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U.S. Task Force Recommends Hepatitis C Tests for All Baby Boomers

The U.S. Preventive Services Task Force (USPSTF) this week recommended that all residents born between 1945 and 1965 should receive hepatitis C virus (HCV) screening as part of their routine health care, strengthening a recommendation issued last fall.

Numerous epidemiological studies have shown that hepatitis C is most common among Baby Boomers, who may have engaged in risky behavior years or decades ago. Over time, chronic HCV can lead to advanced liver damage including cirrhosis and liver cancer. "You may not remember what you did in the 60s and 70s, but your liver does," said Centers for Disease Control and Prevention(CDC) director Thomas Frieden during a Viral Hepatitis Testing Day media briefing in May.

The latest recommendation strengthens guidance issued last November, reflecting the task force's response to public comment. "The USPSTF recommends screening for HCV infection in persons at high risk for infection," according to the finalized statement published in the June 25, 2013, advance edition of Annals of Internal Medicine. "The USPSTF also recommends offering 1-time screening for HCV infection to adults born between 1945 and 1965."

The recommendation received a grade of "B" -- an important consideration, as the Affordable Care Act requires insurers to offer most "A" and "B" level preventive services for free.

The USPSTF's earlier recommendation stated that tests should be given to individuals at high risk for HCV infection -- for example, injection drug users -- but only "considered" for all people in this age group regardless of risk. An accompanying set of literature reviews found insufficient data on the benefits of expanded testing.

In August 2012 the CDC expanded its own guidelines to recommend hepatitis C testing for everyone born between 1945 and 1965. Some advocates and public health officials criticized the task force for its weaker guidance.

Based on more recent studies and in response to public comment, however, the USPSTF decided that the weight of the evidence now indicates that universal screening of this age cohort would have a "moderate net benefit," rather than the "small benefit" suggested by earlier research.

"The comprehensive screening strategies from the USPSTF and CDC create new opportunities for reaching the shared goals of reducing HCV transmission and identifying persons living with HCV and facilitate the receipt of care and treatment," Quyen Ngo-Metzger, John Ward, and Ronald Valdiserri wrote in an editorial accompanying the finalized guidelines. "Passage of the Affordable Care Act has created an environment conducive to implementation of risk-based and birth cohort-based strategies Taken together, the law and newly expanded HCV screening recommendations will help generate the momentum needed to identify millions of Americans previously unaware of their infection status, thus preventing liver disease and deaths attributable to chronic HCV infection."

The change also reflects the advent of better treatments for chronic hepatitis C, which offer a greater chance of a cure with a shorter duration of therapy. Next-generation direct-acting antivirals come with fewer side effects than existing drugs, and interferon-free oral regimens are expected to become available within a couple years.

"Birth-cohort screening has been deemed to be cost-effective and is a critical first-step to avoiding death and HCV morbidity," said Infectious Diseases Society of America president David Relman. "By strengthening its earlier draft recommendation, the task force has embraced a public health opportunity to diagnose, treat, and save the lives of thousands of baby boomers with hepatitis C."

6/27/13

References

VA Moyer on behalf of the U.S. Preventive Services Task Force. Screening for Hepatitis C Virus Infection in Adults: U.S. Preventive Services Task Force Recommendation Statement. Annals of Internal Medicine. June 25, 2013 (Epub ahead of print).

Q Ngo-Metzger, JW Ward, and RO Valdiserr. Expanded hepatitis C virus screening recommendations promote opportunities for care and cure. Annals of Internal Medicine. June 25, 2013 (Epub ahead of print).

Other Source

Infectious Diseases Society of America. ID Experts Applaud Task Force’s Final Recommendation on Hepatitis C Screening. Press release. June 25, 2013.