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Difficulty: EasyPreventive Care and Screening

A 40-year-old man presents to the outpatient clinic for a routine health maintenance evaluation. He has no significant past medical history and takes no medications. He has never smoked and consumes alcohol occasionally. He has no history of injection drug use or prior blood transfusions. A review of his records shows that his last lipid panel and HIV screening test were performed 5 years ago and were normal. He has never been screened for hepatitis C virus (HCV) infection. Vital signs are normal. Physical examination is unremarkable, with no scleral icterus or hepatomegaly. Which of the following is the most appropriate recommendation regarding HCV screening for this patient?

  1. A
    Annual screening with hepatitis C virus antibody testing
  2. B
    One-time screening with hepatitis C virus RNA polymerase chain reaction testing
  3. One-time screening with hepatitis C virus antibody testingAnswer
  4. D
    Screening is not indicated due to the absence of injection drug use history
  5. E
    Screening is not indicated until 50 years of age

Answer

One-time screening with hepatitis C virus antibody testing
The most appropriate next step is one-time screening with hepatitis C virus (HCV) antibody testing. The United States Preventive Services Task Force (USPSTF) recommends one-time universal screening for HCV infection in all adults aged 18 to 79 years, regardless of their risk factors. The initial screening is performed using an HCV antibody test.

Step-by-Step Solution

1
Identify the patient's demographic profile and preventive care needs.
The patient is a 40-year-old man with average risk who has never been screened for hepatitis C virus.
Preventive screening guidelines are heavily dependent on age and prior screening history.
2
Recall the current evidence-based guidelines for hepatitis C virus screening.
The USPSTF recommends universal, one-time screening for hepatitis C virus infection in all adults aged 18 to 79 years.
Applying current guidelines ensures the correct screening intervention is chosen and outdated risk-based practices are avoided.
3
Determine the appropriate initial screening modality.
The initial screening test is the hepatitis C virus antibody test.
Antibody testing is the standard first-step screening tool, followed by confirmatory RNA testing only if the initial result is positive.

Key Concept

The USPSTF recommends one-time screening for hepatitis C virus (HCV) infection with an HCV antibody test for all adults aged 18 to 79 years, regardless of risk factors.
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Topics

Preventive Care and Screening

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