GPAtlas🧭 When to offer testing (and when to suspect HCV)
The hepatitis C virus (HCV) is a blood-borne, single-stranded RNA virus that infects the liver. Acute infection is usually silent.
• Around 1 in 5 (~20%) people clear it spontaneously.
• About 80% develop chronic infection, defined as HCV RNA persisting for 6 months or longer.
• Chronic infection can progress over decades to cirrhosis and hepatocellular carcinoma (HCC).
The reason this matters in primary care is simple:
• Chronic HCV is largely asymptomatic, so the diagnosis depends almost entirely on case-finding.
• Most people acquire it through injecting drug use, and general practice is the most important place to test in the UK.
• HCV is now curable: a short oral course of direct-acting antivirals (DAAs) cures well over 90% of people.
• Finding cases, not treating them, is the bottleneck.
Offer an HCV antibody test to anyone with a risk factor below. Test also whenever liver function tests (LFTs) show unexplained raised transaminases, even when no risk factor is apparent.
| Test – exposure or behavioural risk |
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• Ever injected drugs – even once, or many years ago (the single largest risk group, ~90% of UK cases) |
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• Blood transfusion before September 1991, or an NHS blood product before 1986 (in Scotland, Factor IX before October 1985 or Factor VIII before April 1987) |
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• Tattoos, piercings, acupuncture or medical/dental treatment with non-sterile equipment (including abroad) |
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• Needlestick or sharps injury |
| Test – population or clinical risk |
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• Born or raised in a high-prevalence country (parts of Africa, Asia, the Caribbean, Central/South America, Eastern/Southern Europe, the Middle East, the Pacific) |
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• HIV-positive men who have sex with men (MSM), and chemsex |
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• Prisoners, looked-after children, people who are homeless or in hostels |
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• Babies of HCV-positive mothers; close household, sexual or injecting contacts of a known case |
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