Every American Adult Should Be Tested for Hepatitis C: Task Force
Every adult in the United States should be tested for hepatitis C as part of their basic health care, an influential panel of preventive medical experts says.
The U.S. Preventive Services Task Force now recommends that screening for hepatitis C infection occurs in everyone between 18 and 79, the group announced Monday.
Hepatitis C infections have soared as a result of the opioid epidemic, with heroin users spreading the virus as they share needles, said task force member Dr. Michael Barry, director of the Informed Medical Decisions Program at Massachusetts General Hospital.
An estimated 2.4 million Americans are currently living with chronic hepatitis C, the USPSTF says. An estimated 44,700 new infections occurred in 2017, nearly four times as many cases as there were in 2010.
This is taking place even though there's a safe and effective cure for hepatitis C that has been steadily coming down in price, said Dr. Douglas Dieterich, director of the Institute of Liver Medicine at Mount Sinai Health System in New York City.
"In the U.S., our goal was to eliminate hep C by 2030, but we're actually losing the battle," Dieterich said. "There are more new cases coming in than there are ones we are curing. This [testing recommendation] will be a huge benefit to everyone in picking up these younger folks."
Hepatitis C infection is a chronic, long-term liver disease for many as 4 of 5 people who contract the virus, according to the U.S. Centers for Disease Control and Prevention. It causes liver damage, increasing a person's risk of developing liver cancer or dying from liver disease.
Federal law requires that insurance companies cover preventive medical services recommended by the task force free of charge for patients.
But in this case, the test only costs about $8, Dieterich said. The recommendation is aimed mainly at doctors, to remind them to include this screening as part of regular lab work.
In its 2013 recommendations, the USPSTF limited hepatitis C screening to the baby boomer generation born between 1945 and 1965, Barry said.
"The rationale was that around 75% of hepatitis C infections were in that age range, largely because of the experimentation with IV drugs back in the Vietnam era," Barry said.
Now there's been a surge in new hepatitis C infections among younger people, particularly those between 18 and 44, he said.
"It's very likely that's due to the opioid epidemic with more use of intravenous drugs," Barry said. "Now we're seeing hepatitis C spill into other age groups, particularly younger folks."
The most rapid increase in hepatitis C infection has been in young adults 20 to 39 who inject drugs, the task force said.
Public health officials are particularly frustrated because there now is a cure for hepatitis C that has proven safe and effective, curing more than 90% of cases with virtually no side effects, Dieterich said.
Furthermore, the cost of the cure has steadily declined, with free-market competition lowering the price of treatment by at least 70%, according to an editorial in the Journal of the American Medical Association.
A typical eight-week antiviral regimen to cure hepatitis C costs about $26,400, and last year a generic 12-week drug regimen came onto the market, the editorial says. Louisiana and Washington state are testing flat-rate drug purchasing plans that would reduce the cost even more.
"By screening all adults ages 18 to 79 for hepatitis C we should be able to pick up the cases we were missing previously, which are getting more numerous," Barry said. "The treatments are better, but identifying people and getting them into treatment is a key step, and that's what the guideline is all about."
The task force recommendations appear online March 2 in the Journal of the American Medical Association.
The U.S. Centers for Disease Control and Prevention has more about hepatitis C.
SOURCES: Michael Barry, M.D., director, Informed Medical Decisions Program, Massachusetts General Hospital, and professor, Harvard Medical School, Boston; Douglas Dieterich, M.D., director, Institute of Liver Medicine, Mount Sinai Health System, New York City; March 2, 2020, Journal of the American Medical Association, online