USPSTF recommends testing all U.S. adults aged 18 to 79 for hep C

Last Updated: 2020-03-02

By Linda Carroll

(Reuters Health) - With the improved effectiveness of hepatitis C treatments, a panel of experts says it's worthwhile to screen all U.S. adults aged 18 to 79 for the virus.

The recommendations by the U.S. Preventive Services Task Force (USPSTF) were published on Monday in JAMA alongside a report by the same group that reviews evidence on the effectiveness and safety of newer treatments for the virus.

Experts currently estimate that 4.1 million Americans have hepatitis C and that half are unaware they're infected. Currently, screening rates are low even though previous guidelines recommended that all people born between 1945 and 1965 be tested for the virus.

"The new recommendations are a huge step forward in our efforts to eliminate hepatitis C in the U.S. and they will allow us to pick up all those under-30-year-old folks who have hepatitis C mostly as a result of the opioid epidemic sweeping the nation," said Dr. Douglas Dieterich, director of the Institute for Liver Medicine at the Mount Sinai Health System in New York City and a professor of medicine at the Icahn School of Medicine at Mount Sinai. "Frankly, in the U.S., we've been losing ground in the last few years."

Until recently, the majority of cases of hepatitis C were in Baby Boomers, most of whom were infected by tainted blood products before testing for the virus was implemented, said Dieterich, who was not involved with the new recommendations or the data review.

The USPSTF review of evidence on newer antiviral therapies for hepatitis C found they were 95% effective at clearing the virus, said Dr. Roger Chou, a professor in the department of medical informatics and clinical epidemiology at the Oregon Health and Science University in Portland, and a coauthor of the evidence review.

But their benefits go beyond that. "The treatments are much better tolerated and much shorter than they used to be," Chou said. "That is the main thing that is different between now and when we last reviewed the evidence in 2013."

Older therapies were only 30% to 40% effective and needed to be taken for 48 weeks and sometimes longer, Chou said. And because they just revved-up the immune system in a general way rather being targeted specifically for the hepatitis C virus, the treatments could be quite unpleasant for patients, he said. "You can imagine feeling like you have a low-grade flu for almost a year," he added.

The new antivirals need to be taken for just eight to twelve weeks and all the side effects seem to be short-lived, he said.

Because the newer drugs haven't been around long, there isn't a lot of research on their impact on the longer-term hepatitis C complications. However, a review of 13 studies including 35,8756 patients found that sustained response to the antiviral medications was associated with 60% decrease in all-cause mortality.

With the success of the newer therapies, it made sense to issue new screening recommendations, said Dr. Douglas K. Owens, chair of the USPSTF and a professor of medicine at Stanford University in California.

"Hepatitis C is the most common blood-borne pathogen in the U.S. and it's a major public health problem," Owens said. "We have good tests to detect it and a very good treatment for it. Given that more than 2 million people don't know they have it, screening is an important preventive service we are recommending for all adults aged 18 to79," he added. "We are also recommending screening for anyone younger than 18 or older than 79 if they are at high risk, which would primarily be because they have a history of, or are actively injecting drugs."

Currently there are about 45,000 new infections per year and that number is going up, Owens said. "So that's more than three times as many per year as there were 10 years ago," he added. "The consequences of this virus can be severe and that is why we are recommending a much broader screening so we can get people into treatment before they suffer those complications."

Dr. Nina Shapiro urges all adults to get screened and to raise the subject with their physicians.

"Most people haven't been screened and it's one of those viruses that can be so indolent for so many years it's not a part of routine testing," said Shapiro, a professor at the David Geffen School of Medicine at the University of California, Los Angeles. "It's not something someone would see visually and sometimes when a patient presents with a liver problem that may indeed be due to this virus it's not necessarily thought of."

Until recently, most cases were in Baby Boomers and many of them may not realize they are at risk. While the majority of people were infected through transfusions of tainted blood or IV drug use, it is also possible to get hepatitis C during sex, Shapiro said. "It's one of those illnesses that can go on for years without any symptoms till it's too late for it to be treated," she added. SOURCE: https://bit.ly/2IoxN2J, https://bit.ly/39hpCRs , https://bit.ly/38dbIyf and https://bit.ly/2Tf0Dsf JAMA, online March 2, 2020.