Screen every adult once, because the treatment now cures it

Hepatitis C is a major source of illness and death in the United States,
transmitted primarily through blood — most commonly injection drug use.

The constraints have not moved:

• No vaccine exists
• No effective pre- or post-exposure prophylaxis is available
• More than half of those infected develop chronic infection

What moved is the other side:

**Direct-acting antiviral treatment can result in a virologic cure in most
persons with 8–12 weeks of all-oral medication regimens.**

Two or three months of tablets, and most people are cured.

Why that changes who gets tested

The 2012 recommendation was to test people born during 1945–1965 — a birth
cohort carrying most of the undiagnosed infections, screened because treatment
was long, injected, poorly tolerated and often unsuccessful, so finding cases
outside the highest-prevalence group was hard to justify.

When a diagnosis leads to a cure in twelve weeks, the arithmetic inverts.
Every undiagnosed infection becomes a curable one, and the question is no
longer who is most likely to have it but who might.

Hence the new recommendation:

**Hepatitis C screening at least once in a lifetime for all adults aged ≥18
years**, except where the prevalence of infection is very low.

Once in a lifetime, for everyone. Not a risk assessment, not a conversation
about injection drug use — a single test, like a cholesterol check.

Why "once in a lifetime" is the right shape

It removes the two things that make risk-based screening fail. A clinician does
not have to decide whether this patient is the kind of person who might have
hepatitis C, and a patient does not have to disclose anything to qualify. The
category is "adult".

The exception for very low prevalence settings is the standard caveat: below
some rate, the false positives outnumber the true ones, and a test that mostly
finds people who do not have the disease does harm.

*Source: Centers for Disease Control and Prevention, MMWR Recommendations and
Reports.*