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Recommendations for Hep C Virus testing of persons born during 1945–1965

This month's Annals of Internal Medicine reports on recommendations from the Centers for Disease Control and prevention Hepatitis C virus testing of persons born during 1945–1965.

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The Centers for Disease Control and Prevention developed these evidence-based recommendations to increase the proportion of hepatitis C virus (HCV)–infected persons who know their status and are linked to appropriate care and treatment.

They recommend that adults born during 1945–1965 receive 1-time testing for HCV without prior ascertainment of HCV risk.

The team report that all persons identified with HCV infection receive a brief alcohol screening and intervention as clinically indicated, followed by referral to appropriate care and treatment services for HCV infection and related conditions as indicated.

The Centers for Disease Control and Prevention (CDC) estimates that 3.4 to 4.9 million persons have ever been infected with hepatitis C virus (HCV) in the United States.

All of these persons develop HCV antibodies, and approximately 75% develop a chronic infection.

This results in an estimated 2.7 to 3.9 million persons living with HCV infection in the United States.

Incidence of HCV increased markedly during the 1970s and 1980s, reaching an average of 230,000 new infections each year throughout the 1980s.

Incidence declined rapidly in the 1990s because of effective screening of blood donors starting in 1992, and reduced numbers of new infections among persons who inject drugs.

The CDC reports that the incidence declined until 2006 and has since remained stable, with an estimated 17,000 new infections in 2010.

Those who were infected in the remote past have been living with HCV infection for 20 to 40 years and are at increased risk for HCV-related morbidity and mortality.

Hepatitis C virus infection is the leading indication for liver transplantation, and accounts for more than 50% of incident hepatocellular carcinoma.

The team reports that the fastest-growing cause of cancer-related death in the United States.

The team noted that annual HCV-associated mortality in the United States increased over 50% from 1999 to 2007.

Data from death certificates show that HCV-associated deaths are now more frequent than deaths caused by HIV.

Modeling studies forecast substantial increases in morbidity and mortality among HCV-infected persons as they enter into their third, fourth, and fifth decades of living with infection.

The CDC estimates that without diagnosis and treatment 1.76 million persons with HCV infection will develop cirrhosis during their lifetimes, over 400,000 will develop HCC, and over 1 million will die from HCV-associated disease.

In 1998, the CDC issued recommendations for identifying HCV-infected persons.

Testing for HCV was recommended for persons most likely to be infected, including those who had ever injected drugs, received clotting factor concentrates produced before 1987, ever received long-term hemodialysis, had laboratory evidence of liver disease, or received transfusions of blood or blood components or organ transplants before 1992.

Screening also was recommended for persons who had a recognized blood exposure.

In 1999, HCV testing was recommended for persons infected with HIV.

The success of risk-based testing strategies has been limited.

Depending on the level of risk in the population and site-specific testing practices, an estimated 45% to 85% of U.S. adults are chronically infected with HCV yet unaware of their condition.

Testing for HCV seromarkers is suboptimal even among high-risk populations for whom routine testing is recommended.

The CDC notes that a sizeable percentage of these persons remain unaware of their infection status.

Dr Smith and colleagues conclude, "Because of the limited effectiveness of the current HCV testing recommendations alone in identifying undiagnosed infections, the CDC considered a birth year–based HCV testing strategy to increase the proportion of infected persons who know their HCV infection status."

"1-time HCV testing of persons born during 1945–1965."

"These persons account for 76.5% of all prevalence of those with HCV antibodies."

"Because alcohol accelerates progression of liver disease in HCV-infected persons, the CDC also addressed brief alcohol screening for those with HCV infection."

Ann Intern Med 2012; 157(11): 817-822
07 December 2012

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