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19-08-2012 | Gastroenterology | Article

All baby boomers to be tested in HCV-screening shakeup

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MedWire News: The US Centers for Disease Control and Prevention (CDC) has revised its screening recommendations for hepatitis C virus (HCV) to include testing of all adults born between 1945 and 1965.

The changes come 14 years after the CDC introduced the recommendation for screening in at-risk individuals. However, they acknowledge that this approach has been largely unsuccessful and a substantial proportion of infected individuals in the USA remain unaware of their status.

People born between 1945 and 1965 in the USA have a rate of HCV five times greater than adults born in other years. The authors say diagnosis is needed so that patients can receive treatment with antiviral agents.

"Although certain harms (that is, worry or anxiety while waiting for test results, insurability, liver biopsy complications, and severe adverse events during treatment) can be detrimental to patients, the benefits associated with diagnosis and effective treatment include SVR [sustained virologic response], which is associated with reduction in HCC [hepatocellular carcinoma] and all-cause mortality," say Bryce Smith (CDC, Atlanta, Georgia, USA) and colleagues.

Using data from three nationally representative studies and the National Health and Nutrition Examination Survey (NHANES), the authors found that the proportion of persons born between 1945 and 1965 with HCV antibody was higher than that of the general population. In NHANES, the prevalence was 3.25% in this birth cohort compared with 0.8% among adults born at other times.

Furthermore, their meta-analysis of 30 observational studies found that treatment-induced SVR could significantly reduce the risk of HCC by 76%.

The CDC also recommends alcohol screening and intervention in HCV-positive individuals to help decelerate liver disease progression. This is based on a 2010 meta-analysis that showed that a brief alcohol reduction intervention could reduce consumption by 38 g per week compared with a control group.

The recommendations, published in the Annals of Internal Medicine, are a major change to the CDC screening guidelines, which until now have only recommended testing those with known risk factors. For example, individuals who have injected illicit drugs, those who received blood transfusions before 1992, and patients with HIV infection. However, the authors note several flaws with this approach and say that up to 85% of those infected with HCV in the USA could still be unaware of it.

The CDC says that doctors should still follow their prior recommendations. However, their new guidelines should help overcome reliance on the often impractical risk-based screening in primary care and increase the number of individuals in the USA who are aware of their HCV-positive status.

By Kirsty Oswald, MedWire News Reporter

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