USPSTF: Screen All Adults for Hepatitis C Infection

All adults -- not just Baby Boomers and other considered at high risk -- should be screened for hepatitis C virus (HCV) infection, said the U.S. Preventive Services Task Force (USPSTF).

Citing better treatments with direct-acting antiviral (DAA) therapy and increasing prevalence of HCV infection among younger adults, the Task Force concluded with "moderate certainty" that there was a substantial net benefit in screening adults ages 18-79 for HCV infection ('B' recommendation).

This is an update from its 2013 recommendation, in which the USPSTF recommended screening those at high risk for HCV, as well as a one-time screening for adults born between 1945 and 1965. Support for an update calling for universal screening has been building in the hepatology and public health communities, so the USPSTF's shift did not come as a surprise.

This draft recommendation statement was published on the USPSTF website.

"Today, more people are infected with hepatitis C than there were a decade ago, but there are now better treatments available," USPSTF chair Douglas K. Owens, MD, said in a statement. "The evidence now shows more people can benefit from screening."

The authors noted that since 2013, prevalence of HCV infection has increased in younger persons, though the rate of HCV among adults born between 1945 and 1965 -- the Baby Boomers -- remains "relatively high" and will increase as the population continues to age. In 2012, the CDC recommended screening everyone in that birth cohort.

"It is concerning that we are seeing a significant increase in hepatitis C, and many people don't know they have it," USPSTF vice chair Alex H. Krist, MD, said in a statement. "The good news is that we have newer treatments that are more effective and safer, and screening adults for hepatitis C can detect the infection earlier, before they have complications from the virus."

Notably, they added that increases in acute incidence of HCV has mostly affected young, white injection drug users, particularly in rural areas, as well as women ages 15-44.

Pregnant women should be screened for HCV, especially given that HCV prevalence doubled in women ages 15-44 from 2006 to 2014. The authors noted that clinicians may also want to consider screening pregnant women age <18.

While the Task Force said that there is "limited epidemiologic data" on HCV incidence in adolescents age <18, they added that clinicians may want to consider screening adolescents, and adults age >79, who are at high risk. Past or current injection drug use is the most important risk factor for HCV, with about a third of injection drug users ages 18-30 and 70% to 90% of older injection drug users infected with HCV, they said.

The authors said that they found no direct evidence on the benefits of HCV screening compared with no screening on health outcomes or the effects of prenatal HCV screening on the risk of vertical transmission. However, 49 trials found DAA regimens associated with sustained virologic response (SVR) ranging from 95.5% to 98.9% across HCV genotypes.

While direct evidence on the effects of current DAA regimens on healthcare outcomes was described as "limited," the authors found that SVR after antiviral therapy was associated with decreased risk of all-cause mortality, liver mortality, cirrhosis, and hepatocellular carcinoma versus no SVR. There were also no new harms of screening identified in the research, they said.

Noting gaps, the authors said that more research is needed on repeat versus one-time screening, as well as screening intervals. They also called for more research to identify labor management practices and treatment of HCV infection prior to pregnancy to reduce risk of vertical transmission.

As this is a draft recommendation statement, the USPSTF is accepting public comment on the recommendations until Sept. 23.