USPSTF Recommends All Adults Receive
HCV Screening

Veronica Hackethal, MD

August 27, 2019

The US Preventive Services Task Force has posted new draft recommendations advising that essentially all US adults aged 18 to 79 years should be screened for hepatitis C virus (HCV) (B recommendation).

This recommendation represents a major change from 2013 guidelines, which recommended screening in high-risk individuals and baby boomers (who are at high risk for HCV).

The draft recommendation was posted on the USPSTF website today. It will be open to public comment through September 23.

Reasons for expanded screening are twofold, according to Douglas K. Owens, MD, Task Force chair and professor of medicine at Stanford University in California.

New evidence shows the HCV epidemic has broadened to younger age groups, and treatments for HCV have gotten much better, he told Medscape Medical News.

Since the 2013 recommendations, new evidence suggests the number of new HCV cases per year is now approximately 3.5 times higher compared with 10 years ago.

"Unfortunately, this is now a problem in a much broader age range than it was previously. That is quite likely related to the explosion of opioid abuse," Owens said.

Rates have rapidly increased among younger people — especially women, those who inject drugs, and those who live in rural areas. And as baby boomers age, HCV infections in individuals older than 79 years are expected to increase.

HCV can cause chronic liver disease, cirrhosis, liver cancer, and death, but effective treatments exist. Oral direct-acting antivirals (DAAs) have become standard treatment for HCV, except during pregnancy. Clinical trials have confirmed that DAAs are highly effective, have fewer side effects, and shorter treatment duration than past regimens.

"We can essentially cure most people with HCV if it is detected and treated appropriately," Owens explained.

Expanded screening has the potential to catch more early-stage infections and enable treatment before complications from HCV have developed.

In addition to expanding screening to all adults aged 18 to 79 years, the Task Force adds that clinicians may also need to screen high-risk individuals younger than 18 and older than 79 years, especially injection drug users. Pregnant women under age 18 may also need screening if they are at increased risk for HCV.

Most adults may need to be screened only once, except if they are at increased risk for HCV.  But specific screening intervals for these individuals have not been established.

Owens stressed, "This is an enormously important public health problem that we can address effectively."

"Hepatitis C kills more Americans than all other reportable infectious diseases put together," he added.

HCV is spread through blood contact and represents the most common chronic bloodborne infection in the US. About 4.1 million Americans have current or past HCV infection, and 2.4 million have active infections. Because infection is often asymptomatic, about half of these people may not know they have HCV.

"We hope the word gets out to providers that we recommend screening essentially all adults aged 18-79 and refer those people who have hepatitis C for effective treatment," Owens concluded.

US Preventive Services Task Force. Published online August 27, 2019.

Draft recommendation statement

Evidence Synthesis: Screening for Hepatitis C Virus Infection in Adolescents and Adults: A Systematic Review Update for the U.S. Preventive Services Task Force

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