Public Health

Task force finds evidence insufficient to back routine hepatitis C screening

Last Updated: 2004-03-15 17:00:22 -0400 (Reuters Health)

NEW YORK (Reuters Health) - In a statement, the U.S. Preventive Services Task Force recommends against routine screening for hepatitis C infection (HCV) in asymptomatic, low-risk individuals. Even for high-risk individuals, data are too sparse to recommend for or against routine testing.

"Although screening can accurately detect chronic HCV infection and antiviral treatments can successfully eradicate viremia, there are inadequate data with which to estimate benefits of treatment for long-term clinical outcomes such as death, cirrhosis, hepatocellular cancer, and quality of life," the Task Force writes in the Annals of Internal Medicine for March 16.

The Centers for Disease Control and Prevention and the National Institutes of Health do recommend screening for groups at high risk, such as injection drug users, hemodialysis patients, and recipients of transfusions or organs prior to 1990. Other at-risk populations include those with multiple sexual partners, contacts of HCV-infected individuals, and children born to HCV-infected mothers.

In a review of evidence for the USPS Task Force, Dr. Roger Chou and colleagues at the Oregon Health and Science University in Portland point out that there are no published trials of screening for HCV.

They note that screening can result in anxiety, labeling and unnecessary biopsies, while current treatment is prolonged, costly, and associated with adverse treatment effects. Moreover, the lower rate of progression in asymptomatic infection would yield less clinical effect of treatment than observed in those with symptoms.

And even among patients with cirrhosis or other serious medical or psychiatric conditions, risks and benefits of antiviral treatment must be carefully weighed, they add.

Because of the large health burden of HCV infection over the coming decades, "further research to more accurately determine the benefits and harms of screening is of paramount importance," Dr. Chou's group concludes.

Ann Intern Med 2004;140:462-479.