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March 5, 2020

Providers should screen all adults for hep C, USPSTF says

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    The U.S. Preventive Services Task Force (USPSTF) has expanded its screening guidelines for hepatitis C and is now calling on providers to screen all adults between the ages of 18 and 79 for the disease, according to a new recommendation statement published in JAMA.

    Hep C cases on the rise

    USPSTF updated its hepatitis C screening guidelines amid a surge in new hepatitis C cases in the United States. CDC data show the number of reported hepatitis C cases in the country grew more than three-fold between 2010 and 2017, with 44,700 new cases of the disease reported in 2017 alone. The disease caused at least 18,000 deaths in 2016, CDC said.

    USPSTF estimates there are about 4.1 million people in the United States who have hepatitis C, though some of those individuals may not be exhibiting symptoms of the disease. About 2.4 million people in the United States have active hepatitis C infections, according to USPSTF.

    Public health experts say the stark increase in hepatitis C cases between 2010 and 2017 likely was tied to the U.S. opioid epidemic and an increase in injection drug use during that time. USPSTF said the largest increase in hepatitis C cases during that time occurred among adults ages 20 to 39 who used injectable drugs.

    USPSTF expands hep C screening recommendations

    USPSTF last updated its hepatitis C screening guidelines in 2013, when the task force recommended that clinicians screen only high-risk patients and patients born between 1945 and 1965. However, USPSTF under the recommendation statement published Monday in JAMA now suggests that providers screen all adults between the ages of 18 and 79 for hepatitis C at least once.

    Providers should screen patients considered to be at high risk of developing hepatitis C periodically, regardless of whether they fall into that age range, according to USPSTF. Douglas Owens, USPSTF chair and a professor of medicine at Stanford University, said such patients "primarily" would include those who "have a history of, or are actively injecting drugs."

    USPSTF gave its recommendation a B rating, meaning hepatitis C screening now qualifies as a preventive health service under the Affordable Care Act (ACA). Under the ACA, insurers must cover preventive health services with a B rating or higher without cost-sharing requirements.

    Task force members say change could help curb new hep C infections

    USPSTF members said the new recommendations could help to curb new hepatitis C infections and help patients, particularly those who might know they have the disease, access treatments sooner.

    Owens said, "[M]ore than [two] million people don't know they have" hepatitis C because patients "do not always feel sick." He said, "Screening is key to finding this infection early, when it's easier to treat and cure, helping reduce illnesses and deaths."

    Roger Chou of the Oregon Health and Science University said USPSTF during its research review for hepatitis C screening found that treatments for the disease are now highly effective. According to the research review, which Chou coauthored, more than 95% of hepatitis C cases are cured within two to three months of oral therapy.

    "The treatments are much better tolerated and much shorter than they used to be," Chou said.

    Robert Brown Jr., director of the Center for Liver Disease and Transplantation at NewYork-Presbyterian/Weill Cornell, said, "In this new group of younger patients who are predominately white, nonurban, and who are using prescription and nonprescription opioids, the only way we're going to get rid of hepatitis C is to use treatment as prevention and prevent transmission to other high-risk individuals" (Ross Johnson, Modern Healthcare, 3/2; Gross, New York Times, 3/2; Carroll, Reuters, 3/2; USPSTF, JAMA, 3/2).

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