Recently, the debate for access to newest drugs against the hepatitis C virus has been in front pages and prime time news on the media.
Health authorities of most countries are working hard to clarify a guideline of which patients will have the most expensive new medication. Certainly, resources are not infinite.
A different question is, who should be checked for hepatitis C markers? Is widespread screening for hepatitis C justified? This is the title of a recent article in the BMJ 2015;350:g7809, by Prof. Ronald L Koretz et al.
In 1998, the US Centres for Disease Control and Prevention (CDC), recommended the screening of risk groups (needle drug users, haemodialysis patients, HIV +, organ transplant/blood transfusion receptors), highly suspected patients and those exposed to other infected patients.
In 2012, it was extended to everyone born during 1945-65 since it estimates that three quarters of all people infected are in that age group. These recommendations were adopted by the WHO and most countries.
His conclusions are that at present, as in a large number of cases, the acute infection does not cause serious symptoms and, only some cases progress to chronic hepatitis C:
– “Given the uncertainty about the validity of the surrogate markers, the lack of evidence regarding clinical outcomes of treatment or of screening strategies, and the adverse events caused by the newer regimens, screening may be premature.”
– “Physicians should resist screening until we have strong evidence that antiviral therapy is clinically effective and the benefits outweigh the harms.”