A risk factor for liver disease, cirrhosis and liver cancer, hepatitis C virus (HCV) infection is linked to the deaths of more U.S. patients than the next 60 infectious disease combined – including HIV and tuberculosis. Worryingly, its incidence is on the rise among younger adults, fueled in large part by injection drug use associated with the opioid epidemic.
In an editorial published in JAMA, Camilla S. Graham, MD, MPH, an infectious disease specialist at Beth Israel Deaconess Medical Center (BIDMC), makes the case for universal HCV infection screening in all adults aged 18 to 79 years, regardless of known risk factors as well as for teens who engage in injection drug use. The US Preventive Services Task Force has issued a B Grade for this recommendation, which means Medicare and Medicaid will pay for HCV testing without cost sharing.
According to Graham and colleagues, advances in HCV treatment in the last decade combined with the ongoing opioid epidemic mean that universal HCV screening is more cost effective and more necessary than ever before.
- Screening efforts previously targeted people born between 1945 and 1965 – baby boomers who once comprised 75 percent of all HCV cases in the United States. BIDMC was one of the first adopters of baby boomer screening in April 2013. Graham considers this a successful, but now out-of-date, first step in widespread screening.
- HCV infection rates have risen 133 percent since 2004, with the most dramatic increases within the 18-29 and 30-39 age groups. Because HCV can be transmitted to unborn babies, screening women of childbearing age becomes a critical part of prenatal care.
- New drugs with fewer side effects and higher rates of success mean patients who embark on treatment now have a 99 percent of success (cure) after 8 to 12 weeks of treatment – up from less than 50 percent in the previous decade.
The expansion to universal screening is strongly endorsed by Michael Curry, MD, Medical Director of the Liver Transplantation Program at BIDMC. Curry notes that, anecdotally, about one third of injection drug users are infected with HCV. When diagnosed early and treated early, the incidence of cirrhosis, liver cancer and the need for liver transplants decrease.
Dr. Graham and Dr. Curry welcome the opportunity to speak to you about this important public health topic.