Issue: November 2017
November 21, 2017
2 min read

Should people at low risk for HCV infection be screened for the virus?

Issue: November 2017
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In April, the Canadian Task Force on Preventive Health Care recommended against hepatitis C screening among patients with a low risk for infection.

Jordan Feld

Among the reasons for its recommendation, the group cited low HCV incidence among low-risk Canadian populations and the potential harms of treating infected patients who would not have developed disease.

“Given the lack of direct evidence that mass screening is beneficial and that patients identified by screening will either never develop symptoms of hepatitis C, or will remain well for decades after infection, we have recommended against screening for HCV in adults who are not at elevated risk,” task force member Roland Grad, MD, MSc, an associate professor in the department of family medicine at McGill University in Montreal, said at the time.

Infectious Disease News asked Jordan Feld, MD, MPH, a scientist with the Toronto General Hospital Research Institute and an associate professor of medicine at the University of Toronto, for his opinion on the matter.

With all the progress in HCV, the biggest challenge in the past few years has been trying to obtain these very effective therapies for our patients. It was very exciting in Canada to see recent negotiations with the federal government loosen restrictions and allow us to start treating more people with a promise to have universal access for the country in the next 2 years or even less.

This was fantastic news for patients but was followed shortly by less optimistic news. We now have a guideline from the Canadian Task Force on Preventive Health Care for screening recommendations for HCV in Canada. I must admit that I and many of my colleagues were disappointed to see the conclusions of the task force. They reviewed literature on screening and treatment, and concluded that screening should not be done in people at low risk.

That, in itself, is somewhat of a self-evident statement and unfortunately not very helpful. The Canadian Liver Foundation previously advocated for baby boomer screening similar to that in the United States but with a slightly different birth cohort of 1945 to 1975. That is based on very solid data in Canada showing this is not only effective in identifying HCV, but it is also cost-effective. If the prices on new treatments come down — and they may already be there — this could even be cost-saving for our health care system. Screening makes a lot of sense.

How the task force could look at the data and conclude that we should not be screening, and we should simply stick to our old paradigm of screening high-risk individuals is disconcerting. We know that does not work. It has failed in every country in which it has been attempted and every disease in which it has been implemented. This antiquated recommendation is rather disappointing.

It is hoped that clinicians and academics in Canada will look beyond these guidelines and recognize the evidence supporting broader screening. With this recognition, we can move to include risk-based screening but also to advocate for population-based screening likely based on the birth cohort of 1945 to 1975 so we can identify those with HCV. With improved access to treatment, we can get them cured and reduce the public health burden from this illness.

Disclosure: Feld reports receiving support for research and/or honoraria for scientific consulting for AbbVie, Abbott, Bristol-Myers Squibb, Gilead Sciences, Janssen, Merck, Theravance Biopharma and Trek Therapeutics.