Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, USA.
MMWR Recomm Rep. 2012 Aug 17;61(RR-4):1-32.
Hepatitis C virus (HCV) is an increasing cause of morbidity and mortality in the United States. Many of the 2.7-3.9 million persons living with HCV infection are unaware they are infected and do not receive care (e.g., education, counseling, and medical monitoring) and treatment. CDC estimates that although persons born during 1945-1965 comprise an estimated 27% of the population, they account for approximately three fourths of all HCV infections in the United States, 73% of HCV-associated mortality, and are at greatest risk for hepatocellular carcinoma and other HCV-related liver disease. With the advent of new therapies that can halt disease progression and provide a virologic cure (i.e., sustained viral clearance following completion of treatment) in most persons, targeted testing and linkage to care for infected persons in this birth cohort is expected to reduce HCV-related morbidity and mortality. CDC is augmenting previous recommendations for HCV testing (CDC. Recommendations for prevention and control of hepatitis C virus (HCV) infection and HCV-related chronic disease. MMWR 1998;47[No. RR-19]) to recommend one-time testing without prior ascertainment of HCV risk for persons born during 1945-1965, a population with a disproportionately high prevalence of HCV infection and related disease. Persons identified as having HCV infection should receive a brief screening for alcohol use and intervention as clinically indicated, followed by referral to appropriate care for HCV infection and related conditions. These recommendations do not replace previous guidelines for HCV testing that are based on known risk factors and clinical indications. Rather, they define an additional target population for testing: persons born during 1945-1965. CDC developed these recommendations with the assistance of a work group representing diverse expertise and perspectives. The recommendations are informed by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework, an approach that provides guidance and tools to define the research questions, conduct the systematic review, assess the overall quality of the evidence, and determine strength of the recommendations. This report is intended to serve as a resource for health-care professionals, public health officials, and organizations involved in the development, implementation, and evaluation of prevention and clinical services. These recommendations will be reviewed every 5 years and updated to include advances in the published evidence.
丙型肝炎病毒（HCV）在美国是发病率和死亡率不断上升的原因之一。在美国，约有 270 万至 390 万人感染 HCV，但其中许多人并不知道自己受到感染，也没有接受教育、咨询和医疗监测等护理以及治疗。美国疾病控制与预防中心（CDC）估计，虽然 1945 年至 1965 年出生的人约占总人口的 27%，但他们约占美国所有 HCV 感染的四分之三、所有与 HCV 相关的死亡病例的 73%，并且是罹患肝细胞癌和其他 HCV 相关肝病的最大风险人群。随着新疗法的问世，这些疗法能够阻止疾病进展并为大多数人提供病毒学治愈（即治疗完成后持续病毒清除），因此针对该出生队列中感染者进行有针对性的检测和提供护理有望降低 HCV 相关发病率和死亡率。CDC 正在加强之前针对 HCV 检测的建议（CDC. 预防和控制丙型肝炎病毒（HCV）感染和 HCV 相关慢性疾病的建议。MMWR 1998;47[No. RR-19]），以建议对 1945 年至 1965 年出生的人群进行一次 HCV 检测，而无需事先确定 HCV 感染风险，因为该人群 HCV 感染和相关疾病的流行率过高。被确定为 HCV 感染者的人应接受酒精使用情况的简短筛查和临床干预，随后转介至适当的 HCV 感染和相关疾病护理。这些建议并未取代基于已知风险因素和临床指征的之前的 HCV 检测指南。相反，它们为检测确定了一个额外的目标人群：1945 年至 1965 年出生的人群。CDC 在一个代表不同专业知识和观点的工作组的协助下制定了这些建议。这些建议是根据分级评估、制定与评价（GRADE）框架制定的，该框架提供了指导和工具，以确定研究问题、进行系统评价、评估证据的整体质量，并确定建议的强度。本报告旨在为医疗保健专业人员、公共卫生官员以及参与预防和临床服务的制定、实施和评估的组织提供资源。这些建议将每 5 年审查一次，并进行更新，以纳入已发表证据中的进展。
