This week in the Canadian Medical Association Journalthe Canadian Association for the Study of the Liver published their guidelines for identifying and managing people with hepatitis C virus (HCV). The most significant change from past guidelines is they recommendation that all Canadians aged between 43 and 73 years (i.e., born 1945 – 1975) should be tested for HCV.

According to the association, 44% – 70% of Canadians with HCV remain undiagnosed and many of them are likely older adults.

HCV is spread by blood-to-blood contact. Persons who had a blood transfusion or received blood products prior to July 1990 are at risk for having HCV. Further, person who had procedures, such as getting a tattoo, pedicure, piercing, medical procedure, done with improperly sterilized equipment are at risk for being exposed to the virus. Even sharing a toothbrush or nail clippers with a person infected with HCV can lead to an infection. Most cases are due to patients sharing a needle.

Thereason the association wants those older adults tested is that there is now an effective treatment that can cure people of the virus. If left untreated, persons are at risk for developing chronic liver damage that can be life threatening.

Other populations that the association recommend getting screened for HCV are those patients with:

  • History of current or past (even once) injection drug use*
  • Received health care or personal services where there is a lack of infection prevention and control practices
  • Received a blood transfusion, blood products or organ transplant before 1992 in Canada
  • History of or current incarceration
  • Born or resided in a region where hepatitis C prevalence is > 3%, such as:
    • Central, East and South Asia;
    • Australasia and Oceania;
    • Eastern Europe;
    • Subsaharan Africa;
    • North Africa or Middle East
  • Born to a mother who is HCV-infected
  • History of sexual contact or sharing of personal care items with someone who is HCV-infected*
  • HIV infection, particularly men who have sex with men*
  • Received chronic hemodialysis treatment
  • Elevated alanine aminotransferase

These new recommendations are similar to those recently developed in the United States and France, and would be in line with the World Health Organizations’ push to have HCV completely eliminated by the year 2030.


Shah H, Bilodeau M, Burak KW, et al. The management of chronic hepatitis C: 2018 guideline update from the Canadian Association for the Study of the Liver. CMAJ  2018 ;190:E677-E687. DOI: