December 17, 2019 03:38 pm News Staff – In the absence of a vaccine to counter the spiraling numbers of infections caused by hepatitis C virus -- the most common chronic bloodborne pathogen in the United States -- HCV takes an immense toll, with nearly 45,000 acute cases occurring each year, according to CDC estimates. Most of those infected are asymptomatic or have only mild symptoms and don't seek treatment.
Although the infection spontaneously clears in some who contract it, in about 75% to 85% of cases, acute infection progresses to chronic disease, which can have serious hepatic consequences. So, timely detection of the virus is key to optimizing patient outcomes. To that end, the CDC has announced it intends to expand its current recommendations for HCV screening and is seeking public comment on the proposed changes.
In a 2012 Morbidity and Mortality Weekly Report, the agency recommended a birth cohort approach to screening, calling for one-time screening with anti-HCV antibody testing for all adults born from 1945 through 1965 regardless of whether specific HCV risk factors are present.
That recommendation, in turn, built on the risk-based testing schema the agency outlined in 1998. That earlier MMWR recommended routine testing for current or past injection drug users, including those who injected only once or a few times many years earlier, and for people with certain medical conditions, such as those who
In addition, HCV testing based on a recognized exposure is recommended for health care personnel, emergency medical services providers and public safety workers after needle sticks, sharps or mucosal exposures to HCV-positive blood, as well as for children born to HCV-positive women.
If the anti-HCV antibody test yields a positive screening result, current infection should be confirmed with a qualitative HCV RNA test. In patients with confirmed HCV infection, quantitative HCV RNA testing and testing for HCV genotype is recommended. Management is based on genotype, disease severity, comorbidities and other factors.
The CDC now proposes to take a more inclusive approach to HCV testing. Specifically, the agency is considering broadening its recommendations to call for universal hepatitis C screening for
The agency is also recommending one-time hepatitis C testing, regardless of age or setting prevalence, to include people who have the following recognized conditions or exposures:
Furthermore, the CDC recommends routine periodic testing for people with ongoing risk factors for as long as those risk factors persist. This would pertain to
Finally, the agency proposes that any person who requests hepatitis C testing should receive it, regardless of disclosure of risk, because many people may be reluctant to disclose stigmatizing risks.
It's worth noting that the CDC's proposed changes are largely consistent with a draft recommendation statement the U.S. Preventive Services Task Force issued in September that recommended screening all adults ages 18 to 79 for HCV infection, including pregnant women. The draft statement also suggests that clinicians consider screening patients who are younger than 18 and older than age 79 if they are at high risk for infection.
That's a significant departure from the USPSTF's 2013 final recommendation statement, which called for HCV screening in patients at high risk for infection and one-time screening in adults born between 1945 and 1965. The AAFP supported the task force's final recommendation at that time.
The Academy is reviewing the latest USPSTF draft recommendation and will update its own HCV recommendations after the task force publishes its final recommendation statement.
Meanwhile, comments on the CDC's proposed changes will be accepted through 11:59 p.m. on Dec. 27. Go online to comment.
Related AAFP News Coverage
Draft Recommendation Statement
USPSTF: Screen Adults 18-79 for Hepatitis C Infection
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American Family Physician: Diagnosis and Management of Hepatitis C