The United States Preventive Services Task Force (USPSTF) recommends screening for hepatitis C virus (HCV) infection in persons at high risk for infection and one-time screening for all adults born between 1945 and 1965. USPSTF published the recommendation in the June 25 issue of Annals of Internal Medicine.
USPSTF designated the recommendation as Grade B, which means, according to the task force, "There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial." On that basis, USPSTF suggests that providers offer the HCV screening.
Up to 3.9 million people in the United States are infected with HCV, a virus that can cause inflammation, permanent liver damage and cancer, according to USPSTF. An estimated 15,000 Americans die each year from the consequences of HCV infection.
The most significant risk factor for HCV infection is past or current injection drug use. Receiving a blood transfusion before 1992 is also an established risk factor, the task force said. Additional risk factors include chronic hemodialysis, being born to an HCV-infected mother, incarceration, intranasal drug use, getting an unregulated tattoo, and other percutaneous exposures, such as being a healthcare worker or having surgery before the implementation of universal precautions.
The article stated that HCV infection is most prevalent among people born from 1945 through 1965 -- a population of approximately 80 million individuals collectively referred to as baby boomers -- and many of them are unaware that they are infected. The Centers for Disease Control and Prevention estimates that one out of every 30 baby boomers is living with an HCV infection. This presents a problem because HCV progresses slowly, and the risk of serious complications increases as time passes, the article explained.
The task force found that a risk-based approach may miss detection of a substantial proportion of HCV-infected persons in the birth cohort because of a lack of patient disclosure or knowledge about prior risk status. One-time screening for HCV infection in the birth cohort may identify infected patients at an earlier, more treatable stage of disease, USPSTF said.
This is an update to a previous recommendation. In 2004, USPSTF recommended against routine screening for HCV infection in asymptomatic adults who are not at increased risk for infection. At the time, the task force also found insufficient evidence to recommend for or against routine HCV screening for adults at high risk for infection.
To inform an update, researchers studied published evidence focusing on research gaps identified in the previous review. The researchers found adequate evidence that the antiviral regimens used as treatment for HCV result in improved clinical outcomes, and that targeted screening misses up to two-thirds of infected patients. In addition, screening tests appear to be accurate for identifying HCV-infected patients with minimal risk of harm.
The American Association for the Study of Liver Diseases issued a statement applauding USPSTF for upgrading its recommendation from a C to B level. "This seemingly small change…signals an incredible change in the lives of patients who have HCV and are unaware of it," the statement said. "A 'B' rating allows for payment by Medicare and private insurers for testing with no co-payment by patients."
The authors of an accompanying editorial in the Annals of Internal Medicine wrote that the task force’s expanded screening recommendations are especially important in light of highly effective treatment for HCV. Screening both those at risk and the birth cohort will help to identify millions of Americans previously unaware of their infection status, preventing liver disease and deaths attributable to chronic HCV infections, the report said.