Screening for Hepatitis C Virus Infection: Recommendations from the U.S. Preventive Services Task Force

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The summary below is from the full reports titled "Screening for Hepatitis C Virus Infection in Adults: Recommendation Statement" and "Screening for Hepatitis C Virus Infection: A Review of the Evidence for the U.S. Preventive Services Task Force." They are in the 16 March 2004 issue of Annals of Internal Medicine (volume 140, pages 462-464 and pages 465-479). The first report was written by the U.S. Preventive Services Task Force; the second report was written by R. Chou, E.C. Clark, and M. Helfand.

What is the U.S. Preventive Services Task Force?

The U.S. Preventive Services Task Force (USPSTF) is a group of health experts that reviews published research and makes recommendations about preventive health care. The USPSTF and its review of the published research are supported by the Agency for Healthcare Research and Quality.

What is the problem and what is known about it so far?

Hepatitis C virus (HCV) infection causes liver disease. A person gets HCV infection from contact with the blood of someone with HCV infection. Before routine HCV testing of donated blood began in 1990, many people got HCV infection from blood transfusions. Other risk factors for HCV infection include kidney dialysis, being the child of a mother with HCV infection, sexual contact with a person with HCV infection, illicit drug use, and contact with blood in the workplace (such as might occur in health care workers). However, the source of infection is unknown in many people. Although some people with HCV infection need liver transplants or die, many have no symptoms and never develop liver disease. About 2 out of every 100 U.S. adults have HCV infection, but many people who are infected do not know that they are. Blood tests can identify whether a person has HCV infection. Drugs are available to treat HCV infection, but they can cause side effects, are only partly effective, and are expensive. Screening for HCV would involve testing healthy people for HCV infection so that they could begin treatment before symptoms develop. Screening makes sense only if the benefits of treating HCV infection before symptoms develop are greater than the potential harms.

How did the USPSTF develop these recommendations?

The USPSTF reviewed published research related to the benefits and harms of screening for HCV infection.

What did the USPSTF find?

The USPSTF found that available tests can accurately identify people with HCV infection. However, infection rates among healthy people who have no risk factors for HCV are low, and most people with HCV infection never develop severe liver disease. The USPSTF found no studies that proved that screening for HCV infection leads to better outcomes for patients. The harms of screening include the side effects, inconvenience, and costs of treatment. The USPSTF also found no studies that proved that looking for HCV infection in adults who had no symptoms but were at high risk (that is, had blood transfusions before 1990, used illicit drugs, or had other risk factors) leads to benefits. However, the frequency of infection is much higher among adults with risk factors than it is in adults without risk factors.

What does the USPSTF suggest that patients and doctors do?

Patients and doctors should be aware that there are no studies that prove that screening for HCV infection during routine health care improves patient outcomes. The USPSTF recommends against testing for HCV infection in patients who have no specific risk factors for HCV infection and no symptoms of liver disease. The USPSTF recommends neither for nor against routine testing for HCV infection for patients with specific risk factors for HCV infection.

What are the cautions related to these recommendations?

Recommendations may change as new studies become available. Doctors should test for HCV infection if people have signs or symptoms of liver disease.