Authors' objectives:

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.

Authors' results and conclusions: 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.

Authors' recommendations: 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.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.ahrq.gov/clinic/uspstf/uspshepc.htm

Year Published: 2004

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: United States

Organisation Name: Agency for Healthcare Research and Quality

Contact Address: Center for Outcomes and Evidence Technology Assessment Program, 540 Gaither Road, Rockville, MD 20850, USA. Tel: +1 301 427 1610; Fax: +1 301 427 1639;

Contact Name: martin.erlichman@ahrq.hhs.gov

Contact Email: martin.erlichman@ahrq.hhs.gov

Copyright: Agency for Healthcare Research and Quality (AHRQ)