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Hepatitis C Virus Testing of Persons Born During 1945–1965: Recommendations From the Centers for Disease Control and Prevention FREE

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The full report is titled “Hepatitis C Virus Testing of Persons Born During 1945–1965: Recommendations From the Centers for Disease Control and Prevention.” It is in the 4 December 2012 issue of Annals of Internal Medicine (volume 157, pages 816-821). The authors are B.D. Smith, R. Morgan, G.A. Beckett, Y. Falck-Ytter, D. Holtzman, and J.W. Ward.

This article was published at www.annals.org on 16 August 2012.

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Ann Intern Med. 2012;157(11):I-38. doi:10.7326/0003-4819-157-9-201211060-00530
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Who developed these recommendations?

The Centers for Disease Control and Prevention (CDC) developed these recommendations. The CDC is a U.S. federal agency that works to protect public health and safety.

What is the problem and what is known about it so far?

Hepatitis C virus (HCV) infection is common in the United States. New HCV infection causes liver inflammation that can resolve without treatment. However, infection can become chronic and remains active throughout a person's life, potentially leading to severe liver problems. Treatment with drugs to fight HCV reduces the development of severe liver disease and death. Many people with chronic HCV infection have no symptoms until they have severe liver damage. Screening people with no symptoms of HCV may identify those who would benefit from treatment.

Infection is transmitted by exposure to the blood of someone with HCV infection. This might occur through injection drug use, unprotected sex, exposure to donated blood products, or accidental exposure in health care settings. Before 1992, the virus was sometimes transmitted during blood transfusions. Since then, screening of donated blood has made this type of transmission rare.

The CDC has previously recommended screening people who are known to have specific risks, such as a history of injection drug use or exposure to possibly infected blood. Despite these recommendations, many patients with chronic HCV infection are unaware of their condition. Expanding screening recommendations to cover the birth cohort born during 1945–1965 (among whom HCV prevalence is higher than that among other adults) will lead to the diagnosis of more people with HCV infection. Alcohol use can worsen the progression of liver disease in HCV-infected people, so alcohol-related counseling is important for people diagnosed with HCV infection.

How did the CDC develop these recommendations?

The CDC reviewed published studies that examined the likely effects of adding testing based on birth year to the current testing recommendations, outcomes of HCV treatment, and the effectiveness of alcohol counseling to reduce alcohol use.

What did the authors find?

Available studies showed higher rates of HCV infection in people born during 1945–1965 than during other years. Studies also showed that treatment, especially regimens that include newer antiviral drugs, can result in improved health outcomes. Although adverse effects of HCV treatment are common and can cause patients to stop treatment, most effects resolve after treatment is stopped. No studies specifically examined alcohol counseling in patients with HCV infection, but a review of 22 studies of brief alcohol counseling compared with no alcohol counseling showed that brief counseling reduced alcohol use.

What does the CDC recommend that patients and doctors do?

Adults of all ages who have risk factors for HCV infection should be tested. Adults born during 1945–1965 should have 1-time testing for HCV infection even if they have no other risk factors. People who test positive for infection should receive counseling about alcohol use and have further medical evaluation and appropriate care for HCV and related conditions.

What are the cautions related to these recommendations?

These recommendations add a new category to the list of people for whom HCV testing is indicated and do not replace previously published CDC recommendations for HCV testing.





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