The Public Health Agency of Canada (PHAC) estimates that there are more than 200,000 people living with chronic hepatitis C virus (HCV) infection in Canada. This agency also estimates that 44% of people living with HCV are not aware that they are infected. If left untreated, HCV infection causes gradually worsening liver injury, resulting in serious complications, liver failure and death. Furthermore, the risk of liver cancer is increased among people who have HCV.
Fortunately, there are new medicines that can cure HCV, and Canada’s provinces and territories are subsidizing the cost of these medicines and taking steps to make access to them easier. However, if 44% of people infected with HCV are not aware of their infection status, they are unlikely to seek treatment. Therefore, health systems need to enhance opportunities for the offer of HCV screening.
The Canadian Task Force on Preventive Health Care has released recommendations for policy makers and clinicians who are considering which adult populations should be offered screening for HCV infection. The task force has come out against broad-based screening of symptom-free adults who are not at high risk for exposure to HCV.
The task force recommends that, in addition to pregnant women, doctors and nurses should offer HCV screening to adults in the following populations because they are considered at high risk for HCV infection:
- people who currently inject or have a history of injecting street drugs
- people who have been imprisoned
- people who were born, travelled or resided in countries where HCV is endemic (relatively common)
- people “who have received health care where there is a lack of universal precautions”
- people who have received blood transfusions, blood products or organ transplants before 1992 in Canada
- people who are receiving hemodialysis
- people who have had a needlestick injury
Additionally, the task force notes that some people may have become at elevated risk for HCV because of certain circumstances or situations and should be offered HCV screening. Such people include the following:
- people who have engaged in “high-risk sexual behaviours”
- people who were/are homeless
- people who have engaged in “intranasal and inhalation drug use”
- people who have tattoos or body piercing(s)
- people who have shared “sharp instruments or personal hygiene materials with someone who is HCV positive”
Also, the task force encourages doctors to offer HCV screening to anyone with clinical clues suspicious for HCV infection.
The task force recommendations were based on systematic reviews of the literature and economic modelling studies. Some organizations, such as the Canadian Liver Foundation, have expressed concern that these risk-based screening recommendations will result in low rates of diagnosis for hepatitis C and increases in cirrhosis, liver cancer and avoidable deaths.
For the full guidelines from the task force, see Recommendations on hepatitis C screening for adults. A summary document is also available: Hepatitis C – Clinician Summary.
—Sean R. Hosein
Resources
Testing for hepatitis C from Hepatitis C: An In-depth Guide
The epidemiology of hepatitis C in Canada – CATIE fact sheet
REFERENCE:
Canadian Task Force on Preventive Health Care. Recommendations on hepatitis C screening for adults. Guidelines. CMAJ. 2017 April 24:189(16):E509–604. Available from: http://www.cmaj.ca/content/189/16/E594