USPSTF expands hepatitis C screening recommendation to most adults

All adults ages 18 to 79 years should now be screened at least once, but people who use injection drugs and pregnant women may require screening more often.

The U.S. Preventive Services Task Force (USPSTF) expanded its recommendation on screening for hepatitis C virus (HCV) to include all adults ages 18 to 79 years (B recommendation), following a 3.8-fold increase in acute infections in the past decade due to increasing injection drug use.

The Task Force updated its 2013 recommendation for screening in patients at high risk for infection as well as one-time screening for adults born between 1945 and 1965. Following an evidence review, the Task Force concluded with moderate certainty that screening for hepatitis C infection in adults ages 18 to 79 years without known liver disease has substantial net benefit. The new recommendation and evidence review were published March 2 by JAMA.

A number of factors increase risk, with the most significant being past or current injection drug use, according to the Task Force. It said clinicians may want to consider screening in adolescents younger than age 18 years and in adults older than age 79 years who are at high risk. Pregnant women should be screened, and given the increasing prevalence of HCV in women ages 15 to 44 years and in infants born to infected mothers, clinicians may want to consider screening pregnant women younger than 18 years, the Task Force said.

Most adults need to be screened only once. Those who use injection drugs should be screened periodically, but there is limited information about the best screening interval, as well as how pregnancy changes the need for additional screening, the recommendation stated.

Important considerations for implementation include the following:

  • Screening is voluntary and should be undertaken only with the patient's knowledge.
  • Patients should be informed about HCV infection, how it can (and cannot) be acquired, the meaning of positive and negative test results, and the benefits and harms of treatment.
  • Patients should be provided the opportunity to ask questions.

An accompanying editorial noted that the reduced price of HCV treatment regimens should make broader access more feasible and that the increase in infections in younger people is a compelling reason for expanding screening.

“Meeting the WHO 2030 targets for reducing new HCV infections and increasing treatment will be more likely to succeed if more primary care clinicians and addiction specialists join in the important efforts to screen, treat, and achieve virologic cure for people living with HCV infection,” the editorial stated.