Canada recommends against testing everyone for hepatitis C

(Reuters Health) - Adults who don’t have an increased risk of hepatitis C infection should not be tested for it, the Canadian Task Force on Preventive Health Care recommended today.

The Task Force found no evidence that screening low-risk adults would be beneficial. Also, it said, screening all adults would require a lot of resources.

“For the average Canadian at average risk, don’t screen,” said Task Force member Dr. Roland Grad, who chaired the group that crafted the new recommendation.

Hepatitis C is a blood-borne virus. According to the U.S. Centers for Disease Control and Prevention, people with chronic hepatitis C are often symptom-free for many years, but they can end up with severe liver disease.

Based on its review of the evidence, published in the journal CMAJ, the Task Force estimates a one-time screening of 100,000 Canadians would find 199 chronic hepatitis C infections and save about 40 lives, but at a substantial cost.

The Task Force says just focusing on screening people with symptoms and signs of hepatitis C would find 91 cases among every 100,000 Canadians.

The U.S. Preventive Services Task Force (USPSTF) - the Canadian Task Force’s counterpart in the United States - also reserves hepatitis C screenings for people at an increased risk of infection, including current or former injection drug users, people who were incarcerated, and those who’ve spent time in places where the infection is common.

The USPSTF also recommends one-time hepatitis C screening for anyone born between 1945 and 1965. It says these individuals are at higher risk for hepatitis C, possibly due to blood transfusions and other exposures long ago.

“At the moment, we can’t make a recommendation for all Canadians regardless of what year you were born in to be screened for hepatitis C,” said Grad, who is also affiliated with McGill University in Montreal.

He said the prevalence of hepatitis C in Canada is different than that of the U.S. population.

The Canadian Task Force on Preventive Health Care writes that between 220,000 and 245,000 people in the country have a chronic hepatitis C infection. In the U.S., the CDC puts that number at 3.1 million.

Grad added that unlike the USPSTF, the Canadian Task Force takes finances and resources into account when creating its recommendations.

The Canadian Task Force says recommending against universal screening allows the country to focus its resources on testing those at highest risk for the infection.

Dr. Ellie Carmody, who was not involved with the new recommendation, says the recommendation against screening may be relevant to Canada, but the USPSTF’s recommendation is right for the U.S.

“Screening in the U.S., particularly among the baby boomers, is and continues to be a priority,” said Carmody, who is an assistant professor of infectious diseases at NYU Langone Medical Center in New York.

“Canada is in a different circumstance and at greater resource constraints and a lower prevalence of hepatitis C (and) that changes the risk-benefit profile of screening,” she told Reuters Health.

SOURCE: CMAJ, online April 24, 2017.