of people with hepatitis C are not tested for the virus until they develop
clinical signs and symptoms such as elevated liver enzymes or jaundice, according
to a US study described in the August
16, 2013 Morbidity and Mortality Weekly
Report. These findings support US guidelines
calling for all 'baby boomers' born during 1945 to 1965 to be tested, regardless of
years or decades, chronic hepatitis C virus (HCV) infection can lead to serious
liver disease including cirrhosis and hepatocellular carcinoma. Since 1998, the US Centers for Disease Control and Prevention
(CDC) has recommended HCV testing for people with traditional risk factors such
as injection drug use, receiving a blood transfusion before 1992 or accidental
exposure in healthcare settings. Nevertheless, experts estimate that more than
half of the approximately four million people with hepatitis C in the US are
not aware that they are infected.
August 2012, the CDC updated its hepatitis C
testing guidelines to recommend that everyone born
between 1945 and 1965 should get tested for HCV at least once, regardless of
traditional risk factors. The US Preventive Services Task Force did the
same in June 2013. Numerous epidemiological studies
have shown that hepatitis C is most common among baby boomers, who may have
engaged in risky behavior many years ago.
from the CDC's Epidemic Intelligence Service and colleagues conducted a study
looking at factors that prompted people with hepatitis C to get tested prior to
the new recommendations.
data from participants in the Chronic Hepatitis Cohort Study, which follows people with confirmed chronic hepatitis B or C receiving care at four
integrated healthcare systems in Detroit, Honolulu, Danville, Pennsylvania, and
12,529 adults with hepatitis C who met the inclusion criteria, 10,380
were randomly sampled for the analysis. After excluding 1451 people who had
died and 828 who could not be contacted, the remaining 8101 people were
surveyed by postal mail or telephone during 2011-2012.
were asked to choose from a list of reasons for HCV testing, with responses
grouped into four categories; reasons were not mutually exclusive and
respondents could choose more than one:
risk indications according to the 1998 guidelines including injection drug use
or kidney dialysis.
indications including abnormal liver function tests (elevated ALT or AST) or
liver-related symptoms such as abdominal pain or jaundice (yellowing of the
skin and eyes due to elevated bilirubin).
requirements including testing prior to donating blood, as a qualification for
health insurance, or as a requirement of prisons, employers, schools or the
- Other miscellaneous reasons including recommendations from doctors or spouses, sex
with a person with hepatitis C, being from a country where hepatitis C is
endemic, or suspicion that one had been exposed to hepatitis C.
A total of 4689 people with hepatitis C
(58%) responded to the survey. A large majority of respondents (78%)
were born between 1945 and 1965. More than half (56%) were men, 73% were white and
19% were black.
The 4689 survey
respondents reported a total of 7649 reasons for initial hepatitis C testing.
More than 60% said their
first test was done in a physician's office. Others reported test settings
included blood drives, public health or specialty clinics, emergency
departments and inpatient facilities such as hospitals.
About 45% of respondents said
clinical indications were a reason for getting tested, with the most common
being abnormal liver function tests (71%).
In addition, 37% of
respondents reported that their doctor recommended HCV testing, 22% said they
were tested because they had traditional risk factors (overwhelmingly injection
drug use, at 94%) and 17% cited institutional requirements.
Looking only at the
subgroup of respondents born between 1945 and 1965, proportions citing these reasons
for testing were similar: 47, 36, 21 and 17%, respectively.
findings suggest that "many HCV infections were identified only after the
patient had become symptomatic", the study authors concluded. "Because
a substantial proportion of HCV infections were identified after testing for
clinical indications and few patients reported the 1998 CDC risk indications as
a reason for initial testing, these data further support the CDC recommendation
for testing all persons in the birth cohort of 1945-1965 in addition to
risk-based testing", they added.
US Preventive Services Task Force and CDC recommendations for testing and
identifying strategies that help physicians implement HCV testing in their
offices might help facilitate timely identification of HCV infection and reduce
morbidity and mortality", they advised. "In addition to increasing
testing in physicians' offices, other locations might be important for
increasing the number of HCV-infected persons who are tested and referred to