Screening for Hepatitis C Virus Infection in Adults

USPSTF: June 25, 2013

Importance

Hepatitis C virus is the most common chronic bloodborne pathogen in the United States and a leading cause of complications from chronic liver disease. The prevalence of the anti-HCV antibody in the United States is approximately 1.6% in noninstitutionalized persons. According to data from 1999 to 2008, about three fourths of patients in the United States living with HCV infection were born between 1945 and 1965, with a peak prevalence of 4.3% in persons aged 40 to 49 years from 1999 to 2002 (1, 2). The most important risk factor for HCV infection is past or current injection drug use, with most studies reporting a prevalence of 50% or more. The incidence of HCV infection was more than 200,000 cases per year in the 1980s but decreased to 25,000 cases per year by 2001. According to the Centers for Disease Control and Prevention (CDC), there were an estimated 16,000 new cases of HCV infection in 2009 and an estimated 15,000 deaths in 2007. Hepatitis C–related end-stage liver disease is the most common indication for liver transplants among U.S. adults, accounting for more than 30% of cases. Studies suggest that about one half of the recently observed 3-fold increase in incidence of hepatocellular carcinoma is related to acquisition of HCV infection 2 to 4 decades earlier (1).

Detection

The USPSTF found adequate evidence that anti–HCV antibody testing followed by confirmatory polymerase chain reaction testing accurately detects chronic HCV infection.

In screening strategies targeting persons with risk factors for HCV infection (such as past or present injection drug use, sex with an injection drug user, or blood transfusion before 1992), anti–HCV antibody testing is associated with high sensitivity (>90%) and small numbers needed to screen to identify 1 case of HCV infection (<20 persons) (1). Anti–HCV antibody testing remains highly accurate in low-prevalence populations, although the numbers needed to screen to detect 1 case of HCV infection are higher.

The USPSTF also found adequate evidence that various noninvasive tests have good to very good diagnostic accuracy in diagnosing fibrosis or cirrhosis (3).   Read more