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All adults ages 18 to 79 should be screened for hepatitis C, new recommendation says

Posted March 2, 2020 2:52 p.m. EST

— The US Preventive Services Task Force now recommends screening for hepatitis C infection in all adults ages 18 to 79 without known liver disease, regardless of their risk.

This updated recommendation, published in the medical journal JAMA on Monday, expands the task force's previous 2013 recommendation, which was to screen only adults born between 1945 and 1965 and others at high risk for infection.

"People with hepatitis C do not always feel sick and may not know they have it," Task Force chair Dr. Douglas K. Owens, an author of the recommendation and a general internist, said in a news release on Monday.

"Screening is key to finding this infection early, when it's easier to treat and cure, helping reduce illnesses and deaths," said Owens, who is also an investigator at the Center for Innovation to Implementation at the Veterans Affairs Palo Alto Health Care System.

The USPSTF commissioned a systematic review of current research and evidence on the hepatitis C virus, or HCV, in order to update its prior recommendation. Based on that review, the task force found that screening more adults and teens has "substantial net benefit" since detecting infection early can lead to the early use of effective treatments and interventions.

"Although all adults aged 18 to 79 years should be screened, a number of risk factors increase risk. The most important risk factor for HCV infection is past or current injection drug use. In the US, recent increases in HCV incidence have predominantly been among young persons who inject drugs," the task force wrote in its new recommendation statement.

"The treatment of HCV continues to evolve, resulting in greater benefits and fewer harms than when the USPSTF last considered the evidence," the recommendation statement said. "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."

The change comes at a critical time -- over the last decade, the most rapid increase in the incidence of acute hepatitis C cases has been in young adults ages 20 to 39 who have injected drugs, Dr. Camilla Graham, an infectious disease physician at the Beth Israel Deaconess Medical Center and Harvard Medical School, and Dr. Stacey Trooskin, an infectious disease physician at Penn Medicine, wrote in an editorial that published alongside the recommendation statement in JAMA on Monday.

"It is time to revisit the effective but now outdated baby boomer screening recommendations, and the updated recommendations from the USPSTF are welcome," they wrote.

They also wrote how screening has been shown to be cost-effective when considering the efficacy of available treatments and decreases in drug prices. With the new recommendation, insurance companies will provide reimbursement for screening inline with the new recommendations.

In 2016, the World Health Organization set the goal of eliminating viral hepatitis B and C as a major public threat by 2030. Elimination in this case is defined as a 90% reduction in new chronic infections and 65% reduction in deaths compared with a scenario in which interventions would continue at the level they were in 2015.

"Meeting the WHO 2030 targets for reducing new HCV infections and increasing treatment will be more likely to succeed if more primary care clinicians and addiction specialists join in the important efforts to screen, treat, and achieve virologic cure," Graham and Trooskin wrote.

The United States currently is not on track to achieve those WHO goals, Drs. Jennifer Price and Danielle Brandman, both of the University of California, San Francisco School of Medicine, wrote in a separate editorial published in JAMA Internal Medicine on Monday.

"One estimate is that at present rates of HCV screening, treatment, and new infections, 62% of people with HCV in the US will be aware of their infection by 2030 and 49% will have been cured," Price and Brandman wrote.

"Clearly, reducing incident infections will require programs to reduce transmission during intravenous drug use, such as needle-exchange or other programs," they wrote. "Although the USPSTF HCV screening recommendation is a step forward for controlling HCV infection in the US, it will take a coordinated and funded effort to ensure that the anticipated benefits are realized."

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