August 17, 2012 — All people born between 1945 and 1965 should be screened at least once for hepatitis C virus (HCV) infection, according to new guidelines from the Centers for Disease Control and Prevention (CDC).
Bryce D. Smith, PhD, from the CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention at the CDC's National Center for Environmental Health, Atlanta, Georgia, and colleagues published the new guidelines in the August 17 issue of the Morbidity and Mortality Weekly Report.
"CDC estimates that although persons born during 1945–1965 comprise an estimated 27% of the population, they account for approximately three fourths of all HCV infections in the United States, 73% of HCV-associated mortality, and are at greatest risk for hepatocellular carcinoma and other HCV-related liver disease," Dr. Smith and colleagues write.
Previous recommendations for HCV testing, issued in 1998, stated that only persons with known risk factors and clinical indications should be tested. Risk factors include injection drug use, use of chronic hemodialysis, blood transfusion or organ transplant before July 1992, and use of clotting factor concentrates produced before 1987.
Screening is also recommended for healthcare workers and others with a high risk for exposure. In 1999, HCV testing also was recommended for persons infected with HIV.
Why the Change?
The main rationale for the updates guidelines, says the CDC, is that a substantial number of HCV-infected persons remain unaware of their infection. "Of the estimated 2.7–3.9 million persons living with HCV infection in the United States, 45%–85% are unaware of their infection status," the authors write.
Individuals born between 1945 and 1965, known as the Baby Boomers, were selected by comparing this group with cohorts born between 1950 and 1970 and between 1945 and 1970. The CDC's review of HCV infection prevalence data included 10,619 articles that met the search criteria.
The Baby Boomers had a 5-fold higher prevalence of HCV-infected populations, at about 3.25%, compared with the other 2 groups; non-Hispanic black men born between 1945 and 1965 had the highest prevalence rate, at 8.12%. Among the cohort, the CDC also found strong evidence that achieving sustained virologic response was associated with reduced risk for death and liver cancer.
The researchers considered including those born between1966 and 1970 as another separate cohort; however, they found that this would require testing of an additional 20 million individuals, at a cost of $1.08 billion, and would identify only 300,000 persons with chronic infection.
Steps to Take After Diagnosis
The CDC recommends that all persons with identified HCV infection receive a brief alcohol screening and intervention, as clinically indicated, followed by referral to appropriate care and treatment services for HCV infection and related conditions.
The CDC also describes steps for managing persons tested for HCV Infection. "Persons who test positive for both HCV antibody and HCV RNA should be informed that they have HCV infection and need further medical evaluation for liver disease, ongoing medical monitoring, and possible treatment," the authors note.
A section on posttest counseling in the report describes taking steps to prevent further harm to the liver and ways to minimize the risk for transmission to others.
Dr. Smith has disclosed no relevant financial relationships. Full conflict-of-interest information is available in Appendix A of the article.
Morb Mortal Wkly Rep. 2012;61(RR04):1-18. Full text
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