Performance characteristics and results of a large-scale screening program for viral hepatitis and risk factors associated with exposure to viral hepatitis B and C: Results of the National Hepatitis Screening Survey
✍ Scribed by S Kaur; L Rybicki; B R Bacon; J L Gollan; V K Rustgi; W D Carey
- Publisher
- John Wiley and Sons
- Year
- 1996
- Tongue
- English
- Weight
- 183 KB
- Volume
- 24
- Category
- Article
- ISSN
- 0270-9139
No coin nor oath required. For personal study only.
✦ Synopsis
Screening programs to detect diseases such as hyperten-Chronic viral hepatitis frequently goes undetected unsion, hyperlipidemia, breast cancer, and colorectal cancer til cirrhosis develops. Although the effect of interferon have been conducted for years in the United States. [1][2][3][4][5][6] Sucon the natural history of hepatitis B virus (HBV) or hepacessful screening programs must possess several features, titis C virus (HCV) infection in asymptomatic persons including the acceptability to subjects, safe and effective is unknown, treatment may modify the course of the screening tools, reasonable units, and cumulative costs. Addiinfection, producing cures in some. In September 1992, tionally, effective intervention must be available for the conscreening for HBV and HCV was offered in 40 centers dition that is being screened. 7 The treatment of viral hepatitis throughout the United States. Demographic features,
with interferon provides a reason to consider screening for potential risk factors, and symptoms were studied. chronic viral hepatitis, although the effect of interferon treat-Blood samples were obtained for the determination of ment on the natural history of hepatitis B virus (HBV) and serum alanine aminotransferase levels and for markers hepatitis C virus (HCV) infection in asymptomatic persons is of HBV and HCV infection. Thirteen thousand nine hununknown. Screening seems to be a reasonable option, because dred ninety seven subjects were screened. The prevamost subjects are asymptomatic or have no symptoms specifilence of infection with HBV or HCV was 24.8% (HBV cally referable to the liver. Cases are often detected during 17.8%; HCV 7.0%; and both 2.8%). Hepatitis B and C disvoluntary blood donation, as a part of general physical examiease was present in 0.7% and 4.4% of the population, nation, or during the evaluation of another illness. In many respectively. Risk factors for HBV and HCV infection parts of the world, viral hepatitis is the most common form were similar in: blood transfusions, hemodialysis, IV of chronic liver disease. 8,9 Attempts to reduce the incidence drug use, and sex with an IV drug user. For HBV infecof viral hepatitis through a combination of public education, tion, sex with multiple partners, increasing age, and immunization where feasible, and case finding are approbirth in South East Asia or Africa were additional risk priate. The universal immunization of preschool children factors. The cost to find a case of HCV infection is less against hepatitis B is one such strategy. 10,11 than the costs for finding many other treatable diseases.
Screening for viral hepatitis may lead to the detection of Screening for HBV, though more costly, is reasonably cases that might allow for the treatment in an early stage of efficient, and simultaneous screening for HBV and HCV the disease in some cases. The early detection of HBV markprovides greater efficiency. It is practical to consider ers in some persons may lead to the vaccination of close screening for HBV and HCV in the United States, partichousehold contacts and may possibly reduce the likelihood of ularly if any risk factor is present. Improved treatment transmission to others. The drawbacks of screening include strategies will make screening even more cost effective.
direct costs of the program, limitations of current screening (HEPATOLOGY 1996;24:979-986.) assays (false positive and false-negative results), medical legal issues such as the insurability of a subject with positive markers, and limitations of currently available treatments. Thus, a careful cost-benefit analysis seems justified before Abbreviations: HCV, hepatitis C virus; HBV, hepatitis B virus; HBsAg, hepatitis B advocating a program for hepatitis screening.
surface antigen anti HBc, antibody to hepatitis B core antigen; anti-HCV, antibody to
Screening provides an opportunity to collect important inhepatitis C virus; ALT, alanine aminotransferase; IV, intravenous.
formation about potential risk factors. For example, it is well
From the 1 Department of Gastroenterology, and 2 Department of Biostastics and Epideknown that 40% of the persons with acute HCV infection miology, The Cleveland Clinic,