Draft Hepatitis C Screening Recommendations From USPSTF Open for Review

The U.S. Preventive Services Task Force (USPSTF) is proposing a draft recommendation that physicians routinely screen high-risk adults for hepatitis C virus (HCV) infection. The task force also is suggesting that doctors consider screening adults born between 1945 and 1965.

According to USPSTF Co-vice Chair Michael LeFevre, M.D., M.S.P.H., the updated draft recommendations define the high-risk population as asymptomatic adults with any history of IV drug use or blood transfusions before 1992. He said the task force also concluded with moderate certainty that the benefits of screening the 1945-1965 birth cohort outweigh the harms.

"In plain terms, we give a B recommendation, recommending this service for testing for hepatitis C virus in high-risk groups," LeFevre told AAFP News Now. "Part two -- a C recommendation -- is that we believe there is a small net benefit of testing the so-called 'cohort approach.'"

LeFevre, a family physician from Columbia, Mo., said the only real difference between the high-risk and cohort groups is the prevalence of the disease.

"It (prevalence) is significantly higher in the first group -- 1 in 2 people will be diagnosed with HCV," he said. "So obviously, the benefit to screening in that group is going to be higher than in the cohort approach, which takes (prevalence) down to roughly 1 in 25 to 30 people being diagnosed with HCV. It's about the numbers more than anything else."

LeFevre said it is also important to note that, three-quarters of the people in the United States who are currently infected with HCV are in the 1945-1965 birth cohort.

"So if a family physician wanted to make it easy -- and I wouldn't fault people for this -- and test everybody in (that birth) cohort, then they'd only need to worry about IV drug use in the younger age group, as well as anyone who had a blood transfusion prior to 1992," he said. "Simply put, they should consider (screening) people born between 1945 and 1965 who don't fall into the first category, but understand the yield on that is going to be smaller."

LeFevre said that because some people may not be sure if they had a transfusion before 1992, FPs may need to ask a few more questions.

"Maybe (the patient) was in a car accident and they came in to the emergency room and were hospitalized and they think, 'Maybe I did get blood, but gosh, that was 30 years ago, and I don't really know whether I got blood or not,'" he said. "And that's a little bit harder, but 1992 was when we started testing the blood supply."

With regard to treatment options, LeFevre said antiviral treatment regimens for chronic HCV infection are producing a significantly higher percentage of people with a sustained viral load reduction than in 2004, the last time the task force updated its recommendation.

"The treatments we have available are much more effective at reducing viral load to non-detectable," he said. "So the assumption -- and there are some data supporting this -- is that people with a sustained reduction will also have fewer complications. Although the problem, of course, is that it takes longer term follow up than we have with these drugs to know for sure that it will translate into health benefits."

LeFevre also noted that, unlike an HIV infection, the probability of experiencing bad health outcomes from HCV is fairly small.

"There are people who have chronic HVC infections who we will end up finding and treating, who would actually never have had any of the serious complications -- end-stage liver disease, cirrhosis, cancer of the liver," he said, "whereas with an HIV infection, the percentage of people who experience bad health outcomes is much higher."

The draft recommendations will be open for public comment until Dec. 24 at 5 p.m. EDT.

The AAFP is reviewing the draft recommendations and will update its own 2004 HVC recommendations after the USPSTF publishes its final conclusions in 2013.