CDC issues guidance on exposure to HCV for health professionals

Abstract

In late July, CDC released guidance on the testing and clinical management of health care personnel potentially exposed to hepatitis C virus (HCV). The agency noted that the incidence of acute HCV infections among patients is increasing in the United States as a result of risky behaviors such as injection drug use, placing providers at risk for HCV infections if exposed to the blood and other bodily fluids of infected patients. “Testing for occupational exposure for blood- or fluid-borne pathogens is standard practice for many years,” said Rima A. Mohammad, PharmD, FCCP, BCPS, clinical pharmacist specialist in general surgery/gastroenterology/nutrition at the University of Michigan. “This guideline outlines the steps to take specific to HCV occupational exposure, which is similar to any exposure to other blood- or fluid-borne pathogens. Baseline testing of the source patient and the health care provider should occur immediately, preferably within 48 hours of exposure. CDC notes that the source patient should be tested for HCV RNA using a nucleic acid test. However, for low-risk patients, screening for anti-HCV serology (i.e., antibodies) can be done as an alternative, followed by a nucleic acid test if the serology is positive. For providers, testing should include anti-HCV testing, and if positive, HCV RNA testing. If the HCV RNA is positive at baseline, then the provider is considered to have a preexisting HCV infection and should be referred for HCV treatment. If a patient is anti-HCV positive but HCV RNA negative, then follow-up testing for the provider is not required. However, if the patient is HCV RNA positive or if the RNA status of the patient is unknown, then the provider should have follow-up HCV RNA testing 3 to 6 weeks postexposure and a final anti-HCV test 4 to 6 months postexposure as there may be periods of aviremia during acute HCV infection. Postexposure prophylaxis for HCV is not recommended for health care providers who have occupational exposure to blood or other bodily fluids. It is estimated that only 0.2% of percutaneous exposures and 0% of mucocutaneous exposures result in HCV transmission. CDC recommends that curative antiviral regimens be reserved for treatment if confirmed HCV transmission occurs. “Compared to previous HCV treatments, HCV is much easier to treat with the newer therapies that are a shorter duration, [are] well tolerated, and have efficacy rates of more than 95% for a cure or sustained virologic response,” said Mohammad. “Therefore, we can delay HCV treatment until we confirm that the health care provider is positive for HCV. The key difference between hepatitis B virus (HBV) and HCV occupational exposure is that postexposure prophylaxis is recommended after HBV exposure in select situations. “Unfortunately, with other viruses, such as HBV, there is no ‘cure’ for the infection and health care providers may need to be on long-term treatment,” said Mohammad. “Therefore, it is important to treat providers with postexposure prophylaxis (if appropriate) as soon as we confirm that the patient has an HBV infection. Routine use of the HBV vaccination for health care providers, combined with standard precautions, has resulted in a 98% decline in HBV infections over the past 2 decades, according to CDC. For those who are exposed to HBV, CDC has specific recommendations based on the vaccination status of the provider, the anti-HBs levels of the provider (i.e., < or ≥10 mIU/mL), and the status of the source patient. Postexposure recommendations vary based on these factors, but administration of HBIG and the hepatitis B vaccines are listed as options. The HCV and HBV postexposure guidance documents are available on CDC's website. The new HCV information can be used to update procedures for postexposure testing and clinical management of providers potentially exposed to the virus.