Who this is for
Every adult, once. That is the position of both bodies, and it is a recent change: before 2020 both screened by birth cohort and risk factors instead.
Most people with hepatitis C have no symptoms, and CDC states that nearly one in three people with hepatitis C are unaware of their infection status. The most important risk factor is past or current injection drug use, including once, decades ago. Neither body requires you to disclose a risk factor to be tested, and CDC says explicitly that anyone who requests a test should get one.
Separate from one-time screening, both bodies recommend repeat testing for people with ongoing risk, for as long as the risk persists.
Where the recommendations diverge
- USPSTF 18 to 79
- CDC 18 and older
- CDC Not age-bounded
The USPSTF recommends screening for hepatitis C virus (HCV) infection in adults aged 18 to 79 years.
Our note: Interval from the same page's clinician summary: "One-time screening for most adults. Periodically screen persons with continued risk for HCV infection (eg, persons with past or current injection drug use). There is limited evidence to determine how often to screen persons at increased risk." The statement replaced the 2013 recommendation, which screened only people at high risk plus adults born between 1945 and 1965.
CDC recommends hepatitis C screening of all adults aged ≥18 years once in their lifetimes, and screening of all pregnant women (regardless of age) during each pregnancy.
Our note: From the Conclusion of CDC's own recommendation report, MMWR Recommendations and Reports 69(2), April 10, 2020. Both recommendations carry an exception the quoted sentence does not: settings where HCV RNA-positivity prevalence is under 0.1%. CDC adds that few such settings are known to exist. No upper age is stated, so stop_age is left empty. CDC's clinician page restates the same position and is dated January 31, 2025.
The recommendation for testing of persons with risk factors remains unchanged; those with ongoing risk factors should be tested regardless of age or setting prevalence, including continued periodic testing as long as risks persist.
Our note: Same Conclusion section. This row has no age bounds because the recommendation states none: it applies "regardless of age". CDC's clinician page names the ongoing-risk groups as people who currently inject drugs and share equipment, and people receiving maintenance hemodialysis. USPSTF agrees on periodic testing for continued risk and says the evidence does not fix an interval.
Why they differ
These two agree on the thing that changed people's lives in 2020: screen every adult once, rather than only those who admit a risk factor or were born in a particular twenty-year window. The remaining gap is at the top of the age range.
- USPSTF (2020) bounds its recommendation at 18 to 79.
- CDC (2020) writes "all adults aged ≥18 years" with no ceiling.
USPSTF's page does publish a rationale for moving the range upward, and it is an argument about trial populations rather than about harm: "Clinical trials of DAA treatment included adults in their early 80s, which increases the evidence for the benefits of screening in older adults. In addition, many older adults could experience the benefits of screening." We looked for a passage explaining why the line falls at 79 specifically and did not find one; what the page does add, outside the graded recommendation, is this: "The USPSTF also suggests that clinicians consider screening persons younger than 18 years and older than 79 years who are at high risk for infection (eg, those with past or current injection drug use)."
CDC publishes no upper-age rationale because it sets no upper age. What it publishes instead is a prevalence floor: its recommendations carry an exception for settings where HCV RNA-positivity is under 0.1%, and it notes that few settings are known to exist below that threshold.
Worth noting that the two bodies were writing at the same moment and knew it. USPSTF's page, published five weeks before CDC's report, describes CDC's then-draft guideline in its Recommendations of Others section and states its content correctly.
3 documents set the numbers on this page. The oldest was published in 2020, the newest in 2025.
- USPSTF recommendation
- CDC recommendation
- Clinical Screening and Diagnosis for Hepatitis C (page dated January 31, 2025) 2025
We last re-read these sources on . How we verify.
What the test involves
One blood draw. The laboratory runs an FDA-approved HCV antibody test, and if that is reactive, runs a nucleic acid test for HCV RNA on the same sample where possible. CDC's own sequence is explicit: use an antibody test followed by a NAT for HCV RNA when the antibody is positive or reactive.
A nonreactive antibody test means no HCV antibody was detected and, for most people, no further action. CDC adds one exception: if a recent exposure is suspected, test for HCV RNA anyway, because antibodies take weeks to appear.
If the result is abnormal
A reactive antibody test with detectable HCV RNA means a current infection, and that is the result that leads to treatment: eight to twelve weeks of oral direct-acting antivirals, curing most people. A reactive antibody test with undetectable RNA means a past infection that cleared or was treated; you can be reinfected, so ongoing risk still means ongoing testing.
CDC also asks clinicians to wrap other care around a positive result: screening and intervention for alcohol or drug use, hepatitis A and hepatitis B vaccination, and medical monitoring of liver disease.
More on this screening
Frequently asked questions
I have no risk factors. Do I still need this?
Yes, once. That is the whole point of the 2020 change at both bodies. CDC's own report gives the arithmetic behind it: approximately 45% of people infected with HCV do not recall or report having specific risk factors. Risk-based screening kept missing them.
I am over 80. Does screening still apply?
CDC sets no upper age, so under CDC you are covered. USPSTF's graded recommendation stops at 79, but the same page suggests clinicians consider screening people older than 79 who are at high risk. This is the one place the two bodies do not line up.
My antibody test was positive. Do I have hepatitis C?
Not necessarily. Antibodies persist for life after an infection, including one that cleared on its own or was cured. The RNA test is what decides: detectable RNA means a current infection, undetectable means a past one. CDC requires the second test before anything is concluded.
How often should I be retested?
For most adults, once is the recommendation. For people with ongoing risk, CDC says periodic testing for as long as the risk persists, and names people who currently inject drugs and people on maintenance hemodialysis. USPSTF agrees and says plainly that there is limited evidence to determine how often.