麻豆传媒

The U.S. Preventive Services Task Force (USPSTF) has agreed that all baby boomers should be offered a hepatitis C (HCV) test.

The new recommendation brings the USPSTF into line with the CDC, which in May 2012 urged one-time screening for all people born between 1945 and 1965.

And this final recommendation is stronger than a draft version, issued in November 2012, that only said .

The stronger recommendation arose because new evidence supported a "moderate" net benefit for the one-time birth cohort screening, the USPSTF committee on the issue reported online in Annals of Internal Medicine.

The new position reflects "the strength of evidence on the benefits of HCV testing linked to care, treatments, and improved health outcomes," commented Quyen Ngo-Metzger, MD, of the Agency for Healthcare Research and Quality in Rockville, Md., and colleagues.

In an accompanying editorial, Ngo-Metzger and colleagues argued that the two agencies' positions, taken together, "send a clear signal to healthcare professionals, policymakers, and the public that screening for HCV is effective."

The next step, they argued, is to begin delivering clinical preventive services that will increase HCV diagnosis, care, and treatment.

HCV is the most common chronic blood-borne pathogen in the U.S. and a leading cause of complications from chronic liver disease, the USPSTF panel wrote.

Indeed, end-stage liver disease caused by HCV is the most common reason U.S. adults need liver transplants, accounting for more than 30% of cases.

Overall, about 1.6% of non-institutionalized Americans have anti-HCV antibodies, but about three in four people with HCV were born between 1945 and 1965, with a peak prevalence of 4.3% in people who were 40 to 49 in the years 1999 to 2002, the panel noted.

But since HCV can remain without symptoms for decades, many of those infected are not aware of their status, according to the CDC, which estimates that 2 million baby boomers have HCV and don't know it.

The task force panel, led by Virginia Moyer, MD, of Baylor College of Medicine in Houston, said there's no direct evidence that HCV screening of asymptomatic adults reduces morbidity and mortality.

But there is adequate evidence that treatment can lead to sustained virologic responses (so-called viral cures) and improved clinical outcomes, the panel found.

Screening itself has the potential for harm, including anxiety, patient labeling, and feelings of stigmatization, but the evidence on that is limited, the USPSTF panel noted.

Diagnostic tests, such as liver biopsy, can also have harms -- including bleeding, infection, and death -- although they are rare, and the use of biopsy is declining, the panel reported.

Although current treatments also have a range of adverse events, the panel noted, they are not often serious and usually resolve when treatment ends. Moreover, new treatment approaches will shortly be available that appear to have fewer side effects and can be given for shorter periods of time.

The panel's first recommendation for screening does not change -- high-risk people should be screened. That reflects the knowledge that the most important risk factor for HCV is injection drug use, with most studies reporting that about half of injection drug users have the virus.

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