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Screening for Hepatitis C Virus Infection

Systematic Evidence Reviews, No. 24

Roger Chou, MD, Elizabeth Clark, MD, MPH, and Mark Helfand, MD, MS.

Oregon Evidence-based Practice Center, Portland, OR
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Structured Abstract

Purpose:

This report focuses on whether it is useful to order a hepatitis C virus (HCV) antibody test in either the general population of asymptomatic adults or selected high-risk subpopulations who have no history of liver disease or known liver function test abnormalities.

Data Sources:

A MEDLINE® search, supplemented by searches of the Cochrane Library, reference lists, and periodic hand searches of relevant major journals.

Study Selection:

We selected systematic reviews and controlled studies of antiviral treatment that used HCV infection in treatment-naïve patients as an inclusion criterion and reported relevant intermediate (virologic response) or clinical (symptoms, quality of life, cirrhosis, hepatocellular cancer, mortality) outcomes. We reviewed controlled and observational studies that evaluated clinical outcomes related to hepatitis A infection, hepatitis B infection, alcohol use, or spread of disease in patients found to have HCV. We also reviewed observational studies of the natural history, prevalence, progression, and consequences of untreated subclinical or asymptomatic hepatitis C virus infection.

Data Extraction and Synthesis:

Using preset criteria, we assessed the quality of each systematic review and abstracted information about included studies and results. We also assessed each trial and abstracted information about its setting, patients, interventions, and outcomes to verify the results of the systematic review as it pertains to our population.

Results:

Screening can detect hepatitis C virus antibodies in about 2% of the general US adult population, of whom 55–84% will have evidence of chronic infection (viremia). In certain settings, particularly in those associated with a high prevalence of intravenous drug use, the yield is much higher (50–90% in intravenous drug users). There is no direct evidence on benefits of screening in the general adult population. Many patients in the general population identified by screening will have a low probability of progressing to cirrhosis or another serious complication. Antiviral treatment is generally considered effective in improving intermediate outcomes in patients referred for treatment of chronic hepatitis C, but no trials have been performed specifically in patients likely to be identified by screening, who are likely to have milder or earlier disease. Data are insufficient to determine whether long-term outcomes are improved in patients referred for antiviral treatment of chronic hepatitis. There are no data to estimate the benefit from other interventions in patients identified by screening such as counseling on preventing spread of disease, obtaining appropriate immunizations, or alcohol counseling. Data on the adverse effects of screening (labeling, anxiety) and broader use of treatment are sparse.

Conclusions:

Screening can detect chronic HCV infection. Antiviral treatment can successfully eradicate viremia, but data on long-term clinical outcomes are lacking. Most antiviral trials evaluated patients with more severe liver disease. Although counseling and appropriate immunizations in patients identified by screening are likely to be beneficial, studies estimating the degree of benefit are not available. Harms from antiviral treatment and work-up (liver biopsy) appear minimal, but other harms (labeling, false-positives, anxiety) are more difficult to measure. There is insufficient evidence to accurately weigh the benefits and risks of screening for HCV in the general population of otherwise healthy, asymptomatic adults. The yield from targeted screening in high-risk patients, particularly intravenous drug users, would be substantially higher.

Contents

Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services.1 Contract No. 290-97-0018. Prepared by: Oregon Evidence-based Practice Center, Portland, OR.

This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.

AHRQ is the lead Federal agency charged with supporting research designed to improve the quality of health care, reduce its cost, address patient safety and medical errors, and broaden access to essential services. AHRQ sponsors and conducts research that provides evidence-based information on health care outcomes; quality; and cost, use, and access. The information helps health care decisionmakers—patients and clinicians, health system leaders, and policymakers—make more informed decisions and improve the quality of health care services.

1

540 Gaither Road, Rockville, MD 20850. www​.ahrq.gov

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