Screening of asymptomatic patients for HBV and HCV

The following groups, and their contacts, are at high risk for HBV and/or HCV and should be offered testing routinely.

• Immigrant detainees / origin from high prevalence countries (Africa, Asia, South/Eastern Europe, Middle East, Central/South America, Pacific Islands)
• Babies of HB/HC mothers
• Current or past recreational drug use
• Homeless, living in hostel
• Prisoners, young offenders
• Looked after children and young people
• Close contacts of known HB/HCV sufferer
• MSM
• Multiple sexual partners
• Commercial sex workers
• Blood transfusion < 1991; blood products < 1986

Note: refer symptomatic patients with jaundice or ascites to an acute jaundice clinic.

Examination:

• Ascites or Jaundice
• Enlarged liver and/or spleen

Blood tests:

The screening test for HBV is Hepatitis B Surface Antigen.

If this is positive the laboratory will do further tests to

(a) determine if infection is acute or chronic

(b) determine ‘e’ antigen status.

The screening test for HCV is Hepatitis C antibody.

If this is positive the laboratory will ‘reflex’ test for HCV RNA to decide between past or current infection, or request a further sample if insufficient sample available to complete testing.

Consider screening for HIV

Many high risk patients will also be at high risk for HIV and offering an HIV test is advised

Confirmed HBV or HCV infection

Refer to secondary care specialist

All patients positive for Hepatitis B surface antigen should be referred.

For hepatitis C, only refer patients if the HCV RNA is positive, not HCV antibody positive RNA negative patients.

Reassure HCV RNA negative patients that they do not have on-going HCV infection.

Positive antibody results are either due to past infection or non-specific reactivity in the screening test.

If there are any concerns/difficulties in interpreting the results please phone the Clinical Virology team who will be happy to help:

Virology Consultant Virologist/Clinical Lead Virology and Molecular Pathology  Ext: 25340 Virology Clinical Scientist(s)  Ext: 25471/25349

Referral information should include: medical history, mental health history, risk factors history, alcohol / substance misuse, sexual history

Further action in primary care

High risk patients may have on-going risk of acquiring infection (eg if current drug use etc) so it is worthwhile starting a HBV vaccination course after 1st bloods taken.

If the result comes back as positive for HBV infection then further vaccination is unnecessary – but no harm will have been done. If negative for HBV then complete the course.

If a patient is confirmed as having HCV infection then avoiding acquisition of HBV is particularly important, so offer patients with HCV infection vaccination against HBV infection if this has not already been done.

For confirmed cases of HBV infection offer HBV vaccination to close contacts / sexual partners / family members / household contacts.

Refer to Immunisation Against Disease (The Green Book)

Offer advice regarding prevention of onward transmission e.g. safe sex, donating blood, needle sharing.

Request ‘New Liver Patient’ screen, and state on form that patient has newly diagnosed HBV or HCV. This profile will help the hepatologist make best use of the first out-patient appointment.

The panel is: A1 antitrypsin, liver/kidney antibodies, auto-antibody screen, alphafetoprotein, FBC, ferritin, gamma GT, glucose, immunoglobulins, INR, LFTs, U&Es. Please do not request this profile until the diagnosis of HBV or HCV is made.

For HBV positive patients it is also helpful to the hepatologist, but not essential, if an HBV viral load (3 x EDTA blood bottles) is requested, so that this result is available for the first out-patient visit.

For either HBV or HCV positive patients please offer an HIV test if not already done

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