USPSTF: Screen All Adults, Young and Old, for Hepatitis C

Adults aged 18 to 79 years should be screened for hepatitis C virus (HCV) infection, according to an updated grade B recommendation from the US Preventive Services Task Force (USPSTF), published online March 2, 2020 in JAMA.

The recommendation applies to asymptomatic adults-including pregnant women-without   known liver disease and expands upon the USPSTF’s 2013 recommendation to screen adults born between 1945 and 1965. 

“The treatment of HCV continues to evolve, resulting in greater benefits and fewer harms than when the USPSTF last considered the evidence,” wrote corresponding author Douglas K. Owens, MD, MS, of Stanford University, California, and colleagues. “As a result, the USPSTF concluded that broadening the age for HCV screening beyond its previous recommendation will identify infected patients at earlier stages of disease who could greatly benefit from effective treatment before developing complications.”

In the last 10 years, HCV cases increased approximately 3.8-fold due to rising injection drug use related to the opioid epidemic and better surveillance, according to the task force.  

This increase has not been seen only in Baby Boomers. In the past decade, the burden of HCV has shifted from older adults to young adults who were the population hardest hit by the opioid epidemic.

The updated recommendation is based on an evidence report that included 8 randomized, controlled trials, 48 additional treatment studies, and 33 cohort studies published through February 2019 with a total of 179 230 people.

Physicians should screen adults with anti-HCV antibody testing followed by confirmatory polymerase chain reaction testing. The USPSTF also recommends that physicians consider screening high-risk patients who are either below or above the suggested age range.

One-time screening is sufficient for most adults, but physicians should periodically screen patients with continued HCV risk (eg, those with past or current injection drug use), according to the task force.

When implementing HCV screening, physicians should consider:

• Communicating to patients that screening is voluntary and only done with the patient’s knowledge.
• Informing patients about HCV infection, how it can and cannot be acquired, the meaning of both positive and negative results, and the benefits and harms of treatment.
• Giving patients the chance to ask questions or decline screening.

The USPSTF did not identify any direct evidence on the benefit of screening in asymptomatic adults, however, “there is convincing evidence that the newer DAA [direct-acting antiviral] regimens result in SVR [sustained virologic response] in a very high proportion (>95%) of adults aged 18 to 79 y and adequate evidence of SVR in adolescents,” wrote authors.  

The report’s findings were limited by several factors including the relatively small number of studies involving current DAA treatments along with limited data on baseline symptoms, adolescents, and potential long-term harms of DAA therapy, the task force noted.