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H E PAT O L O G Y I N F O C U S
GASTROENTEROLOGY & ENDOSCOPY NEWS • MAY 2013
HCV Screening continued from page 1
on HCV screening to support one-time screening for all baby boomers. Hepatologists insist that a strong recommendation from the task force will save both lives and dollars in the long run. “If we can get a single, coordinated effort to get all baby boomers screened, that is going to be best for our patients,” said Neeral Shah, MD, a hepatologist and assistant professor of internal medicine at the University of Virginia School of Medicine in Charlottesville. “Without such a recommendation, we’re going to continue to miss the 800,000 people who do not know they have hepatitis C.
screening for that age cohort. In a statement explaining the decision, task force member Kirsten BibbinsDomingo, MD, PhD, MAS, associate professor of medicine, epidemiology and biostatistics at the University of California, San Francisco, said: “Based on what we know today, the task force concluded that screening provides substantial benefits for people at high risk. We also found that screening people from the baby-boom
generation also provides real, although smaller, benefits. People at high risk have about a 50% chance of being infected with hepatitis C, whereas people born between 1945 and 1965 have a 3% to 4% chance of being infected.”
Hepatologists Lobby for Change For specialists in hepatology and infectious disease, the USPSTF decision comes up short.
‘If we can get a single, coordinated effort to get all baby boomers screened, that is going to be best for our patients. Without such a recommendation, we’re going
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to continue to miss the 800,000 people who do not know they have hepatitis C.’ —Neeral Shah, MD
“There is a British term, ‘penny wise, pound foolish,’ ” he added. “If we try to save our money now by not screening the population to find these people with silent hepatitis C, then we’ll be dealing with the enormous costs of end-stage liver disease and transplant down the line.”
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Conflicting Recommendations In August, the Centers for Disease Control and Prevention (CDC) recommended a one-time screening for all Americans born between 1945 and 1965. According to the CDC report, 75% of HCV-infected individuals in the United States were born during those years, but the overwhelming majority—as many as 75%—are unaware of their HCV [hepatitis C virus] status. The CDC said that screening baby boomers could lead to the detection of more than 800,000 HCV infections, and avert cases of advanced liver disease and as many as 120,000 deaths. But the CDC’s recommendation received a lukewarm response from the USPSTF. In its draft opinion, the task force said screening should be offered to adults at high risk, such as those with a history of IV drug use and those who received blood transfusions before 1992. For baby boomers, the task force said clinicians may “consider offering” HCV
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Douglas R. LaBrecque, MD, professor and director of Liver Service, Department of Internal Medicine, University of Iowa, University Heights, argued that, by definition, all baby boomers in the United States are high-risk. “One in 30 baby boomers is going to be positive. That’s pretty high risk,” he said. He added that many cases of hepatitis C will be missed if screening efforts target only IV drug users or people who