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Testing for Hepatitis C Virus Infection Should Be Routine for Persons at Increased Risk for Infection
- Miriam J. Alter, PhD;
- Leonard B. Seeff, MD;
- Bruce R. Bacon, MD;
- David L. Thomas, MD;
- Michael O. Rigsby, MD; and
- Adrian M. Di Bisceglie, MD
- From National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland; American Association for the Study of Liver Diseases and The Infectious Diseases Society of America, Alexandria, Virginia; Veterans Health Administration, Department of Veterans Affairs, Washington, DC; and Hepatitis Council, American Liver Foundation, New York, New York.
Abstract
In the United States, chronic hepatitis C virus (HCV) infection affects an estimated 3 million persons, most younger than 50 years of age. It is one of the leading causes of chronic liver disease morbidity and mortality and the most common indication for liver transplantation. Effective treatment can eradicate the virus and eliminate or reduce liver inflammation and fibrosis, and counseling and immunization can modify or prevent the adverse effect of cofactors (for example, alcohol consumption or co-infections) on disease progression. However, controversy surrounds the need to routinely identify asymptomatic HCV-infected persons. Because no data currently demonstrate that treatment or other interventions will reduce future cases of HCV-related chronic disease and deaths, the U.S. Preventive Services Task Force found insufficient evidence to recommend for or against routine screening for HCV infection in adults at high risk. Chronic hepatitis C would require many years of follow-up to determine the incidence of complication after treatment of or other interventions in asymptomatic persons. It seems inappropriate to wait several decades to measure the impact of early identification of this viral infection when current data support a positive therapeutic effect that points to long-term benefits. In addition, treatment and other interventions must be provided before cirrhosis or liver failure occurs. Therefore, medical and public health professionals should continue the practice of screening persons for risk factors; offering testing to those at increased risk for HCV infection; and providing infected persons with appropriate counseling, medical evaluation, and treatment.
Article and Author Information
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Acknowledgments: The authors thank Jay H. Hoofnagle, MD, National Institutes of Health, Bethesda, Maryland, and John G. McHutchison, Duke University Medical Center, Durham, North Carolina, for their valuable contributions to this manuscript.
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Potential Financial Conflicts of Interest: Consultancies: A.M. Di Bisceglie (Schering-Plough, Roche, Idenix, SciClone Pharmaceuticals, Chiron Corp., Vertex, 3M); Honoraria: D.L. Thomas (Roche, Schering-Plough), A.M. Di Bisceglie (Schering-Plough, Roche); Grants received: A.M. Di Bisceglie (Schering-Plough, Roche, Idenix, SciClone Pharmaceuticals); Other: D.L. Thomas (Chiron Corp., Roche).
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Requests for Single Reprints: Miriam J. Alter, PhD, Division of Viral Hepatitis, Mailstop D66, Centers for Disease Control and Prevention, Atlanta, GA 30333.
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Current Author Addresses: Dr. Alter: Division of Viral Hepatitis, Mailstop D66, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333.
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Dr. Seeff: Liver Disease Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, 31A Center Drive, Room 9A27, Bethesda, MD 20892.
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Dr. Bacon: Saint Louis University School of Medicine, 3635 Vista Avenue, St. Louis, MO 63110.
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Dr. Thomas: The Johns Hopkins Medical Institution, 1513 East Jefferson Street, Baltimore, MD 21231.
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Dr. Rigsby: Department of Veterans Affairs, 950 Campbell Avenue, West Haven, CT 06516.
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Dr. Di Bisceglie: Saint Louis University School of Medicine, 3635 Vista Avenue, St. Louis, MO 63110.
