PHILADELPHIA,
August 17, 2012 – Without other risk factors, all Americans born between 1945
and 1965 should have a one-time screening for the hepatitis C virus (HCV)
according to new recommendations being published early online today in Annals of
Internal Medicine, the flagship journal of the American College of Physicians.
The Centers for Disease Control and Prevention (CDC) also recommends that all
persons identified with HCV should receive a brief alcohol screening and
intervention and be referred to appropriate care and treatment services for HCV
and related conditions.
Up to 3.9 million people in the United States are infected with HCV, a virus that
can cause inflammation and permanent liver damage. The infection is most
prevalent among people born from 1945 through 1965, and approximately 50 to 75
percent of those with HCV are unaware that they are infected. This is a problem
because HCV progresses slowly, and the risk of serious complications increases
as time passes.
The recommendation developers sought to identify testing strategies that would
increase the proportion of HCV-infected persons who know their status. In
particular, whether a testing strategy based on year of birth would identify
persons living with HCV infection who have not been identified by risk-based
testing. They conducted a systematic review of evidence published between 1995
and February 2012 to assess the prevalence of HCV and clinical outcomes. They
found that the proportion of people born between 1945 and 1965 with HCV antibody
was higher than that of the general population. Among that cohort, the
recommendation authors found strong evidence that achieving sustained virologic
response (SVR) was associated with reduced risk for death and liver
cancer.
The CDC recommends that persons identified with HCV have a brief alcohol screening
and intervention, as alcohol use has been shown to accelerate the progression of
liver disease. The recommendation authors considered evidence from a systematic
review of 22 randomized, controlled trials published since 2010 to determine
the effects of a brief alcohol intervention versus no intervention on reduction
of alcohol use. The research showed that patients who had a brief alcohol
reduction intervention reduced their weekly alcohol consumption by an average
of 38.42 grams compared with those who had no intervention.
Previously, the CDC recommended antibody screening only of individuals with health or
lifestyle indicators suggesting potential infection. These indicators include a
history of injecting drugs, having a blood transfusion before 1992, or being a
chronic hemodialysis patient. Low case identification may result from the
difficulty of implementing risk-based screening given the limited time of
primary care visits and unease in discussing behavioral risks.
-------------------
Recommendations
for the Identification of Chronic Hepatitis C Virus Infection Among Persons Born
During 1945–1965
Recommendations
and Reports
August
17, 2012 / 61(RR04);1-18
Prepared by
Bryce D. Smith, PhD1
Rebecca L. Morgan, MPH1
Geoff A. Beckett, PA-C, MPH1
Yngve Falck-Ytter, MD2
Deborah Holtzman, PhD1
Chong-Gee Teo, MD, PhD1
Amy Jewett, MPH3
Brittney Baack, MPH3
David B. Rein, PhD4
Nita Patel, PhD6
Miriam Alter, PhD5
Anthony Yartel, MPH6
John W. Ward, MD1
1Division of
Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB
Prevention
2 Case Western
Reserve University, Case and VA Medical Center, Cleveland, Ohio
3Oak Ridge
Institute for Science and Education, Oak Ridge, Tennessee
4NORC at the
University of Chicago, Atlanta, Georgia
5University of
Texas Medical Branch, Galveston, Texas
6Centers for
Disease Control and Prevention Foundation
August 17, 2012 – Without other risk factors, all Americans born between 1945
and 1965 should have a one-time screening for the hepatitis C virus (HCV)
according to new recommendations being published early online today in Annals of
Internal Medicine, the flagship journal of the American College of Physicians.
The Centers for Disease Control and Prevention (CDC) also recommends that all
persons identified with HCV should receive a brief alcohol screening and
intervention and be referred to appropriate care and treatment services for HCV
and related conditions.
Up to 3.9 million people in the United States are infected with HCV, a virus that
can cause inflammation and permanent liver damage. The infection is most
prevalent among people born from 1945 through 1965, and approximately 50 to 75
percent of those with HCV are unaware that they are infected. This is a problem
because HCV progresses slowly, and the risk of serious complications increases
as time passes.
The recommendation developers sought to identify testing strategies that would
increase the proportion of HCV-infected persons who know their status. In
particular, whether a testing strategy based on year of birth would identify
persons living with HCV infection who have not been identified by risk-based
testing. They conducted a systematic review of evidence published between 1995
and February 2012 to assess the prevalence of HCV and clinical outcomes. They
found that the proportion of people born between 1945 and 1965 with HCV antibody
was higher than that of the general population. Among that cohort, the
recommendation authors found strong evidence that achieving sustained virologic
response (SVR) was associated with reduced risk for death and liver
cancer.
The CDC recommends that persons identified with HCV have a brief alcohol screening
and intervention, as alcohol use has been shown to accelerate the progression of
liver disease. The recommendation authors considered evidence from a systematic
review of 22 randomized, controlled trials published since 2010 to determine
the effects of a brief alcohol intervention versus no intervention on reduction
of alcohol use. The research showed that patients who had a brief alcohol
reduction intervention reduced their weekly alcohol consumption by an average
of 38.42 grams compared with those who had no intervention.
Previously, the CDC recommended antibody screening only of individuals with health or
lifestyle indicators suggesting potential infection. These indicators include a
history of injecting drugs, having a blood transfusion before 1992, or being a
chronic hemodialysis patient. Low case identification may result from the
difficulty of implementing risk-based screening given the limited time of
primary care visits and unease in discussing behavioral risks.
-------------------
Recommendations
for the Identification of Chronic Hepatitis C Virus Infection Among Persons Born
During 1945–1965
Recommendations
and Reports
August
17, 2012 / 61(RR04);1-18
Prepared by
Bryce D. Smith, PhD1
Rebecca L. Morgan, MPH1
Geoff A. Beckett, PA-C, MPH1
Yngve Falck-Ytter, MD2
Deborah Holtzman, PhD1
Chong-Gee Teo, MD, PhD1
Amy Jewett, MPH3
Brittney Baack, MPH3
David B. Rein, PhD4
Nita Patel, PhD6
Miriam Alter, PhD5
Anthony Yartel, MPH6
John W. Ward, MD1
1Division of
Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB
Prevention
2 Case Western
Reserve University, Case and VA Medical Center, Cleveland, Ohio
3Oak Ridge
Institute for Science and Education, Oak Ridge, Tennessee
4NORC at the
University of Chicago, Atlanta, Georgia
5University of
Texas Medical Branch, Galveston, Texas
6Centers for
Disease Control and Prevention Foundation
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