Given preliminary estimates that one in five patients with severe mental illness is infected with HCV, a strong argument can be made that all such persons should be screened for the virus. Certainly, all patients known to be infected with HIV should be screened for anti-HCV antibodies as part of their initial evaluation, as should those with high-risk behavior. HCV is primarily spread through infected blood and is therefore a common complication of injection drug use. HCV may be spread by maternal fetal transmission and by noninjected drug use activities as well. Risk for sexual transmission is low but not absent. In a significant minority of cases the mode of transmission is unknown. Like HIV, rates of HCV in the United States are higher in African Americans and Latinos than among Caucasians.
HCV infection should be confirmed with qualitative PCR assay if the patient is at low risk and the diagnosis seems in doubt. Moreover, there is a small but measurable false negative rate for antibody testing in patients who are severely immunosuppressed.
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