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History of Injection Drug Users: both CDC & HHS Recommend HCV Screening and Services
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from Jules: This week both the CDC & HHS issued recommendations & guidelines that all with a history of IDU should be screened for HCV, that means if a person used injection drugs once there was a risk for HCV-infection & they should be tested for HCV. The HHS USPSTF draft recommendation gave, this a Grade B which means screening should be reimbursed by insurance carriers. I know many people were disappointed the HHS USPSTF draft recommendations did not adequately support screening for the 'baby boomers' by giving it only a grade C recommendation, which is a weaker grade and leaves the decision to screen to the discretion of a clinician. But now we can & should focus on establishing screening programs for IDUs throughout the USA & globally as well. The prevalence among IDUS for HCV is very high, 50-90% of IDUs have HCV-infection. The resources needed to successfully screen & provide care to this patient population are demanding. The NYC "Check Hep C" project is designed to target this group and is a model for screening with the new HCV rapid test, creating large scale multi-media awareness promotion, linkage to care with highly dedicated, specialized & trained patient navigators, community based care clinics and very important weekly internet based clinical training for treatment & care providers which serves as a model for a program which to expand the pool of treaters when we have too few well trained treaters, and this clinical training component can be expanded. In fact the "Check Hep C" model was designed to be expanded & duplicated in other cities & states throughout the USA & globally. The Check Hep C model can easily be adapted to address the full scope of affected patient communities: from the least marginalized to the most marginalized. Multi-media awareness programs can be individualized and adapted based on the types of group(s)targeted, linkage to care programs can be adapted to the different types of patient groups, and selected care centers for referral can also be adapted.
CDC HIV & Hepatitis C Screening & Services Guidelines/ Recommendations - IDUs Highlighted - (11/30/12)
"All persons who use or inject drugs illicitly should routinely be offered screening and counseling for HCV infection. Persons with a history of risk, even those who have injected illicitly once or many years ago, should be offered screening and counseling for HCV infection. Facilities that provide counseling and testing should include services or referrals for medical evaluation and management of persons identified as infected with HCV."
HCV Screening USPSTF Draft Recommendations Open for Public Comment - (11/28/12)
HCV Screening USPSTF Draft Recommendations OPEN for PUBLIC COMMENT for 27 Days Explained - (11/28/12)
The U.S. Preventive Services Task Force (USPSTF) recommends screening for hepatitis C virus (HCV) infection in adults at high risk, including those with any history of intravenous drug use or blood transfusions prior to 1992 (see the Clinical Considerations for more information on risk factors).
This is a grade B recommendation.
HCV is the most common chronic bloodborne pathogen in the United States. It is a leading cause of complications from chronic liver disease. The prevalence of the antiHCV antibody in the United States is approximately 1.6%. From 1999 to 2008, about three fourths of patients in the United States with HCV infection were born between 1945 and 1965, with a peak prevalence of 4.3% in persons ages 40 to 49 years in 1999 to 2002 (1, 2). The strongest risk factor for HCV infection is a history of past or current intravenous drug use, with most studies reporting a prevalence of ≥50%. The yearly incidence of HCV infection averaged more than 200,000 cases per year in the 1980s, but had decreased to 25,000 cases per year by 2001. In 2009, the Centers for Disease Control and Prevention (CDC) estimated that 16,000 new cases of HCV infection occurred. There were an estimated 15,000 deaths from HCV infection in 2007. HCV-related end-stage liver disease is the most common indication for liver transplantation among U.S. adults (>30% of cases). Studies suggest that about half of the recently observed threefold increase in incidence of hepatocellular carcinoma is related to acquisition of HCV infection 2 to 4 decades earlier (1).
The USPSTF found adequate evidence that antiviral regimens result in sustained viral response (SVR). The USPSTF also found adequate evidence that SVR is associated with a reduction in the long-term clinical outcome of all-cause mortality. The USPSTF concluded that screening is of moderate benefit for populations at high risk. The USPSTF concluded that the benefit of screening all adults in the birth cohort born between 1945 and 1965 is at least small. The benefit is smaller given the lower prevalence in this population.
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