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, while about 80% develop chronic infection – defined as HCV RNA persisting for 6 months or longer – which 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 single most important testing setting in the UK. Crucially, it is now curable – a short oral course of direct-acting antivirals (DAAs) cures well over 90% of people – so 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 / behavioural risk | Test – population / clinical risk |
|---|---|
|
• Ever injected drugs – even once, or many years ago (the single largest risk group, ~90% of UK cases) |
• 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) |
|
• Blood transfusion before September 1991, or an NHS blood product before 1986 (in Scotland, Factor IX before October 1985 / Factor VIII before April 1987) |
• HIV-positive men who have sex with men (MSM), and chemsex |
|
• Tattoos, piercings, acupuncture or medical/dental treatment with non-sterile equipment (including abroad) |
• Prisoners, looked-after children, people who are homeless or in hostels |
|
• Needlestick or sharps injury |
• Babies of HCV-positive mothers; close household, sexual or injecting contacts of a known case |
Source: NICE PH43 · UKHSA
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