Georgetown University. US: In light of recent
recommendations for widespread hepatitis C screening, researchers are
calling for clinical trials to determine if that screening would result
in greater benefit or harm.
Though the recommendations have vocal support from some experts and
advocates, no studies have yet established whether such screening would
result in greater benefit than harm to patients, three physicians and an
investigative medical journalist explain in the Jan. 17 issue of the
British Medical Journal.
In 2012, the U.S. Centers for Disease Control and Prevention (CDC) recommended that all people born between 1945 and 1965 be screened for hepatitis C. The U.S. Preventive Services Task Force (USPSTF) followed
suit in 2013 and the World Health Organization called for expanded
screening in 2014. Previously, screening recommendations had focused
only on those at high risk of developing the disease, such as
intravenous drug users and those who received a transfusion prior to
1992.
In issuing its 2013 recommendations, the USPSTF noted the absence of
studies on “long-term harms associated with antiviral regimens” and “the
outcomes of treatment in screen-detected patients.”
“We have a limited window of opportunity to collect appropriate
evidence on whether this [widespread screening] is a good idea,” write
the authors, which include lead author Jeanne Lenzer, an investigative
medical journalist, and physicians Ronald L. Koretz, MD, of David
Geffen-UCLA School of Medicine; John P. A. Ioannidis, MD, of Stanford
University; and Kenneth W. Lin, MD, of Georgetown University School of Medicine.
One missing piece of evidence, says Georgetown’s Lin, is to
understand who is most likely to benefit from antiviral medications,
many of which come with a hefty price tag.
“We know current medications can result in the virus becoming
undetectable in a high number of people after 3 to 6 months, but 80
percent of people with hepatitis C do fine with or without treatment,”
explains Lin. “We need to know if the treatments have any long-term
impact on the remaining 20 percent who are destined to develop liver
failure, liver cancer or die from the disease.”
The authors report that at least
2.7 million people have hepatitis C in the U.S. Many people with the
disease do not have symptoms and are not aware they have it. About
16,000 require a liver transplant or die from hepatitis C each year.
“Since most individuals with
hepatitis C never develop symptoms and die with it not of it, exposing
these individuals to the harms of treatment with no possible benefit
might outweigh benefits for the minority destined to develop end-stage
disease,” Lin argues.
The authors report having no personal financial interests related to the study.
About Georgetown University Medical Center
Georgetown
University Medical Center (GUMC) is an internationally recognized
academic medical center with a three-part mission of research, teaching
and patient care (through MedStar Health). GUMC’s mission is carried
out with a strong emphasis on public service and a dedication to the
Catholic, Jesuit principle of cura personalis -- or "care of the whole
person." The Medical Center includes the School of Medicine and the
School of Nursing & Health Studies, both nationally ranked;
Georgetown Lombardi Comprehensive Cancer Center, designated as a
comprehensive cancer center by the National Cancer Institute; and the
Biomedical Graduate Research Organization, which accounts for the
majority of externally funded research at GUMC including a Clinical and
Translational Science Award from the National Institutes of Health.