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Wednesday, July 15, 2020
Home Specialties Infectious Disease Screen All Adults for Hepatitis C Regardless of Risk, Says USPSTF

Screen All Adults for Hepatitis C Regardless of Risk, Says USPSTF

The number of hepatitis C cases has increased so much in recent years — largely due to the growing popularity of intravenous drugs — that the U.S. Preventive Services Taskforce is expanding its screening protocol for the viral infection, which attacks the liver.

Published in the Journal of the American Medical Association, the new guidelines say all adults between 18 and 79 years old without any known liver disease should receiving screening. The previous recommendations called for screening in individuals born between 1945 and 1965 (because they’re more likely to have received a blood transfusion or transplant with infected with HCV) and those at high risk.

What prompted the change to the guidelines?

An increase in the use of injected drugs have propelled the number of new cases of hepatitis C virus (HCV) to a nearly fourfold increase over the past 10 years, according to JAMA. And although the past five years have seen advances in treatment, the number of HCV infections is still rising. In 2017, there were roughly 44,700 new hepatitis C infections in the U.S., according to federal data.

HCV, the most common, chronic, blood-borne pathogen in the U.S., is a leading cause of complications from chronic liver disease. What’s more, it’s the deadliest, reportable infectious disease; the next 60 (including HIV) combined still do not kill as many people as HCV alone. Roughly 2.4 million Americans are living with hepatitis C. 

Why do the guidelines matter?

According to Task Force chair Douglas K. Owens, MD, MS, the revised guidelines address both the negative public perception of hep C and delays in patients seeking treatment because they don’t know they’re sick.

“Some people may not be aware of their risk or they may not want to disclose it to you, so the way to capture the most people is to screen everyone,” Dr. Owens told The New York Times. “It also helps reduce the stigma.”

Who else should be screened for HCV?

Adults older than 79 and teens younger than 18 with a history of injecting drugs. The virus is spread primarily through sharing needles. About one-third of 18 to 30-year-olds who inject drugs are HCV-positive — as are 70 to 90 percent of older, intravenous drug users.

Pregnant people. Between 2006 and 2014, HCV prevalence doubled in women between 15 and 44. This coincided with a 68 percent increase in the proportion of infants born to HCV-infected mothers. The CDC recommends screening during every pregnancy, the JAMA article notes.

All persons with risk factors, including persons with HIV, prior recipients of blood transfusions, and those born to an HCV-infected mother, should receive periodic testing. The overall risk of sexual transmission of HCV is low, according to CDC, but a having an STI, multiple sexual partners, and/or rough sex appears to increase hep-C risk.

References:

Screening for Hepatitis C Virus Infection in Adolescents and Adults: US Preventive Services Task Force Recommendation Statement, Journal of the American Medical Association.

Most Adults Should be Screened for Hepatitis C, New U.S. Guidelines Urge, The New York Times.

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