USPSTF recommends hepatitis C screening for baby boomers and high-risk patients

All patients born between 1945 and 1965 should be screened for hepatitis C virus (HCV), as should all high-risk patients, the U.S. Preventive Services Task Force recently recommended.

The recommendations, published by Annals of Internal Medicine on June 25, concluded that one-time screening of patients born 1945-1965 is moderately certain to provide moderate benefit (a B recommendation). Patients in this age group may have undergone blood transfusions before 1992 or have a long-ago history of other risk factors. A risk-based approach could miss a substantial proportion of HCV-infected persons in this cohort, the USPSTF said.

As for high-risk patients, past or present injection drug use and a blood transfusion before 1992 were identified as the most significant risk factors meriting screening (also moderately certain to be of moderate benefit). Other risk factors include long-term hemodialysis, being born to an HCV-infected mother, incarceration, intranasal drug use, getting an unregulated tattoo, and other percutaneous exposures, but the relative significance of these risks may differ by location and other factors, the Task Force noted. It recommended periodic screening of patients who continue to be high risk but noted that the optimal frequency of screening is unknown.

The new recommendations represent a significant change from those issued in 2004, when the USPSTF recommended against screening for HCV infection in adults not at increased risk and found insufficient evidence to recommend for or against screening in adults at high risk. However, in 2011, the FDA approved two new anti-HCV medications that demonstrated improved efficacy when used in combination with older antiviral therapies for patients with genotype 1, and other treatments are under study that may decrease the morbidity and mortality associated with HCV infection when used in affected patients identified through screening. The new recommendations are based on two systematic reviews of screening for and treatment of HCV infection in asymptomatic adults, especially focused on research published since 2004.

Anti-HCV antibody testing is recommended for initial screening. If negative, no further testing is necessary. If positive, this test should be followed by polymerase chain reaction testing for HCV RNA. Positive polymerase chain reaction testing for HCV RNA indicates current HCV infection. It should be opt-out screening, in which patients are informed orally or in writing that HCV testing will be performed unless they decline. Before HCV screening, patients should receive an explanation of HCV infection, how it can and cannot be acquired, the meaning of positive and negative test results, and the benefits and harms of treatment, as well as an opportunity to ask questions and to decline testing.

The USPSTF noted that the new recommendations match current CDC recommendations. An accompanying editorial suggested that the Affordable Care Act will facilitate implementation of these recommendations, as it requires preventive services with an A or B recommendation from the USPSTF to be covered by private health plans without patient cost.