HCV-positive mothers
- People with HIV or hepatitis B
- People with unexplained elevation in ALT or AST or signs of liver disease (e.g. acute hepatitis, cirrhosis, liver cancer)
- People born in regions of higher prevalence (dark blue) - see map below, from: Hanafiah, K., Groeger, J., Flaxman, A.D. & Wiersma, S.T. et al. (2013)
For more information about hepatitis C testing, see the National Hepatitis C Testing Policy.
Vaccination for hepatitis B
Any patient from one of these groups who remains susceptible to hepatitis B infection should be offered hepatitis B vaccination. Susceptible means negative for HBsAg, anti-HBc and anti-HBs. This is provided free in many states and territiories, however eligibility varies according to jurisidiction - see the HepBhelp website for information on eligibility and ordering vaccine. Vaccination can occur before, during or after treatment for hepatitis C.