HCV screening recommended for high-risk individuals and baby boomers

USPSTF Endorses HCV Screen for High-Risk, Baby Boomers
USPSTF Endorses HCV Screen for High-Risk, Baby Boomers

HealthDay News -- The US Preventive Services Task Force (USPSTF) recommends screening high-risk individuals for hepatitis C virus (HCV) infection, and recommends a one-time screening for all adults born from 1945 to 1965, according to a statement published in Annals of Internal Medicine.

Somewhere between 2.7 and 3.9 million Americans are living with an HCV infection, which is the leading cause of liver transplants. When untreated, 40% of cases will cause cirrhosis or cancer. Yet as many as 85% of those with chronic HCV are unaware of their condition, which partially explains why HCV-related mortality increased by 50% between 1999 and 2007. If this absence of treatment persists, an estimated 1 million more people will die from HCV-related causes, according to the CDC.

On the other hand, appropriate care and testing could potentially cut HCV mortality in half. Current available antiviral agents cause virologic clearance or cure in 79% of patients, and clinicians expect that figure to rise after the implementation of new, more effective drugs that have shorter treatment durations and fewer adverse effects.

In their study, researchers from the USPSTF conducted a systematic literature review to update the 2004 recommendation statement for asymptomatic adults, which reported insufficient evidence to justify promoting the screening of low risk individuals.

Although it was found that incidence of HCV has dropped significantly since the 1980s, the results showed that three out of four patients living with HCV infection between 1999 and 2008 were born between 1945 and 1965. Moreover, persons in this birth cohort accounted for more than 70% of HCV-related deaths in 2007. This dynamic may be caused by the demographic's possible exposure to infected blood transfusions, which weren't screened until 1992.

Other high risk factors are drug use via injection, or intercourse with someone who has used drugs via injection.  Risk-based methods for screening have proven successful in identifying HCV patients within certain vulnerable populations, like people with AIDS, people receiving hemodialysis or people who have gotten unregulated tattoos.  However, these approaches have been less successful when applied to the general population, failing to identify many individuals in the aforementioned birth cohort.

As a result, the task force recommends a two-pronged approach. First, it recommends HCV screening in those at high risk for infection; the suggestion applies to all asymptomatic adults without known liver disease or functional abnormalities. In addition, one-time screening should be offered to adults born between 1945 and 1965.

The hope is that increased screening will help find individuals who did not know they had HCV and would have otherwise not bothered to check.  “Even though they may have no symptoms yet, the evidence is convincing that one-time screening will help find millions of Americans with the infection before they develop a serious liver disease," said task force co-chair Albert Siu, MD at the Mount Sinai Hospital.


References

  1. Moyer VA et al. Annals of Internal Medicine. 2013;doi:10.7326/0003-4819-159-5-201309030-00672.
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