Screen all baby boomers for hepatitis C, expert panel says
The guidelines, released Monday, mirror recommendations from the U.S. Centers for Disease Control and Prevention and provide a long-awaited policy from the task force, an independent panel of experts.
"For everyone born between 1945 and 1965 we recommend a one-time screening," said task force member Dr. Kirsten Bibbins-Domingo, an associate professor in residence at the University of California, San Francisco, School of Medicine.
People in this age group account for three-quarters of all hepatitis C cases in the United States, Bibbins-Domingo said. Many contracted the disease decades ago but don't know it.
Hepatitis C—a leading cause of liver damage and liver disease in the United States—is considered a silent killer because it progresses without any indications of illness. More than 30 percent of U.S. patients needing liver transplants have end-stage liver disease related to hepatitis C.
"The challenge is that many people have hepatitis C and don't have signs and symptoms of the disease," Bibbins-Domingo said. "Those people should be identified and consider treatment."
An estimated 3.9 million people are infected with hepatitis C in the United States, the task force said. Unlike other types of hepatitis, there is no vaccine for hepatitis C.
In its 2004 statement, the task force advised against routine screening of adults without symptoms and high risk of infection. It also said it had too little evidence to recommend for or against routine screening for adults with high risk of infection.
It became apparent, however, that two-thirds of infected people weren't getting screened, while treatment was becoming more successful.
"Many people appear to benefit from treatment," Bibbins-Domingo said. "That is what led the task force to conclude that it is beneficial for people to find out they have hepatitis C in order to seek treatment."
Dr. Marc Siegel, an associate professor of medicine at NYU Langone Medical Center in New York City, said he welcomes the new guidelines, which were published June 25 in the Annals of Internal Medicine.
"I am absolutely thrilled that the U.S. Preventive Services Task Force, which has had a head-in-the-sand approach toward screening, has come out for a one-time screening for hepatitis C," Siegel said.
Siegel encourages everyone at risk to get tested.
Screening for hepatitis C involves a simple, inexpensive blood test. Those who test positive usually receive a course of antiviral medication over several months. Most people have no detectable virus following treatment, Bibbins-Domingo said.
"Treatment is effective in preventing the complications of hepatitis C," Bibbins-Domingo said. "Treatments have gotten better, and I suspect treatments will continue to get better."
Many people who test positive for the virus have no signs of active infection. Whether they should be treated should be discussed with their doctor, she said.
Although baby boomers should have a one-time screening, those who continue to be at risk for the infection should be screened more often, Bibbins-Domingo said.
Past or current injection-drug use is the greatest risk for hepatitis C infection. Also at high risk are people with a history of blood transfusions before widespread adoption of screening and infection-control measures in 1992; people who have undergone long-term dialysis treatment; and those with exposure to hepatitis C in health care settings. People with HIV/AIDS, a history of intranasal drug use or tattoos from unregulated or unsafe parlors also are at greater risk than the general population.
This expanded screening may identify millions of Americans who were unaware of their infection, the task force said.