Troubling Trends in Hepatitis C Screening

People who might be infected with the hepatitis C virus are not getting tested early or often enough, according to a new study by the University of Michigan Health System (Ann Arbor, USA). Moreover, those who do test positive may not always get referred for specialty care. U-M researchers say this is possibly because doctors are not asking their patients about hepatitis risk factors, ordering tests, and referring those who test positive for evaluation and treatment.

The study suggests that both doctors and patients need to be more aware of the risk factors for hepatitis C, such as intravenous drug use or a blood transfusion before 1992.
New mechanisms may be needed to help doctors identify those at risk. In the study, out of 2,348 hepatitis C screening tests ordered by primary care doctors, only a quarter were ordered because the doctor had identified that patient as having a risk factor. Another 65% had the test because of prior liver problems or because routine blood tests showed elevated liver enzymes, and the remaining 10% of patients requested the test. Almost half of the 57 patients who tested positive and had a liver biopsy turned out to have significant liver scarring, either cirrhosis or fibrosis, suggesting a longstanding infection.

"Ideally, early diagnosis can be made if doctors ask about hepatitis C risk factors and patients answer honestly,” says Dr. Anna Lok, professor of gastroenterology at U-M Medical School. "We shouldn't wait until patients have symptoms or until the infection has progressed, as treatment is often more effective if it's begun early.” Dr. Lok and colleagues will present the study findings at the Digestive Disease Week meeting in Atlanta (FL, USA).




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