Outcome of Screening for Hepatitis C Virus Infection Based on Risk Factors

Division of Gastroenterology, Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
The American Journal of Gastroenterology (Impact Factor: 10.76). 02/2008; 103(1):131-7. DOI: 10.1111/j.1572-0241.2007.01522.x
Source: PubMed


Screening for hepatitis C virus (HCV) infection in individuals at increased risk is currently recommended by most, but not all, health authorities. This study identifies outcomes of individuals diagnosed through a screening program targeting high-risk patients.
Veterans presenting for care in VA facilities are assessed for HCV risk factors by a questionnaire. Those with a risk factor are offered anti-HCV testing. Between October 1998 and May 2004, 25,701 patients were assessed and 8,471 patients had a risk factor for HCV. Patients diagnosed through the screening program were assessed per study protocol.
The prevalence of a positive HCV antibody in veterans who identified a risk factor was 7.3% (95% CI 6.6-8.0%). Among those diagnosed through the screening program (N = 260), 47% had chronic hepatitis C. Among patients with chronic HCV, 18% had evidence of advanced liver disease (stage III/IV on biopsy or clinical cirrhosis) while 34% had persistently normal alanine aminotransferase (ALT). Two-thirds of individuals who underwent liver biopsy had minimal or no fibrosis. About half (47%) of the screen-detected patients with chronic HCV were treatment candidates. Forty-four percent were not immediate candidates secondary to medical or psychiatric comorbidities or active substance abuse. Twenty-two patients (8%) had died after a median follow-up of 911 days. Two were liver-related deaths.
Screening for hepatitis C in persons at high risk can lead to early identification of individuals at risk for progressive liver disease who may benefit from antiviral therapy and counseling to reduce HCV-related liver injury.

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    • "Also, early detection through screening population at high risk for HCV (those lacking access to healthcare and/or addicted to alcohol or injected drugs) can lead to counselling about antiviral therapy. Counselling can promote cessation or modification of activities known to contribute to HCV-related hepatic damage and can lead to recommendations to medically monitor antiviral therapy that assists in the reduction of the progression of liver disease (Mallette et al., 2008). Trepka et al. (2007) state, " Decreasing alcohol consumption may be one of the most important potential intermediate benefits of screening and counseling " , but caution that the empirical data are sometimes conflicting, depending on the type of population under study. "
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