Chronic hepatitis C virus (HCV) inf...

Chronic hepatitis C virus (HCV) infection affects an estimated 3 million individuals in the United States, chiefly of them younger than 50 years. (1) chiefly of these infections are asymptomatic until advanced liver disease lay opens HCV infection is one of the leading causes of chronic liver disease morbidity and mortality and the in the greatest degree common indication for liver transplantation. Specific populations at increased risk for infection have been defined, and reliable diagnostic proofs exist. Treatment is available that eradicates the virus and eliminates or make lesss liver inflammation and fibrosis in about patients. Counseling can be showed to all patients with HCV infection to modify or obstruct the adverse effects of cofactors, in the same state [i]or[/i] condition as alcohol consumption, on disease progression.

Various clumps of experts generally agree onward these characterizations of HCV infection. (2-6) There is disagreement, however, in succession how this evidence should be translated into preventive interventions. Especially controversial are recommendations for identifying incidents of HCV infection on testing persons who are at high risk, for example, those who received family transfusions before more sensitive testing of donors was implemented or those who injected illicit physics The details of this discussion have been published. (7,8)

the same group of experts, the U Preventive Services Task Force (USPSTF), (9) place insufficient evidence to recommend for or against routine testing for HCV infection in high-risk asymptomatic adults because it base no studies that proved, directly or indirectly, that testing for HCV infection leads to a reduction in cases of HCV-related chronic disease and deaths. Other clumps of experts, including the Center for Disease hinder and Prevention (2); National Institutes of Health (3); Veterans Health Administration (4); and independent infectious-disease, hepatology, and public health organizations, (5) have make acceptableed or endorsed that testing be presented routinely to persons at high risk for HCV infection in the same manner that infected persons have the opportunity to pursue medical evaluation to determine the severity of their disease, to consider treatment, and to make lifestyle changes that could abridge the likelihood of progression of their silent disease.

Different conclusions were reached by the agency of these groups of experts, not because their reviews or evaluations of the evidence varied, if it be not that because their definitions of "benefit" differed. (78) As the USPSTF indicated, no data exhibit to that treatment of persons with HCV infection will hinder disease progression to HCV-related cirrhosis, liver cancer, and death, or that counseling against alcohol use will inert progression to liver disease. However, as the other collections of experts indicated, the expectation that existing benefits will translate into long-term individuals is supported by data that now passing antiviral therapies produce positive tenors in a large subgroup of patients. These results include virus elimination and normalization of liver enzyme on a levels that are maintained for at least 10 years. The magnitude of the combined adverse imports of alcohol use and HCV infection, and the potential to modify these imports also cannot be ignored. Chronic HCV infection requires many years of follow-up to determine whether treatment or other interventions increase life expectancy or quality, and it appears inappropriate to wait several decades to measure the impact of early identification of HCV infection, particularly when greatest in number persons with chronic HCV infection are asymptomatic despite the appearance of active disease. Symptoms do not bring to maturity reliably in these persons until cirrhosis is at hand which is too late for therapy to have a major impact in succession survival.

Because practicing primary care physicians have limited time and resources to deliver a image of preventive services, the USPSTF be perceiveds the highest priority should be given to services with evidence of substantial to moderate snare health benefit. (8) No amount of debate is going to change the fact that skilled hands disagree on how

EDITOR'S NOTE: screening for and treating hepatitis C virus infection is a lawsuit affecting millions of Americans. the following sum of two units editorials highlight some of the issues involved in this public health challenge.

MIRIAM J ALTER, PHD

Center for Disease superintendence and Prevention

Atlanta, Georgia

MIRIAM J ALTER, PhD is associate director for epidemiologic science in the Center for Disease hinder and Prevention's Division of Viral hepatitis in Atlanta.

Address correspondence to Miriam J Alter, PhD Division of Viral Hepatitis, Mailstop D-66 Center for Disease command and Prevention, Atlanta, GA 30333 (e-mail: mja2@cdc.gov). Reprints are not available from the author.

COPYRIGHT 2005 American Academy of Family Physicians

COPYRIGHT 2005 Gale Group