Response to U.S. Preventative Services Task Force Recommendations on Screening for HCV Infection
The Treatment Action Group (TAG) believes the U.S. Preventative Services Task Force (USPSTF) should reconsider their recent recommendation on routine screening for persons at high risk of infection with the hepatitis C virus (HCV). The USPSTF "... found insufficient evidence to recommend for or against routine screening for HCV infection in adults at high risk for infection ... and no evidence that screening for HCV in adults at high risk leads to improved outcomes."
TAG believes that this recommendation is ill advised for several reasons:
- The USPTF recommendation does not benefit individual and public health. Individuals who are at high risk for a serious, potentially life-threatening illness deserve the opportunity to find out whether or not they are actually infected, regardless of the amount of data on long-term treatment outcomes.
- The USPTF recommendation can be used by third-party payors and under-funded entitlement programs as a rationale to withhold reimbursement for HCV testing. Lack of coverage for HCV testing will be especially devastating for high-prevalence populations such as current and former injection drug users, prisoners, homeless persons and the poor.
- HCV is a transmissible disease. Diagnosis of transmissible diseases such HCV is a cornerstone of prevention of new infections. People who are aware of their HCV status can take proactive steps to prevent transmission to others.
- HIV-positive people are at high risk for HCV coinfection, due to overlapping modes of transmission. HCV is prevalent among people with HIV infection, approximately 300,000 of whom are HCV coinfected. Hepatitis C is an opportunistic infection of HIV disease because HIV accelerates HCV disease progression and increases risk of mortality; HCV-related end-stage liver disease has become a leading cause of mortality in people with HIV. Expert panels convened by The U.S. Public Health Service (USPHS), the Centers for Disease Control (CDC), the National Institutes of Health (NIH), the American Association for the Study of Liver Diseases (AASLD) and the Veteran's Administration (VA) all recommend HCV screening for all HIV-positive persons. Are people with HIV, a high-risk population, included in this recommendation?
- According to the NIH's 2002 Consensus Statement on Management of Hepatitis C, "All patients with chronic hepatitis C are potential candidates for antiviral therapy." It would be outrageous not to recommend screening of individuals at high risk for any other illness, particularly for a disease that can be eradicated with treatment.
- The majority of people with HCV in the United States have been infected for at least 15 years, and will become more vulnerable to complications from HCV in upcoming years. It is estimated that complications such as cirrhosis, liver failure and hepatocellular carcinoma will increase dramatically in the next fifteen years, not for lack of effective treatment, but for lack of knowledge. Most people who have HCV are unaware that they are infected. Screening of high-risk individuals, and treatment for those who require it may save thousands of lives.
The USPSTF recommendation contradicts screening recommendations from expert panels at the U.S. Public Health Service, the Centers for Disease Control, National Institutes of Health, the American Association for the Study of Liver Diseases, and the Veteran's Administration. TAG shares the concerns of the American Association for the Study of Liver Diseases and the American Liver Foundation regarding the U.S. Preventative Services Task Force (USPSTF) Recommendation on Screening for Hepatitis C Virus Infection in Adults.