Hepatitis C: USPSTF Recommends All Baby Boomers Be Screened

In an update of its 2004 recommendations, the US Preventive Services Task Force (USPSTF) now recommends a one-time screening for the hepatitis C virus (HCV) for all adults born between 1945 and 1965, in addition to screening persons at high risk for infection. The recommendation statement was published online June 24 in the Annals of Internal Medicine.

The rationale for the recommendation was based on the increased risk for exposure to HCV among persons born between 1945 and 1965 ("baby boomers") because of the lack of universal blood screening for the virus before 1992. The USPSTF members conclude that "the benefit of screening for HCV infection in persons in the birth cohort is likely similar to the benefit of screening in persons at higher risk for infection." Similar screening has been recommended by the Centers for Disease Control and Prevention (CDC), beginning in 2012.

The USPSTF acknowledges that "there is no direct evidence of the benefit of screening for HCV infection in asymptomatic adults in reducing morbidity or mortality," and that an increase in screening may lead to an increase in overtreatment. The task force concludes, however, that the risk for underdiagnosis is greater, given the discovery of more effective treatment protocols and improved outcomes for patients infected with the hepatitis virus.

In addition to screening protocols, the panel also reviewed therapeutic interventions for HCV. Standard treatment for the disease involves a combination of pegylated interferon (alfa-2a or alfa-2b) and ribavirin. New research using protease inhibitors has also shown sustained virologic response, the principal outcome used to assess success of antiviral therapy, when used alone or in combination with standard therapy.

In an accompanying editorial, Quyen Ngo-Metzger, MD, MPH, from the Agency for Healthcare Research and Quality, Rockville, Maryland, and colleagues write: "These recommendations, which are consistent with those issued by the CDC in 2012, reflect the strength of evidence on the benefits of HCV testing linked to care, treatments, and improved health outcomes."

Dr. Ngo-Metzger and colleagues note that the 2012 CDC modeling study found that approximately 76% of persons living with hepatitis C were born between 1945 and 1965 and that "persons in this birth cohort...accounted for more than 70% of all HCV-associated deaths in 2007."

"In reviewing the prevalence data on high-risk groups and the potential for reduced transmission, the USPSTF concluded that screening in high-risk persons (prevalence of ≥50%) and the birth cohort (prevalence of about 3% to 4%) would result in a moderate net benefit," write the task force members.

Improvements in antiviral therapy leading to sustained virologic response and reduction in all-cause and liver-related mortality have led to an improvement in clinical outcomes for patients infected with HCV, explain the authors. Birth-cohort screening may help identify infected patients earlier and allow for early intervention.

Ann Intern Med. Published online June 24, 2013. Guidelines full text, Editorial full text

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