CDC Updates Hepatitis C Treatment Guidelines

Preventative measures emphasized to reduce transmission of disease.

The CDC has provided new recommendations that update the 2010 guidelines on the treatment and management of sexually transmitted diseases. The 2015 guidelines were published online June 5 issue in the US Centers for Disease Control and Prevention (CDC) Morbidity and Mortality Weekly Report.

The guidelines were authored by a multidisciplinary workgroup, who identified the major issues associated with the treatment and clinical management of STDs not previously covered in the 2010 Sexually Transmitted Diseases Treatment Guidelines.

The updated guidelines include yearly hepatitis C virus (HCV) testing in HIV-infected individuals.

“Studies of HCV transmission between heterosexual or homosexual couples have yielded mixed results, but generally have found either no or very minimally increased rates of HCV infection in partners of persons with HCV infection compared with those whose partners are not HCV-infected,” the authors wrote. “However, data indicate that sexual transmission of HCV can occur, especially among persons with HIV infection.”

The CDC noted that increasing incidence of acute HCV infection among HIV-infected men who have sex with men were reported in New York City and Boston, in addition to multiple European cities. These men commonly engage in “high-risk and traumatic sexual practices and might have concurrent genital ulcerative disease or STD-related proctitis.”

Additional common practices linked to new incidents of HCV infection include group sex, cocaine use and other nonintravenous drug use during sex. Prior research indicates that the of infection risk increases commensurate with increasing numbers of sex partners among heterosexual persons with HIV infection and men who have sex with men, especially if when one of the partners carries an HIV coinfection.

“Reducing the burden of HCV infection and disease in the United States requires implementation of both primary and secondary prevention activities,” the authors wrote. “Primary prevention reduces or eliminates HCV transmission, whereas secondary prevention activities are aimed at reducing CLD and other chronic diseases in persons with HCV infection by first identifying them and then providing medical management and antiviral therapy, if appropriate. No vaccine for hepatitis C is available, and prophylaxis with immune globulin is not effective in preventing HCV infection after exposure.”

The updated guidelines note: persons with HCV infection should be provided information regarding how to protect their liver from further harm (i.e., hepatotoxic agents); for instance, persons with HCV infection should be advised to avoid drinking alcohol and taking any new medicines (including over-the-counter and herbal medications) without checking with their clinician. In addition, a determination for the need of hepatitis A and B vaccination should be made; persons who are not immune should be vaccinated.

To reduce the risk of transmitting the virus to others, HCV-infected patients should be advised:

• not to donate blood, body organs, other tissue, or semen;
• not to share any personal items that might have blood on them (e.g., toothbrushes and razors); and
• to cover cuts and sores on the skin to keep the virus from spreading by blood or secretions. Women with HCV infection do not need to avoid pregnancy or breastfeeding.

HCV-infected drug uses are encouraged to take the following steps to reduce personal and public health risks:

• never reuse or share syringes, water, or drug preparation equipment;
• only use syringes obtained from a reliable source (e.g., pharmacies);
• use a new, sterile syringe to prepare and inject drugs;
• if possible, use sterile water to prepare drugs; otherwise, use clean water from a reliable source (e.g., fresh tap water);
• use a new or disinfected container (i.e., cooker) and a new filter (i.e., cotton) to prepare drugs;
• clean the injection site before injection with a new alcohol swab; and
• safely dispose of syringes after one use.