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

Abstract

Chronic viral hepatitis frequently goes undetected until cirrhosis develops. Although the effect of interferon on the natural history of hepatitis B virus (HBV) or hepatitis C virus (HCV) infection in asymptomatic persons is unknown, treatment may modify the course of the infection, producing cures in some. In September 1992, screening for HBV and HCV was offered in 40 centers throughout the United States. Demographic features, potential risk factors, and symptoms were studied. Blood samples were obtained for the determination of serum alanine aminotransferase levels and for markers of HBV and HCV infection. Thirteen thousand nine hundred ninety seven subjects were screened. The prevalence of infection with HBV or HCV was 24.8% (HBV 17.8%; HCV 7.0%; and both 2.8%). Hepatitis B and C disease was present in 0.7% and 4.4% of the population, respectively. Risk factors for HBV and HCV infection were similar in: blood transfusions, hemodialysis, IV drug use, and sex with an IV drug user. For HBV infection, sex with multiple partners, increasing age, and birth in South East Asia or Africa were additional risk factors. The cost to find a case of HCV infection is less than the costs for finding many other treatable diseases. Screening for HBV, though more costly, is reasonably efficient, and simultaneous screening for HBV and HCV provides greater efficiency. It is practical to consider screening for HBV and HCV in the United States, particularly if any risk factor is present. Improved treatment strategies will make screening even more cost effective.

The cost-effectiveness of testing for hepatitis C in former injecting drug users

“…This strongly suggests that some selection (by patients or clinicians) is occurring between the offer of testing and its uptake. A similar finding was shown in a US study of screening for HCV based on a public awareness campaign and voluntary testing, 103 which identified a population with a relatively high prevalence of HCV. …”

Dual chronic hepatitis B virus and hepatitis C virus infection

“…For example, in northern Europe where the hepatitis B surface antigen (HBsAg) carriage rate is low (\1%), patients dually infected with hepatitis B virus (HBV) and HCV are few [1]. However, in areas where HBV infection is endemic such as Southeast Asia, the Far East, and southern Europe, a substantial number of patients are infected with both HBV and HCV (Table 1) [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16]. Worldwide, if the prevalence of anti-HCV positivity is around 1-2% in the general population, then the number of individuals with HCV-HBV dual infection will be at least 3.5-7 million among the 350 million HBV carriers.…”

PHS Guideline for Reducing Human Immunodeficiency Virus, Hepatitis B Virus, and Hepatitis C Virus Transmission through Organ Transplantation

“…126 One study also considered steroid injection but did not find a significant relationship between injection steroid use and HBV infection. 122 The evidence of prevalence of IDU, reported in the general population study as 3.5%, 123 was rated low quality.…”