medwireNews: Clinicians should consider screening for hepatitis C virus (HCV) in all patients born between 1945 and 1965, the US Preventive Services Task Force says in draft guidance.
The recommendation backs advice given earlier this year by the US Centers for Disease Control and Prevention (CDC) as reported by medwireNews (click here).
The review of evidence, published in the Annals of Internal Medicine, found inadequate support for direct benefits of screening in adults without symptoms. However, results of targeted screening strategies based on multiple risk factors (eg, past or present intravenous drug use, sex with an intravenous drug user, or blood transfusion prior to 1992) showed they could achieve sensitivities of over 90% and reduce the number needed to screen to identify one infected patient below 20.
Using narrower screening criteria, such as only screening people with a history of drug injection, reduced the number needed to screen to less than two but also resulted in two-thirds of infected patients being missed.
In 2004, the Task Force found insufficient evidence to make a recommendation on screening in high-risk groups, but it now considers there to be moderate evidence for a modest benefit in this population.
The Task Force also concludes that there is moderate evidence in favor of screening all baby boomers, but that the benefit is likely to be less than in groups with specific risk factors.
"Clinicians may consider a birth cohort-based screening approach for patients born between 1945 and 1965 who have no other known HCV risk factors," the Task Force report.
"Screening in the birth cohort for HCV infection may identify infected patients at earlier stages of disease, before they develop complications from liver damage."
The authors say their review highlights the lack of evidence for comparisons between different screening strategies.
"Clinical studies that prospectively evaluate that accuracy, yield, and outcomes of alternative HCV screening strategies, including the birth cohort approach, are needed," write Roger Chou (Oregon Health & Science University, Portland, USA) and colleagues.
The Task Force also reviewed the efficacy of current treatments and the potential to reduce mother-to-child transmission of the virus, which will be incorporated into final guidance published next year.
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USPSTF Draft Recommendation Statement