Perspective from Michael S. Saag, MD
June 26, 2013
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USPSTF recommends HCV testing for high-risk adults, baby boomers

Perspective from Michael S. Saag, MD
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The United States Preventive Services Task Force recently recommended screening for adults at high risk for hepatitis C virus infection and one-time screening for all Americans born between 1945 and 1965 because the birth cohort is at greater risk for infection compared with other age groups.

The new guidelines, published in the Annals of Internal Medicine, follow a less enthusiastic endorsement of HCV screening from the USPSTF last year, when the task force recommended that clinicians consider testing for their patients, but did not advise routine screening for all Americans in the birth cohort.

In 2004, the USPSTF recommended against screening for HCV in adults who were not at high risk for infection. According to the task force, the decision was based on “a low prevalence of HCV infection, the natural history of chronic HCV infection, a lack of direct evidence showing that screening or antiviral treatments improve important health outcomes, and the potential harms of screening.”

The USPSTF also found insufficient evidence at the time to recommend screening for high-risk adults.

Virginia A. Moyer, MD, MPH, and colleagues from the task force conducted two systematic reviews focused on evidence gaps identified in 2004 and on studies on HCV screening and treatment published since then. This time, the task force found adequate evidence that HCV screening would provide “moderate net benefit,” citing more effective treatments and accurate, noninvasive screening as part of their rationale. Also, a large proportion of HCV-infected patients are unaware of their status, and a risk-based approach to screening may fail to detect many of them, the task force said.

The American Association for the Study of Liver Diseases, the Infectious Diseases Society of America and the American College of Gastroenterology all recommend HCV screening for higher-risk adults, and the CDC currently recommends screening both for high-risk adults and the birth cohort.

David A. Relman, MD 

David A. Relman

“This important recommendation will not only influence medical practice, but will also help expand access to screening services, as private and public insurers look to the task force’s recommendations in making coverage decisions,” IDSA President David A. Relman, MD, said in a statement.

For more information:

Moyer VA. Ann Intern Med. 2013;doi:10.7326/0003-4819-159-5-201309030-00672.

U.S. Preventive Services Task Force. Ann Intern Med. 2004;140:462-464.

Disclosure: The researchers report no relevant financial disclosures.