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Doctors should consider hepatitis C testing: panel

By Genevra Pittman

NEW YORK (Reuters Health) - A government-backed panel advises doctors to "consider offering screening" for hepatitis C to adults born between 1945 and 1965, in a draft statement released today.

The recommendations, from the U.S. Preventive Services Task Force (USPSTF), are an update to the group's 2004 statement, which recommended against screening people at average risk of hepatitis C. At the time, it also said there wasn't enough evidence for or against screening high-risk adults, such as injection drug users.

"There were a lot of uncertainties in 2004," said Dr. Albert Siu from the Mount Sinai School of Medicine in New York, who is co-vice chair of the task force.

"The evidence has increased over the years. The tests haven't really changed, but there is more certainty in terms of the overall net benefit here," he told Reuters Health.

Earlier this year, the Centers for Disease Control and Prevention called for hepatitis C testing for all baby boomers, who make up three-quarters of people in the United States with the infection.

The USPSTF now also recommends screening all high-risk adults, regardless of when they were born.

Hepatitis C is passed through blood. Along with drug users who share needles, people who had a blood transfusion or received an organ transplant before mandatory viral testing began in 1992 are also at increased risk of hepatitis C.

Between 1 and 2 percent of people in the U.S. have hepatitis C, which can cause cirrhosis and liver failure over many years. Among the baby boomer generation, that rate is between 3 and 4 percent.

In the new draft recommendations, the task force says there is enough evidence showing blood tests used to detect hepatitis C are accurate. However, there is no direct, long-term proof that screening ultimately reduces liver disease and death - in part because the harmful effects of hepatitis C progress slowly and it takes many years to see such results.

Siu said the screening process is safer than it used to be because fewer people are getting invasive liver biopsies to confirm positive blood tests. That helps tip the scale in favor of screening.

In addition, for many people with hepatitis C, treatment with anti-viral drugs - especially three-drug combinations including medications recently approved by the Food and Drug Administration - can decrease the amount of virus in the blood to an undetectable level, the USPSTF found.

Side effects of the newest drugs, known as boceprevir (Victrelis) and telaprevir (Incivek), include anemia and rashes. Those medications are added to a combination regimen of ribavirin and peginterferon alfa (also commonly known as Pegasys and Peg-Intron), which has been the standard of treatment since the early 2000s.

"In general, when we are talking about infectious diseases screening, (question) one is prevalence rate in the population and two is, are there any effective treatments?" said Dr. Lu-Yu Hwang, who has studied hepatitis C infection and transmission at The University of Texas Health Science Center at Houston.

"Today… people are more optimistic for hepatitis C treatment than for hepatitis B or HIV. People believe there's a good way you can get rid of the virus, and we do have a good number of people recovering from chronic infection," Hwang, who is not part of the USPSTF, told Reuters Health.

Evidence reviews completed for the task force also suggest that for pregnant women with hepatitis C, delivering a baby via cesarean section or avoiding breastfeeding does not cut down on virus transmission. That suggests transmission may occur while a fetus is still in utero, Dr. Roger Chou and colleagues from Oregon Health & Science University in Portland said.

Hwang suggested screening could be useful for women who are considering becoming pregnant. Then if they are positive for hepatitis C, women can be treated and reduce their viral levels before there's a risk of passing the virus on to the baby.

The reviews used by the USPSTF are published in the Annals of Internal Medicine. The draft recommendations will be on the task force website (http://bit.ly/9e1DhW) and available for public comment between November 27 and December 24.

SOURCE: http://bit.ly/N0G6LY Annals of Internal Medicine, online November 26, 2012.

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