Over 4 million Americans are believed to be antibody-positive for the hepatitis C virus (HCV) (1,2), and approximately 75-85% of these are likely to be chronically infected.(3) More than 50% of HCV-infected persons are unaware of their infection (4) and only 12% have received treatment. About 20,000 new infections occur annually. (5) Most will develop into chronic infection, increasing the risk for developing chronic liver diseases such as cirrhosis and cancer.

Because HCV is a blood borne infection, the risk for HCV transmission is mainly associated with exposure to contaminated blood or blood products (7). The prevalence of HCV infection is higher among persons born from 1945 to 1965 (3.25%) when compared to persons born outside that birth cohort (0.88%) (8).

  • Born between 1945 and 1965

  • Risk Behaviors
    • Injection-drug use (current or ever, including those who injected once)
    • Intranasal illicit drug use

  • Risk Exposures
    • Long-term hemodialysis (ever)
    • Getting a tattoo in an unregulated setting
    • Healthcare, emergency medical, and public safety workers after needle sticks, sharps, or mucosal exposures to HCV-infected blood
    • Children born to HCV-infected women
    • Prior recipients of transfusions or organ transplants, including persons who:
      • were notified that they received blood from a donor who later tested positive for HCV infection
      • received a transfusion of blood or blood components, or underwent an organ transplant before July 1992
      • received clotting factor concentrates produced before 1987
    • Persons who were ever incarcerated

  • Other Medical Conditions
    • HIV infection
    • Unexplained chronic liver disease and chronic hepatitis including elevated alanine aminotransferase levels

There are clear health risks to delaying treatment for HCV infection. HCV can stay active in the body and attack the liver for years without producing recognizable symptoms. If new case identification strategies are not implemented, the morbidity and mortality attributable to HCV infection will increase dramatically in the next decade as undiagnosed patients develop HCV-related complications as they age (9,10). It has been estimated that from 2010 to 2020, cirrhosis related to HCV infection will lead to a 106% increase in liver failure, an 81% increase in liver cancer, and 180% increase in liver-related deaths. (11)

Medical care costs associated with chronic HCV patients are also expected to increase. Without changes to the HCV diagnosis and treatment paradigms, total medical costs for patients with HCV infection are expected to more than double, from $30 billion to over $85 billion over the next 20 years (12).

Since 1998, the CDC has recommended HCV antibody screening of individuals with past behaviors or health indicators that are associated with HCV infection (e.g. history of injection drug use, hemodialysis, etc.), and to test selected individuals who have an identifiable risk factor (1). Despite these recommendations, more than 50% of patients with chronic hepatitis C continue to be unaware of their infections (6), leading to questions about the effectiveness of such "risk-based" screening.

On August 17, 2012, the CDC released a new set of recommendations that are designed to expand the 1998 guidelines to include one-time testing for HCV virus infection for all persons born between 1945 and 1965 (ie, "baby boomers"), without prior ascertainment of HCV risk factors. This recommendation (7) for routine testing of this baby boomer cohort was based on results from recent studies comparing the effectiveness, benefits and costs associated with current risk-based screening compared to a birth-cohort approach to HCV screening.