in adults at high risk for HCV infection. In making this recommendation the USPSTF notes potential harms of screening and treatment including labeling of the patient, adverse treatment effects, and unnecessary liver biopsies.This recommendation should be interpreted as suggesting the need for additional research [2]. A response from the Centers for Disease Control and Prevention to the USPSTF recommendation emphasizes that medical and public health professionals should continue the practice of screening persons for risk factors, and offering testing to those at increased risk [3].Centers for Disease Control and Prevention The Centers for Disease Control and Prevention recommend that testing for HCV should be routine in patients at increased risk for infection, including those who (www.cdc.gov/mmwr/pdf/rr/rr5203.pdf and http://www.cdc.gov.libproxy.lib.unc.edu/mmwr/preview/mmwrhtml/rr5912a1.htm):Ever injected illegal drugsReceived clotting factors made before 1987Received blood/organs before July 1992Were ever on chronic hemodialysisHave evidence of liver disease (elevated alanine aminotransferase [ALT] level)Are infected with HIVTesting should also be performed based upon the need for exposure management including:Healthcare, emergency, and public safety workers after needle stick/mucosal exposure to HCV-positive bloodChildren born to HCV-positive womenRoutine testing is not recommended (unless an additional risk factor is identified) in:Healthcare, emergency medical, and public safety workersPregnant womenHousehold (non-sexual) contacts of HCV-positive personsThe general populationThe need for testing is uncertain in the following groups:Recipients of transplanted tissue after 1992Intranasal cocaine or other non-injecting illicit drug usersThose with a history of tattooing, body piercingThose with a history of sexually transmitted diseases or multiple sex partnersLong-term steady sexual partners of HCV-positive personsNational Institutes of Health The National Institutes of Health (NIH) consensus guidelines are similar to those of the CDC. In addition to the CDC guidelines, the NIH guidelines recommended screening individuals who:Received a blood transfusion or organ transplantation prior to 1990 (rather than 1992)Have had multiple sexual partnersAre spouses or household contacts of HCV-infected patientsShare instruments for intranasal cocaine useAmerican Association for the Study of Liver Diseases A 2009 practice guideline issued by the American Association for the Study of Liver Diseases (AASLD) recommends testing for the following groups [4]:Those who have injected illicit drugs in the recent and remote past, including those who injected only once and do not consider themselves to be drug usersThose with conditions associated with a high prevalence of HCV including patients with HIV infection, those with hemophilia who received clotting factor concentrates before 1987, persons who were ever on hemodialysis, and those with unexplained abnormal aminotransferase levelsPrior recipients of transfusions or organ transplants before July 1992, including those who were notified that they received blood from a donor who later tested positive for HCV infectionChildren born to HCV-infected mothersHealthcare, emergency and public safety workers after a needle stick injury or mucosal exposure to HCV-positive bloodCurrent sexual partners of HCV-infected personsAuthors' recommendations Our general approach is consistent with the guidelines recommended by the AASLD. Notably, the presence of an abnormal serum ALT level, any history of injection drug use, or a history of blood transfusion before 1992 identified 85 percent of HCV RNA positive participants between the ages 20 to 59 in the most recent National Health and Nutrition Examination Survey in the