This series of fact sheets is based on the work of the U.S. Preventive Services Task Force (USPSTF). The USPSTF systematically reviews the evidence of effectiveness of a wide range of clinical preventive services—including screening, counseling, and chemoprevention (the use of medication to prevent diseases)—to develop recommendations for preventive care in the primary care setting.
This fact sheet presents highlights of USPSTF recommendations on this topic and should not be used to make treatment or policy decisions. More detailed information on this subject is available from the USPSTF.
The U.S. Preventive Services Task Force (USPSTF) recommends against routine screening for hepatitis C virus (HCV) infection for asymptomatic adults who are not at increased risk for infection. The USPSTF found insufficient evidence to recommend for or against routine screening for HCV infection in adults at high risk for infection.
Screening tests can detect HCV infection in asymptomatic adults who are not at increased risk for infection, but there is no evidence that such screening leads to improved long-term health outcomes such as decreased cirrhosis, hepatocellular cancer, or mortality. Because the prevalence of HCV infection in the general population is low, so would be the yield of screening.
The yield of screening for HCV infection in adults at increased risk would be substantially higher than the yield of screening in the general population, but there is no evidence that such screening leads to improved long-term health outcomes.
There is no evidence that screening for HCV infection leads to improved long-term health outcomes. |
Established risk factors for HCV infection include current or past intravenous drug use, blood transfusion before 1990, dialysis, and being a child of an HCV-infected mother. High-risk sexual behavior (particularly sex with someone infected with HCV) and the use of illegal drugs also have been associated with increased risk for HCV infection.
There is evidence that anti-viral therapy improves intermediate health outcomes, such as viremia, but there is no evidence that such treatment improves long-term health outcomes. There is currently no evidence that newer treatments for HCV infection, such as pegylated interferon plus ribavirin, improve long-term health outcomes. There is limited evidence that older therapies have some long-term health benefits for patients referred for treatment, but these studies were done outside the United States. It is not known whether these results can be generalized to the U.S. population. There is limited evidence that available treatments are effective in preventing cirrhosis in patients with asymptomatic HCV infection.
Potential harms of screening for HCV include anxiety, negative effects on partner relationships, unnecessary biopsies, labeling, and treatment regimens that have a high incidence of adverse effects.
The majority of patients receiving interferon-based therapies alone or in combination with ribavirin experience adverse effects, the most common of which is a flu-like syndrome, including myalgia, fatigue, headache, and fever. As a result of these adverse effects, the current treatment regimen is associated with a high patient dropout rate. Treatment regimens for HCV infection are long and costly.
The adverse effects of treatment are common and result in high patient dropout rates. |
The Centers for Disease Control and Prevention
www.cdc.gov
healthfinder®
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National Institutes of Health
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More detailed information on this subject is available in Screening for Hepatitis C Virus Infection: Systematic Evidence Review for the U.S. Preventive Services Task Force and in the USPSTF Recommendation Statement, which can be found on the Agency for Healthcare Research and Quality (AHRQ) Web site (www.preventiveservices.ahrq.gov) and through the National Guideline Clearinghouse™ (www.guideline.gov). The Summary of Evidence and the USPSTF Recommendation Statement are available in print through the AHRQ Clearinghouse (1-800-358-9295, or ahrqpubs@ahrq.gov).
The USPSTF is an independent panel of experts who represent the fields of family medicine, gerontology, obstetrics-gynecology, pediatrics, nursing, prevention research, and psychology. Members of the USPSTF when its recommendation on this topic was finalized:
Alfred O. Berg, M.D., M.P.H., chair
Janet D. Allan, Ph.D., R.N., C.S., vice-chair
Ned Calonge, M.D., M.P.H.
Paul S. Frame, M.D.
Joxel Garcia, M.D., M.B.A.
Russell Harris, M.D., M.P.H.
Mark S. Johnson, M.D., M.P.H.
Jonathan D. Klein, M.D., M.P.H.
Carol Loveland-Cherry, Ph.D., R.N.
Virginia A. Moyer, M.D., M.P.H.
C. Tracy Orleans, Ph.D.
Albert L. Siu, M.D., M.S.P.H.
Steven M. Teutsch, M.D., M.P.H.
Carolyn Westhoff, M.D., M.Sc.
Steven H. Woolf, M.D., M.P.H.
AHRQ Publication No. 04-IP007
Current as of March 2004
Internet Citation:
Screening for Hepatitis C in Adults. What's New from the USPSTF. AHRQ Publication No. 04-IP007, 2004. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/3rduspstf/hepcscr/hepcwh.htm
U.S. Preventive Services Task Force (USPSTF)
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