Roger Chou, MD; Erika Barth Cottrell, PhD, MPP; Ngoc Wasson, MPH; Basmah Rahman, MPH; Jeanne-Marie Guise, MD, MPH
Disclaimer: The findings and conclusions in this document are those of the authors, who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
Acknowledgment: The authors thank Robin Paynter, MLIS; Rose Campbell, MLIS; Christina Bougatsos, MPH; Ian Blazina, MPH; Tracy Dana, MLS; Jessica Griffin, MS; AHRQ Task Order Officer Christine Chang, MD, MPH; and USPSTF Medical Officer Iris Mabry-Hernandez, MD, MPH.
Grant Support: By AHRQ (contract 290-2007-10057-I, task order 8), Rockville, Maryland.
Potential Conflicts of Interest: Dr. Chou: Grant (money to institution): AHRQ; Support for travel to meetings for the study or other purposes: AHRQ. Dr. Cottrell: Grant: AHRQ. Dr. Wasson: Grant: AHRQ. Dr. Rahman: None disclosed. Dr. Guise: Grant (money to institution): AHRQ; Provision of writing assistance, medicines, equipment, or administrative support (money to institution): AHRQ. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-1650.
Requests for Single Reprints: Roger Chou, MD, 3181 SW Sam Jackson Park Road, Mail Code BICC, Portland, OR 97239; e-mail, email@example.com.
Current Author Addresses: Drs. Chou, Cottrell, Wasson, Rahman, and Guise: 3181 SW Sam Jackson Park Road, Mail Code BICC, Portland, OR 97239.
Author Contributions: Conception and design: R. Chou, J.M. Guise.
Analysis and interpretation of the data: R. Chou, E.B. Cottrell, N. Wasson.
Drafting of the article: R. Chou, J.M. Guise.
Critical revision of the article for important intellectual content: R. Chou, E.B. Cottrell, N. Wasson, J.M. Guise.
Final approval of the article: R. Chou, E.B. Cottrell, J.M. Guise.
Obtaining of funding: R. Chou, J.M. Guise.
Administrative, technical, or logistic support: E.B. Cottrell, N. Wasson, B. Rahman, J.M. Guise.
Collection and assembly of data: R. Chou, E.B. Cottrell, N. Wasson, B. Rahman, J.M. Guise.
Identification of hepatitis C virus (HCV)–infected persons through screening could lead to interventions that improve clinical outcomes.
To review evidence about potential benefits and harms of HCV screening in asymptomatic adults without known liver enzyme abnormalities.
English-language publications identified from MEDLINE (1947 to May 2012), the Cochrane Library Database, clinical trial registries, and reference lists.
Randomized trials and cohort, case–control, and cross-sectional studies that assessed yield or clinical outcomes of screening; studies reporting harms from HCV screening; and large series reporting harms of diagnostic liver biopsies.
Multiple investigators abstracted and checked study details and quality by using predefined criteria.
No study evaluated clinical outcomes associated with screening compared with no screening or of different risk- or prevalence-based strategies. Three cross-sectional studies in higher prevalence populations found that screening strategies that targeted multiple risk factors were associated with sensitivities greater than 90% and numbers needed to screen to identify 1 case of HCV infection of less than 20. Data on direct harms of screening were sparse. A large study of percutaneous liver biopsies (n = 2740) in HCV-infected patients with compensated cirrhosis reported no deaths and a 1.1% rate of serious adverse events (primarily bleeding and severe pain).
Modeling studies were not examined. High or unreported proportions of potentially eligible patients in the observational studies were not included in calculations of screening yield because of unknown HCV status.
Although screening tests can accurately identify adults with chronic HCV infection, targeted screening strategies based on the presence of risk factors misses some patients with HCV infection. Well-designed prospective studies are needed to better understand the effects of different HCV screening strategies on diagnostic yield and clinical outcomes.
Agency for Healthcare Research and Quality.
Summary of evidence search and selection.
The flow diagram summarizes the search and selection of articles addressing the following key questions: 1. Does screening for hepatitis C virus (HCV) infection in nonpregnant adults without known abnormal liver enzymes reduce mortality and morbidity due to HCV, affect quality of life, or reduce transmission of HCV? 2. What is the effectiveness of different risk- or prevalence-based methods for screening for HCV infection on clinical outcomes? 3. What is the sensitivity and number needed to screen to identify 1 case of HCV infection of different risk- or prevalence-based methods for screening for HCV infection? 4. What are the harms associated with screening for HCV infection, including diagnostic liver biopsies? Reproduced from reference 26.
* Includes hand searches and gray literature searches.
† The total number of studies included in the full report, which addresses additional key questions, is 166.
Studies of Alternative Screening Strategies
Screening Strategies: Effects of Applying Alternative Screening Criteria on Proportion Screened, Sensitivity, Specificity, and Number Needed to Screen to Identify 1 Case of HCV Infection
Summary of Evidence
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Chou R, Cottrell EB, Wasson N, Rahman B, Guise J. Screening for Hepatitis C Virus Infection in Adults: A Systematic Review for the U.S. Preventive Services Task Force. Ann Intern Med. 2013;158:101-108. doi: 10.7326/0003-4819-158-2-201301150-00574
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Published: Ann Intern Med. 2013;158(2):101-108.
Gastroenterology/Hepatology, Infectious Disease, Prevention/Screening, Viral Hepatitis.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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