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Hepatitis testing conducted during colonoscopy appointments aided older patients

Testing older patients for hepatitis during colonoscopy appointments may be an effective and easily implemented approach to mass screening, according to recent results.

In a prospective study, researchers offered viral hepatitis testing to 500 patients aged 50 to 65 years during appointments for outpatient colonoscopy between October 2010 and January 2011. Along with blood samples, participants reported their risk factors and vaccination history for and potential exposure to hepatitis. Vaccination was offered to patients without existing HAV or HBV immunity, and follow-up was conducted for those who tested positive for HCV antibodies or hepatitis B surface antigen (HBsAg).

Evaluable blood samples were collected from 346 of 376 patients who agreed to be tested. Ninety-three percent did not have immunity to either HAV, HBV or both, with 240 patients testing negative for HAV and 283 negative for HBV antibodies. Fifty-one patients were vaccinated after the study.

One or more risk factors for chronic hepatitis were observed in 36% of the cohort; 8% had multiple risk factors. Being tattooed before 2000 (8%), high-risk sexual behavior and/or having STDs (8%) and having ever injected or snorted drugs (7%) were the most common risk factors.

No HBsAg positivity was detected, and HCV antibodies were present in four cases, with one instance of detectable virus. All four anti-HCV-positive participants complied with testing and follow-up. Investigators said one patient with detectable virus later received vaccination against HAV and HBV, improved his diet, stopped consuming alcohol and will undergo noninterferon-based treatment.

“With the recommendation for one-time hepatitis screening of over 80 million baby boomers in the United States, utilizing an existing health-care screening system to deliver this service is highly desirable,” the researchers wrote. “Incorporating viral hepatitis screening into colorectal cancer screening has the potential to be an easily instituted mass-screening mechanism. We hypothesize that this strategy will focus our limited national health care resources on those patients who are most likely to appear for follow-up testing and ultimately curative therapy. This will have to be explored … to determine the validity of this claim.”