The U.S. Preventive Services Task Force (USPSTF), an independent panel of national experts, now recommends screening all adults, ages 18 to 79 for hepatitis C virus (HCV), regardless of their risk factors. This draft recommendation updates the USPSTF's 2013 guidelines only to screen people with high infection risk and to provide one-time screenings for people born between 1945 and 1965.
The recommendation to screen all adults at least once is based on improved hepatitis C treatments, which are now more beneficial and less harmful than in the past. Additionally, hepatitis C infection has increased in younger adults since the USPSTF's last guideline. The number of new hepatitis C infections per year increased about 3.5 times between 2010 and 2016, according to the USPSTF.
Since injection drug use is a major risk factor for HCV, the infection increase may be linked to the opioid epidemic. Young, white people who inject drugs, especially those living in rural areas, have been most affected. Increasing rates of HCV infection also affect women 15 to 44 years old.
Screening is an important part of detecting HCV because symptoms can be flu-like and nondescript or even nonexistent. Most adults only need to be screened once, according to the USPSTF. Those at higher risk, such as individuals who use or have used injection drugs, should be screened more frequently. The USPSTF does not specify how frequently to screen higher risk populations.
Hepatitis C is carried in the blood and infects the liver, causing inflammation. It is the most common chronic bloodborne disease in the United States and a main cause of chronic liver disease. Chronic HCV infections can lead to significant liver damage, including cirrhosis, liver cancer, and even death. Hepatitis C infections kill more Americans than all other government-reportable diseases combined, including HIV.
Hepatitis C is now a treatable disease with new oral direct-acting antiviral medication, except during pregnancy. It is most beneficial to treat chronic hepatitis before it causes permanent liver damage, when success rates of treatment approach 100% and prevent complications such as cirrhosis and liver cancer.
Teens younger than age 18 and adults older than 79 may also require screening if they have risk factors. Pregnant individuals younger than 18 may also require screening if they have a higher risk for infection.
Hepatitis C screening is performed with a blood test that detects antibodies against the hepatitis C virus. A positive antibody test indicates exposure to HCV, but it cannot tell whether someone has an active infection or an infection that occurred in the past. In some cases, this may be a false-positive result. Therefore, the Centers for Disease Control and Prevention (CDC) recommends following all positive HCV antibody tests with a test that detects viral RNA in the blood to determine if someone has an current infection.
The USPSTF considers HCV tests accurate for identifying chronic infections. The screening procedure is non-invasive and low risk.
This draft recommendation is open for public comment until September 23, 2019 and will be finalized after "careful consideration of the feedback received," according to the USPSTF.