American Society for Clinical Pathology
View all recommendations from this societySeptember 4, 2019
Do not repeat Hepatitis C virus antibody testing in patients with a previous positive Hepatitis C virus (HCV) test. Instead, order Hepatitis C viral load testing for assessment of active versus resolved infection.
There are joint guidelines from the Infectious Diseases Society of America and the American Association for the Study of Liver Diseases, which are consistent with guidance from the Centers for Disease Control and Prevention regarding the testing, management and treatment of patients with HCV infection (1, 2). A positive HCV antibody test remains positive for life (3). Repeat HCV antibody testing, adds cost but no clinical benefit, so it should not be performed. A common reason for unnecessary repeat testing is the inclusion of this test in order sets (eg, hepatitis and/or opioid screening order sets), or a result of problematic follow-up of HCV positive patients in an outpatient setting.
A positive HCV serologic test (or a proven history of positive results) should be followed by an HCV viral load test, which distinguishes an active from resolved infection. The result of the HCV viral load establishes a baseline in patients with active disease by which the efficacy of therapy can be monitored. Patients with active infection (i.e. positive serology and HCV viral load) may often need an HCV genotyping assay to guide therapy.
Patients who have had a remote and resolved HCV infection who are suspected to have been reinfected, should be tested using the HCV viral load test, rather than the HCV antibody test, since this latter test remains positive for life. Viral load reflects the degree and severity of active infection and also acts as a useful component in monitoring antiviral therapy in medication-managed patients.
These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.
How The List Was Created
1-5: The American Society for Clinical Pathology (ASCP) list was developed under the leadership of the chair of ASCP’s Institute Advisory Committee and Past President of ASCP. Subject matter and test utilization experts across the fields of pathology and laboratory medicine were included in this process for their expertise and guidance. The review panel examined hundreds of options based on both the practice of pathology and evidence available through an extensive review of the literature. The laboratory tests targeted in our recommendations were selected because they are tests that are performed frequently; there is evidence that the test either offers no benefit or is harmful; use of the test is costly and it does not provide higher quality care; and, eliminating it or changing to another test is within the control of the clinician. The final list is not exhaustive (many other tests/procedures were also identified and were also worthy of consideration), but the recommendations, if instituted, would result in higher quality care, lower costs, and more effective use of our laboratory resources and personnel.
6–15: The American Society for Clinical Pathology (ASCP) list of recommendations was developed under the leadership of the ASCP Choosing Wisely Ad Hoc Committee. This committee is chaired by an ASCP Past President and comprises subject matter and test utilization experts across the fields of pathology and laboratory medicine. The committee considered an initial list of possible recommendations compiled as the result of a survey administered to Society members serving on ASCP’s many commissions, committees, and councils. The laboratory tests targeted in our recommendations were selected because they are tests that are performed frequently; there is evidence that the test either offers no benefit or is harmful; use of the test is costly and it does not provide higher quality care; and
eliminating it or changing to another test is within the control of the clinician. Implementation of these recommendations will result in higher quality care, lower costs, and a more effective use of our laboratory resources and personnel.
16-35 The American Society for Clinical Pathology (ASCP) list of recommendations was developed under the leadership of the ASCP Effective Test Utilization Steering Committee. This committee is chaired by an ASCP Past President and is comprised of subject matter and test utilization experts across the fields of pathology and laboratory medicine. The committee considered a list of possible recommendations compiled as the result of a survey administered to Society members serving on ASCP’s many commissions, committees and councils. In addition, an announcement was made to ASCP’s newly formed Advisory Board seeking suggestions for possible recommendations to promote member involvement. The laboratory tests targeted in our recommendations were selected because they are tests that are performed frequently; there is evidence that the test either offers no benefit or is harmful; use of the test is costly and it does not provide higher quality care; and eliminating it or changing to another test is within the control of the clinician. Implementation of these recommendations will result in higher quality care, lower costs and a more effective use of our laboratory resources and personnel.
ASCP’s disclosure and conflict of interest policy can be found at www.ascp.org.
Sources
Infectious Disease Association of America. HCV guidance: recommendations for testing, managing, and treating hepatitis C. Accessed on July 22, 2016 at http://www.hcvguidelines.org/full-report/initial-treatment-hcv-infection.
Centers for Disease Control and Prevention. Viral Hepatitis – Hepatitis C Information. Hepatitis C FAQs for health professionals. Accessed on July 22, 2016 at http://www.cdc.gov/hepatitis/hcv/hcvfaq.htm#section3.
Kanakis CE. The “C” in HCV Stands for “Curable” [Internet]. Lablogatory. ASCP; 2018 [cited 2018Mar2]. Available from: https://labmedicineblog.com/2018/02/26/the-c-in-hcv-stands-for-curable/.
