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AASLD response to recommendations on screening HCV by US Preventive Services Task force
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From the President of the American Association for the Study of Liver Diseases:
March 16, 2004
A study was published today in the Annals of Internal Medicine entitled Screening for Hepatitis C Virus Infection: Recommendations from the U.S. Preventive Services Task Force, concluding that it "found no evidence that screening for HCV infection in adults at high risk leads to improvedlong-term health outcomes". It is critical that the contents of this study be understood and not misinterpreted.
--The report points out that "Antiviral treatment can successfully eradicate HCV, but data on long-term outcomes in the populations likely to be identified by screening are lacking."
While this statement is true, it would be erroneous and dangerous toconclude from it that screening of high-risk populations, therefore, is nota public health benefit to the American people.
--There are no data on long-term studies of the effectiveness of screening and treatment.
The reason for this is that the disease can often take 20 or more yearsbefore symptoms appear and effective treatments for the disease usingcombination therapies have only been developed in the past 6 years andfurther improved in the past two years.
--The report is correct when it says in its final paragraph:
Complications from chronic HCV infection present an enormous health burden that is expected to increase 2- to 4-fold over the next 2 to 4 decades. Further research to more accurately determine the benefits and harms of screening is of paramount importance. (p. 475)
Researchers will not be able to determine the "benefits and harms of screening" unless there is screening of high-risk populations. To misinterpret the report to say that such screening should be stopped would be a terrible mistake with grave consequences over the next two decades.
The study correctly points out some key data about infection with the hepatitis C virus that argue strongly in favor of screening of high-risk populations:
- Hepatitis C is the most common chronic bloodborne pathogen in the United States. (p.465)
- Approximately 2.3% of adults 20 years or older are positive for anti-HCV and 55% to 84% of these have chronic infection. (p.465)
- Most of those infected are not aware of it and, therefore, can and do spread the disease. (p.465)
- In the U.S., HCV is associated with 40% of cases of chronic liver disease and 8,000 to 10,000 deaths per year. (p. 465)
In addition, it should be noted that HCV is a leading cause of cirrhosis, a common cause of hepatocellular carcinoma (HCC) and the leading cause of liver transplantation in the United States. 1 Early and effective treatment of HCV holds the potential to reduce the number of liver transplants needed and to alleviate the current severe shortage of donor organs.
This study makes a valuable contribution to the public debate about addressing the epidemic of HCV in the United States. Other contributions on the subject include the AASLD practice guidelines for the diagnosis, management and treatment of hepatitis C which are posted on the AASLD web site and published in the April issue HEPATOLOGY (and on the NATAP website). AASLD looks forward to continuing to participate in the discussion as our members make valuable contributions to the research on this important and deadly disease.
Bruce R. Bacon, MD, President,
American Association for the Study of Liver Diseases (AASLD)
AASLD is the leading medical organization for advancing the science and practice of hepatology. Founded by physicians in 1950, AASLD's vision is to prevent and cure liver diseases.
1 NIH Consensus Statement. HEPATOLOGY, Vol. 36, no. 5, Suppl.1, 2002, S13.
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