Task Force Recommends Hepatitis C Testing for Baby Boomers

The U.S. Preventive Services Task Force recommends that all patients born between 1945 and 1965 as well as high-risk patients of all ages be tested for hepatitis C.

The U.S. Preventive Services Task Force (USPSTF) now recommends that patients of all ages at high risk as well as all patients born between 1945 and 1965 be screened for hepatitis C (HCV). The new recommendations, released in a statement published online on June 25, 2013, in the Annals of Internal Medicine, match those issued in 2012 by the Centers for Disease Control and Prevention.

Previous USPSTF recommendations released in 2004 advised against testing patients without risk factors and symptoms for HCV and did not indicate whether patients at high risk should be screened or not. To update these recommendations, the Agency for Healthcare Research and Quality conducted 2 systematic reviews of studies published since 2004 on the potential benefits and harms of HCV screening and treatment.

Although no studies included in the reviews specifically showed that HCV screenings in patients without symptoms reduce morbidity rates, some studies did show that current treatments lead to sustained virologic response and improved patient outcomes. The reviews also found that anti-HCV antibody testing is more than 90% accurate in detecting HCV infections in high-risk patients. Anti-HCV antibody testing, as well as other noninvasive tests, was also found to be highly accurate in asymptomatic patients.

The harms of screening for HCV were found to be uncommon and included anxiety and feelings of stigmatization. More serious reactions, including bleeding, infection, and pain, were associated with approximately 1% of patients who received a liver biopsy after diagnosis in order to guide treatment. The use of liver biopsies is declining, however, and less than 0.2% of biopsies resulted in death. Antiviral therapy treatments are also associated with adverse reactions such as fatigue, headache, flu-like symptoms, and rash. These side effects usually resolve at the end of treatment, and serious adverse events are uncommon.

Considering the effectiveness of treatments, the accuracy of testing, and the minimal adverse effects, the USPSTF recommends that all individuals born between 1945 and 1965 be offered a 1-time screening for HCV, as people born during this span are more likely to be diagnosed with an infection. The USPTF also suggests that patients at high risk for infection be tested, although it does not indicate how frequently these screenings should be administered.

In an accompanying editorial, Quyen Ngo-Metzger, MD, MPH, John W. Ward, MD, and Ronald O. Valdiserri, MD, MPH, stress the importance of the recommendation that all baby boomers be tested for HCV as many patients infected with the virus do not show any symptoms. The editorialists estimate that testing, combined with proper treatment, can reduce the risk of hepatocellular carcinoma by 70% and the risk of any HCV-related death by 50%.

“We can now focus our efforts on ensuring capacity for the delivery of clinical preventive services that can reduce missed opportunities for HCV diagnosis and linkage to care and treatment,” they write.

To read the full statement visit: http://annals.org/article.aspx?articleid=1700383