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25 June 2013 Annals of Internal Medicine Tip Sheet

Below is information about articles being published in the June 25 issue of Annals of Internal Medicine. The information is not intended to substitute for the full articled as a source of information. Annals of Internal Medicine attribution is required for all coverage.

Task Force Recommendation: Screen All Baby Boomers and High-risk Patients for Hep C

The United States Preventive Services Task Force (USPSTF) recommends screening for hepatitis C virus (HCV) infection in persons at high risk for infection and one-time screening for all adults born between 1945 and 1965. Up to 3.9 million people in the United States are infected with HCV, a virus that can cause inflammation, permanent liver damage, and cancer. The most significant risk factor for HCV infection is past or current injection drug use. Receiving a drug transfusion before 1992 is also an established risk factor. Additional risk factors include chronic hemodialysis, being born to an HCV-infected mother, incarceration, intranasal drug use, getting an unregulated tattoo, and other percutaneous exposures, such as being a health care worker or having surgery before the implementation of universal precautions. HCV infection is most prevalent among people born from 1945 through 1965, and many of them 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 Task Force found that a risk-based approach may miss detection of a substantial proportion of HCV-infected persons in the birth cohort because of a lack of patient disclosure or knowledge about prior risk status. One-time screening for HCV infection in the birth cohort may identify infected patients at an earlier, more treatable stage of disease. This is an update to a previous recommendation. In 2004, the USPSTF recommended against routine screening for HCV infection in asymptomatic adults who are not at increased risk for infection. At the time, the Task Force also found insufficient evidence to recommend for or against routine HCV screening for adults at high risk for infection. To inform an update, researchers studied published evidence focusing on research gaps identified in the previous review. The researchers found adequate evidence that the antiviral regimens used as treatment for HCV result in improved clinical outcomes, and that targeted screening misses up to two-thirds of infected patients. Screening tests appear to be accurate for identifying HCV-infected patients with minimal risk of harm. The authors of an accompanying editorial write that the Task Force’s expanded screening recommendations are especially important in light of highly effective treatment for HCV. Screening both those at risk and the birth cohort will help to identify millions of Americans previously unaware of their infection status, preventing liver disease and deaths attributable to chronic HCV infections.