ESTES PARK, COLO. – The era of selective screening for hepatitis C infection based upon risk factors such as alcoholism or a history of illicit drug use or incarceration has come to an end.
The June 2013 U.S Preventive Services Task Force Grade B recommendation for one-time testing of all baby boomers for hepatitis C infection means that the birth cohort–based testing will be a covered benefit under the Affordable Care Act, Dr. Gregory T. Everson noted at a conference on internal medicine sponsored by the University of Colorado.
The task force’s action was an endorsement of an earlier Centers for Disease Control and Prevention recommendation that all adults born in 1945-1965 should receive one-time testing for HCV without prior assessment of HCV risk (MMWR Recomm. Rep. 2012;61(RR-4):1-32). This is sound policy for several reasons, said Dr. Everson, professor of medicine and director of hepatology at the University of Colorado, Denver.
First, baby boomers account for roughly 75% of all cases of chronic hepatitis C virus (HCV) infection in the United States. Most of these cases remain undiagnosed. The CDC estimates that one-time universal testing of baby boomers would identify 800,000 new cases and prevent more than 120,000 deaths. The prevalence of HCV in the United States isn’t expected to peak until the year 2020.
In addition, recent dramatic advances in the treatment of chronic HCV make it likely that the therapy will move from hepatology clinics to primary care physicians’ offices, where preventive medicine is a priority, Dr. Everson noted.
The screening entails a blood test for HCV antibody. If the results are positive, the next step is to confirm the diagnosis via a polymerase chain reaction–based test for HCV RNA quantification. There is roughly a 75% chance that an HCV antibody–positive patient will be HCV RNA positive, which indicates the patient has a chronic HCV infection. The natural history of HCV infection is roughly a 30-year timeline from acute infection to liver transplantation or death.
Dr. Everson said that for assessing the severity of hepatic fibrosis in patients with HCV, he still relies heavily on liver biopsy, which most experts consider the gold standard.
The Food and Drug Administration has approved ultrasound-based transient elastography via the FibroScan device as a noninvasive alternative. The device, which costs about $130,000, is good at identifying cirrhosis but less accurate in staging intermediate levels of fibrosis, Dr. Everson noted. The same is true of an FDA-approved serologic test for fibrosis, he said.
Dr. Everson is involved in developing new treatments for HCV. He reported that he receives research grants from, serves as a consultant to, or serves as an advisory board member for roughly two dozen pharmaceutical companies.