Letters to the Editor  |   June 2013
Updated Recommendations for Diagnosis and Management of the US population for Hepatitis C
Article Information
Letters to the Editor   |   June 2013
Updated Recommendations for Diagnosis and Management of the US population for Hepatitis C
The Journal of the American Osteopathic Association, June 2013, Vol. 113, 445-446. doi:
The Journal of the American Osteopathic Association, June 2013, Vol. 113, 445-446. doi:
To the Editor: 
On January 11, 2013, the US Centers for Disease Control and Prevention (CDC) sponsored a special meeting at its headquarters in Atlanta, Georgia, to disseminate new recommendations for screening the US population for hepatitis C. The CDC wanted to inform all medical practitioners, especially primary care physicians, of the new recommendations. As a gastroenterologist and a DO, I was pleased to represent the American Osteopathic Association and the large number of primary care physicians in the osteopathic medical profession. 
An estimated 3.5 to 4 million people in the United States have hepatitis C, and most of them are unaware that they are infected.1 After several years, a substantial number of those infected will develop cirrhosis and possibly 1 of its lethal complications such as hepatocellular carcinoma, gastroesophageal varices, or ascites.1 The infection usually produces no symptoms until end-stage liver disease and cirrhosis are already established.1 
Eradication of the virus can prevent the development of cirrhosis and its attending complications, such as esophageal varices, intractable ascites, and, in advanced cases, hepatocellular carcinoma.1 With recently introduced and more effective medications to manage hepatitis C,2 the infection can often be cured. To accomplish this, hepatitis C infection must be diagnosed before severe liver damage occurs.2 
Until now, screening the population for hepatitis C has consisted of discerning whether a patient has a risk factor for contracting the disease and then preemptively examining the patient for it.2 These risk factors include elevated liver enzyme levels, a history of intravenous drug use, transfusion of blood or blood products prior to 1990, and multiple sexual partners.2 Because screening on the basis of these risk factors has failed to reveal the majority of persons in the United States with hepatitis C,2 the CDC has investigated different strategies for identifying people with hepatitis C. 
Results of cost analysis revealed that a reasonable strategy would be to screen all individuals born between 1945 and 1965.3,4 Approximately 70% of all US adults that have hepatitis C were born during this period.2 In addition, the CDC recommends a brief alcohol screening for patients that are infected because alcohol use accelerates liver damage.2 
Osteopathic physicians in family practice, general internal medicine, geriatrics, or any other area of primary care can be especially effective at discerning people with this disease. A simple blood test for the antibody to the hepatitis C virus is inexpensive, and the test results have good positive and negative predictive values in determining which persons need further evaluation.2 
Persons of any age group with risk factors as noted above should continue to be screened, but it now should be standard practice to also screen the cohort of people born between 1945 and 1965 who do not carry any of these risk factors. 
With most osteopathic physicians in the United States serving in primary care practices, we have the opportunity to contribute extensively not only to the well-being of our individual patients, but also to the well-being of the entire country. 
More information on updated hepatitis C guidelines can be found at and 
Smith BD, Morgan RL, Beckett GA, Falck-Ytter Y, Holtzman D, Ward JW. Hepatitis C virus testing of persons born during 1945-1965: recommendations from the Centers for Disease Control and Prevention. Ann Intern Med. 2012;157(11):817-822. [CrossRef] [PubMed]
Smith BD, Morgan RL, Beckett GAet al. Recommendations for the identification of chronic hepatitis C virus infection among persons born during 1945-1965 [published correction appears in MMWR. 2012;61(43);886]. MMWR Recomm Rep. 2012;61(RR-4):1-32. [PubMed]
Rein D, Smith BD, Wittenborn JSet al. The cost-effectiveness of birth cohort hepatitis C antibody screening in U.S. primary care settings. Ann Intern Med. 2011;156(4):263-270. [CrossRef] [PubMed]
McGarry LJ, Pawar VS, Panchmatia HRet al. Economic model of a birth cohort screening program for hepatitis C virus. Hepatology. 2012;55(5):1344-1355. [CrossRef] [PubMed]