With the U.S. Preventive Services Task Force (USPSTF) in the process of developing(www.uspreventiveservicestaskforce.org) new draft recommendations on screening for hepatitis C virus (HCV) infection in adults, the timing of the CDC's proposal to expand its current HCV screening recommendations(www.cdc.gov) may raise questions among practicing family physicians. Because the AAFP and USPSTF currently do not recommend routine HCV screening, the CDC's action seemingly puts the agency at odds with the two organizations.
Chronic hepatitis C virus infection puts patients at increased risk for liver cirrhosis, liver cancer and hepatocellular carcinoma.
The CDC is calling for(www.regulations.gov) HCV screening for all people born from 1945 through 1965, a recommendation that experts say could lead to a sizeable uptick in the number of baby boomer patients looking to be tested. At this time, both the AAFP (scroll down to "Hepatitis C Virus Infection, Adult") and USPSTF(www.uspreventiveservicestaskforce.org) recommend against routine screening for HCV infection in asymptomatic adults who are not at increased risk for infection and do not recommend for or against routine screening in high-risk adults.
But the seeming discrepancy in these recommendations doesn't mean FPs should be wringing their hands, said USPSTF Co-vice Chair Michael LeFevre, M.D., M.S.P.H.
"The CDC and the USPSTF have been communicating on their independent work in this area for over two years, but each has its own specific mission and processes that may, at times, overlap," he told AAFP News Now. "I cannot say much about their timing; presumably, it fits well with the culmination of their work.
- The CDC is proposing to expand its recommendations on screening for hepatitis C virus (HCV) infection in adults to include all persons born from 1945 through 1965.
- The comment period for the CDC proposal ends June 8.
- The U.S. Preventive Services Task Force (USPSTF) is in the process of developing draft recommendations on screening for HCV infection in adults, but those recommendations are not expected to be released until later this year.
- Currently, the AAFP and USPSTF do not recommend routine HCV screening.
"I think it is also fair to point out that the current (USPSTF) recommendations are old. The last time this topic was updated was in 2004, and we all acknowledge that the science has changed. While we all hope that the science is clear and definitive on important topics, in complex and rapidly developing fields, it is possible, if not expected, that groups that use slightly different processes and may have different perspectives can come to different conclusions."
The CDC announcement notes that in 75 percent to 85 percent of people infected with HCV, the disease persists as a chronic infection, placing them at risk for liver cirrhosis, liver cancer and hepatocellular carcinoma, as well as complications involving other organ systems that can develop in the decades following onset of infection. Instances of cirrhosis hepatocellular carcinoma and HCV-related deaths have been increasing and stand to become even more widespread in the coming decades.
"HCV-infected persons who are aware of their infection can benefit from health services to prevent additional harm to the liver (e.g., hepatitis A virus and hepatitis B virus vaccination), medical monitoring and behavioral changes (e.g., reductions in alcohol use)," says the agency. "Further, antiviral therapies can clear HCV from the system (i.e., a virologic cure) and halt disease progression for many patients living with HCV infection."
The public comment period on the CDC's proposal ends June 8. Specifically, the agency is seeking public comment on whether other data, evidence or studies should be considered regarding
- the burden of HCV infection morbidity and mortality in the populations for whom testing is recommended;
- the number of people living with HCV who are unaware of their infection status;
- the benefits and harms of HCV testing, care and treatment;
- the cost-effectiveness of the proposed recommendations; and
- settings in a community where testing should be targeted.
The agency also is seeking input on whether additional factors should be considered in the development of the recommendations, as well as comments about the utility of the information to be presented.
LeFevre, a family physician from Columbia, Mo., said the USPSTF anticipates releasing its draft recommendations for public comment later this year, most likely in the late fall. In the interim, he said FPs may want to wait and review more than one take on the science before making a decision to change practice.
"If I was not on the task force … and the CDC released a guideline and the task force had a different recommendation out and I knew that another one was coming in this calendar year, I, personally, would wait," he said. "I would say, 'Well, I wonder what the task force thinks about this, and I'm interested to see what their take on the evidence is.' That would be the way I would respond as a practicing physician."
Doug Campos-Outcalt, M.D., M.P.A., of Phoenix, the Academy's liaison to the USPSTF, is a member of the work group writing the task force's forthcoming HCV screening recommendations.