New Guidelines Recommend Testing Adults Aged 18-79 for Hepatitis C

A panel of experts in disease prevention recommends that all adults aged 18 to 79 should get screened for hepatitis C.^1,2

The U.S. Preventive Services Task Force (USPSTF) published this statement in the Journal of the American Medical Association (JAMA) in March 2020. The USPSTF is a group of experts that makes recommendations about screenings, counseling services, and preventive medications.

Their new guidelines agree with those made by other agencies, including the Centers for Disease Control and Prevention (CDC) and the American Association for the Study of Liver Disease.

The USPSTF expects that expanded screening will stop the spike in hepatitis C infections caused by increased injected drug use.

What do the new guidelines say?

The new USPSTF guidelines recommend that:

• All adults aged 18-49 should be tested for hepatitis C once
• Doctors should consider screening for people younger than 18 or older than 79 with past or current injection drug use
• Doctors should consider screening for pregnant persons younger than 18
• People who use injection drugs should be screened periodically

The guidelines also state that doctors should communicate that screening is voluntary, and provide information about the benefits and potential harms of treatment.

These guidelines are based on the accuracy of current testing methods and success of current treatment methods. The panel acknowledged that screening could potentially cause anxiety and stigmatization. However, there is no direct evidence of this. So, they determined that there is substantial benefit and minimal harm for expanded screening.

What has changed since the last set of guidelines?

The expanded recommendation is an update of a set of guidelines from 2013. This earlier set recommended screening only for adults born between 1945 and 1965 and others at high risk.³ Two trends over the past 7 years have caused the USPSTF to expand the guidelines, including:

1. Increased opioid use

The most important risk factor for hepatitis C is current injection drug use. One-third of people who inject drugs aged 18-30 years become infected with hepatitis C.⁴ The number of hepatitis C cases is rising mostly due to the opioid epidemic. Also, research shows that opioid users tend to be less likely to seek treatment.² Expanded screening will help identify young folks who have hepatitis C due to opioid use.

2. Improved treatment

Current antiviral treatments are safer than older therapies. Treatment duration is also shorter, now taking only 8-12 weeks. More than 95% of hepatitis C cases are cured within 2-3 months of antiviral treatment, with few side effects. Identifying people with hepatitis C would have a large impact on health outcomes because treatment is now so effective and safe.

How will the new guidelines help?

The number of cases of acute hepatitis C infection multiplied by almost 4 times from 2010 to 2017. The most rapid increase has been in young adults aged 20 to 39 years who inject drugs. This is most pronounced among Native Americans and Alaska Natives, and non-Hispanic white people.⁵

Although it is now simple to treat, hepatitis C remains a major public health issue. This is largely a detection issue: Almost half of the estimated 4 million people with hepatitis C in the US do not know that they have it.⁶

Because of this, the USPSTF concludes with “moderate certainty” that expanded screening will greatly improve health outcomes. It will help find people who tend not to seek treatment, especially young people who use opioids. And it will also identify people with hepatitis C at earlier stages when treatment is most effective.