Widespread hepatitis C screening—do benefits outweigh harms?

January 13, 2015, Georgetown University Medical Center
Electron micrographs of hepatitis C virus purified from cell culture. Scale bar is 50 nanometers. Credit: Center for the Study of Hepatitis C, The Rockefeller University.

In light of recent recommendations for widespread hepatitis C screening, researchers are calling for clinical trials to determine if that screening would result in greater benefit or harm.

Though the have vocal support from some experts and advocates, no studies have yet established whether such screening would result in greater benefit than harm to patients, three physicians and an investigative medical journalist explain in the Jan. 17 issue of the British Medical Journal.

In 2012, the U.S. Centers for Disease Control and Prevention (CDC) recommended that all people born between 1945 and 1965 be screened for C. The U.S. Preventive Services Task Force (USPSTF) followed suit in 2013 and the World Health Organization called for expanded screening in 2014. Previously, had focused only on those at high risk of developing the disease, such as intravenous drug users and those who received a transfusion prior to 1992.

In issuing its 2013 recommendations, the USPSTF noted the absence of studies on "long-term harms associated with antiviral regimens" and "the outcomes of treatment in screen-detected patients."

"We have a limited window of opportunity to collect appropriate evidence on whether this [widespread ] is a good idea," write the authors, which include lead author Jeanne Lenzer, an investigative medical journalist, and physicians Ronald L. Koretz, MD, of David Geffen-UCLA School of Medicine; John P. A. Ioannidis, MD, of Stanford University; and Kenneth W. Lin, MD, of Georgetown University School of Medicine.

One missing piece of evidence, says Georgetown's Lin, is to understand who is most likely to benefit from antiviral medications, many of which come with a hefty price tag.

"We know current medications can result in the virus becoming undetectable in a high number of people after 3 to 6 months, but 80 percent of people with hepatitis C do fine with or without treatment," explains Lin. "We need to know if the treatments have any long-term impact on the remaining 20 percent who are destined to develop liver failure, liver cancer or die from the disease."

The authors report that at least 2.7 million people have hepatitis C in the U.S. Many people with the disease do not have symptoms and are not aware they have it. About 16,000 require a liver transplant or die from hepatitis C each year.

"Since most individuals with hepatitis C never develop symptoms and die with it not of it, exposing these individuals to the harms of treatment with no possible benefit might outweigh benefits for the minority destined to develop end-stage disease," Lin argues.

Explore further: Many with hepatitis C missing out on treatment, study finds

More information: British Medical Journal, www.bmj.com/cgi/doi/10.1136/bmj.g7809

Related Stories

Many with hepatitis C missing out on treatment, study finds

January 11, 2015
(HealthDay)—Many hepatitis C patients get "lost" in the U.S. health care system, a new study suggests.

Screen all baby boomers for hepatitis C, expert panel says

June 24, 2013
(HealthDay)—All adults born between 1945 and 1965—the baby boom generation—should be screened for the hepatitis C virus along with injection-drug users and anyone transfused before 1992, according to new recommendations ...

U.S. task force: Baby boomers should be tested for hepatitis C

November 26, 2012
(HealthDay)—A U.S. task force suggests that people at high risk for the hepatitis C virus should be screened, which includes those with a history of intravenous drug use and those who received blood transfusions before ...

Task force recommends hep B screening for high-risk people

May 27, 2014
(HealthDay)—Doctors should regularly screen people at high risk for contracting the hepatitis B virus, which causes chronic illness and can lead to liver cancer if left untreated, a national panel of health experts has ...

Baby boomers need hepatitis C test, CDC study confirms

August 15, 2013
(HealthDay)—Baby boomers—the generation known for sex, drugs and rock and roll—are the most likely Americans to develop hepatitis C, and too many of them aren't tested until it's too late to prevent liver damage, U.S. ...

Benefits of thyroid screening unclear

October 27, 2014
Researchers for the U.S. Preventive Services Task Force (USPSTF) suggest that more research is needed to determine the benefits of screening asymptomatic individuals for thyroid dysfunction. Their review is being published ...

Recommended for you

Infants born to obese mothers risk developing liver disease, obesity

November 16, 2018
Infant gut microbes altered by their mother's obesity can cause inflammation and other major changes within the baby, increasing the risk of obesity and non-alcoholic fatty liver disease later in life, according to researchers ...

New study shows NKT cell subsets play a large role in the advancement of NAFLD

November 16, 2018
Since 2015 it has been known that the gut microbiota could have a direct impact on nonalcoholic fatty liver disease (NAFLD), which affects up to 12% of adults and is a leading cause of chronic liver disease. In the November ...

Antibiotic prescribing influenced by team dynamics within hospitals

November 15, 2018
Antibiotic prescribing by doctors is influenced by team dynamics and cultures within hospitals.

Zika may hijack mother-fetus immunity route

November 14, 2018
To cross the placenta, Zika virus may hijack the route by which acquired immunity is transferred from mother to fetus, new research suggests.

New research aims to help improve uptake of hepatitis C testing

November 14, 2018
New research published in Scientific Reports shows persisting fears about HIV infection may impact testing uptake for the hepatitis C Virus (HCV).

Maternally acquired Zika immunity can increase dengue disease severity in mouse pups

November 14, 2018
To say that the immune system is complex is an understatement: an immune response protective in one context can turn deadly over time, as evidenced by numerous epidemiological studies on dengue infection, spanning multiple ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.