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USPSTF Recommends Against Screening for HCV Infection

The USPSTF concludes that the harms of HCV screening outweigh the benefits in the general population.

The third U.S. Preventive Services Task Force (USPSTF) has been releasing new and updated guidelines during the past 3 years (guidelines homepage; Journal Watch May 15 2001 and Journal Watch Feb 17 2004).

USPSTF 3 concludes each of its guidelines with a recommendation, graded as follows:

A -- The intervention is strongly recommended.

B -- The intervention is recommended.

C -- The USPSTF makes no recommendation for or against the intervention.

D -- The intervention is not routinely recommended.

I -- Evidence is insufficient to recommend for or against the intervention.

The USPSTF recommends against routine screening for hepatitis C virus (HCV) infection in asymptomatic adults. Although tests can detect HCV infection, and therapy can improve intermediate outcomes (e.g., viremia, elevated transaminase levels), harms of screening likely outweigh benefits. The task force found that:

• The prevalence of infection is low in the U.S.
  
• Most HCV-positive people do not develop adverse health outcomes (e.g., cirrhosis); 10%-20% of individuals with chronic infection develop cirrhosis within 20-30 years.
  
• No evidence showed that screening improves health outcomes (e.g., lower rates of cirrhosis, hepatoma, or mortality).
  
• Treatment is long-term and costly, and many patients discontinue treatment due to side effects.
  
• Screening can lead to unnecessary biopsies and can label patients as having a chronic disease.
  

The USPSTF concluded that the harms of screening outweigh the benefits in the general population. Recommendation: D

In high-risk adults, the USPSTF found insufficient evidence to recommend for or against routine HCV screening. Although the prevalence of infection is higher in this population than in others, no evidence showed that screening led to improved long-term health outcomes. The USPSTF could not determine the balance between benefits and harms of screening in this group. Recommendation: I

Comment: Hepatitis C infection has received a great deal of attention from physicians and patients and much publicity from public health agencies. This campaign has emphasized HCV's serious health consequences and the efficacy of treatment. The USPSTF reminds us that screening in general populations sometimes can be ineffective or even harmful. A formal cost-utility analysis would be a reasonable next step to compare harms and benefits of screening for HCV infection. At the time of publication, the full text of the recommendation statement and the evidence review was available free of charge.

— Richard Saitz, MD, MPH, FACP, FASAM

Published in Journal Watch General Medicine March 26, 2004

Citation(s):

U.S. Preventive Services Task Force. Screening for hepatitis C infection in adults: Recommendation statement. Ann Intern Med 2004 Mar 16; 140:462-4.

• Original article (Subscription may be required)
• Medline abstract (Free)

Chou R et al. Screening for hepatitis C virus infection: A review of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 2004 Mar 16; 140:465-79.

• Original article (Subscription may be required)
• Medline abstract (Free)