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USPSTF recommends HCV testing for high-risk adults, baby boomers
The United States Preventive Services Task Force recently recommended screening for adults at high risk for hepatitis C virus infection and one-time screening for all Americans born between 1945 and 1965 because the birth cohort is at greater risk for infection compared with other age groups.
The new guidelines, published in the Annals of Internal Medicine, follow a less enthusiastic endorsement of HCV screening from the USPSTF last year, when the task force recommended that clinicians consider testing for their patients, but did not advise routine screening for all Americans in the birth cohort.
In 2004, the USPSTF recommended against screening for HCV in adults who were not at high risk for infection. According to the task force, the decision was based on “a low prevalence of HCV infection, the natural history of chronic HCV infection, a lack of direct evidence showing that screening or antiviral treatments improve important health outcomes, and the potential harms of screening.”
The USPSTF also found insufficient evidence at the time to recommend screening for high-risk adults.
Virginia A. Moyer, MD, MPH, and colleagues from the task force conducted two systematic reviews focused on evidence gaps identified in 2004 and on studies on HCV screening and treatment published since then. This time, the task force found adequate evidence that HCV screening would provide “moderate net benefit,” citing more effective treatments and accurate, noninvasive screening as part of their rationale. Also, a large proportion of HCV-infected patients are unaware of their status, and a risk-based approach to screening may fail to detect many of them, the task force said.
The American Association for the Study of Liver Diseases, the Infectious Diseases Society of America and the American College of Gastroenterology all recommend HCV screening for higher-risk adults, and the CDC currently recommends screening both for high-risk adults and the birth cohort.
David A. Relman
“This important recommendation will not only influence medical practice, but will also help expand access to screening services, as private and public insurers look to the task force’s recommendations in making coverage decisions,” IDSA President David A. Relman, MD, said in a statement.
For more information:
Moyer VA. Ann Intern Med. 2013;doi:10.7326/0003-4819-159-5-201309030-00672.
U.S. Preventive Services Task Force. Ann Intern Med. 2004;140:462-464.
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Hepatitis C is a silent epidemic in the United States. The majority of people who have hepatitis C don’t know their status. Oftentimes, once a diagnosis is made, it’s usually when someone is ill, and their average mortality after diagnosis can be 3 years. So, in other words, if someone who presents with advanced liver disease — cirrhosis or hepatocellular carcinoma — it’s too late.
All the lessons we learned in HIV are almost directly applicable to hepatitis C. In particular, 1) the majority of people with HCV in the United States today are unaware of their status; 2) the people who do show up, show up too late to be treated; 3) once they do show up, their mortality is high; and 4) the only way we are going to identify people early enough to intervene will be through more universal testing. A key difference between HIV and HCV is that a high concentration of people became infected roughly between 1945 and 1965, so therefore we have a concentrated population to look at, and in essence that’s what these recommendations are about. Starting there, we can identify those who are infected and get them into care. A second key difference, of course, is that we can cure HCV.
There were a couple of reasons that the Task Force has reconsidered its position. First, there is more epidemiological data now, and the CDC has already made these same types of recommendations. But the biggest difference now is that, on the horizon and in fact probably within the next year, there’s going to be very effective therapies that are all oral and do not require interferon or injections. These therapies have a 90-plus percent chance of curing hepatitis C and thereby remove all risk for advanced liver disease by simply treating their infection and getting rid of it, especially among asymptomatic patients.
It’s a great step forward that the Task Force has endorsed this approach, and it will begin to make a huge difference for long-term survival for those infected with hepatitis C today. The impact of the recommendations combined with these new drugs is going to make a huge difference in the incidence of cirrhosis and hepatocellular carcinoma for, let’s say, the year 2030. This is going to be an enormous step forward for those patients and their families.