Screening for Hepatitis C:  A Common Sense Approach

Recently in the Annals of Internal Medicine, the U.S. Preventive Task Force has recommended against screening for HCV infection. This interpretation, without input from experts at the Centers for Disease Control and Prevention – Division of Viral Hepatitis, members of the American Association for the Study of Liver Diseases, or experienced hepatologists, differs from that held by most authorities in the field .

To clarify some of these issues, the Hepatitis Foundation International’s scientific advisors offer the following comments:

The majority of Americans who are HCV infected are unaware of their infection. are at increased risk of accelerating damage to their liver by consuming alcohol, may spread infection to others, and may fail to take appropriate steps to reduce the risk of superimposed hepatitis virus infections.. Waiting for the development of symptoms before testing for HCV infection is likely to result in more advanced liver disease and a lower likelihood of successful therapy. As a result HFI believes it is vitally important that anyone who has participated in high risk behavior, regardless of duration or how long in the past, be tested for HCV infection.

HCV-infected individuals should be:

• Counseled about the dangers of alcohol consumption

• Informed of the risk of transmitting infection

• Educated about methods to reduce the risk of spreading infection

• Vaccinated against hepatitis A and B if susceptible to these infections

Because HCV-infection is usually silent until very late in the course of the disease, awareness and education are essential to identify infected individuals and encourage them to seek medical attention. There is a clear urgency to identify those who are most likely to be infected due to their past or current participation in risky behaviors since the risk of infection in such individuals is higher than in the general population. Continued use of alcohol without treating the infection will eventually lead to serious damamge to the liver, often without warning, until the only option available to save their life is a liver transplant. Evaluation for medical intervention and to increase knowledge should help individuals take responsibility for their own healthcare and to adopt healthy lifestyle behaviors.

Opportunities exist to reach the majority of individuals at high risk of infection at STD clinics, in corrections facilities, and in drug rehabilitation programs to test them for hepatitis. Others who should be tested include those with recognized exposures, i.e., health care, emergency medical and public safety workers after needle sticks, sharps or mucosal exposures to HCV positive blood and children born to HCV-positive women.

When taking a patient’s history, physicians, nurse practitioners and other healthcare providers need to discuss prior use of drugs and high risk behaviors with patients to ascertain whether or not they may be infected and to order a hepatitis panel of tests.

Education is an essential first step to encourage the patient’s active participation his or her own healthcare. Medical evaluation is the next essential step with the goal of clearing the hepatitis C virus and improving the damage to the liver.

Benefits of early detection of HCV.

• Decreasing the likelihood of disease progression

• Saving lives

• Limiting the need for liver transplants for those with end-stage liver disease

• Reducing healthcare costs.

Primary prevention through screening, education, and secondary prevention- helping those who are infected to avoid further damage to the liver and treating their infection - are essential to bringing hepatitis C under control.

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