Most adults in the United States should be screened for hepatitis C, according to guidelines published Monday, as the opioid crisis and more prevalent use of illicit injected drugs have driven a nearly fourfold increase in new cases over the last decade.
Despite substantial advances in treatment over the past five years, infections are on the rise. Roughly 44,700 new hepatitis C infections were reported in the United States in 2017, according to federal data. A major challenge for health officials is that a significant number of people have the virus but do not know they are infected, said the U.S. Preventive Services Task Force, a national panel of health experts.
The expanded guidelines, which were published in The Journal of the American Medical Association, call for the screening of all adults between the ages of 18 and 79. Previously, U.S. health guidelines had recommended testing for adults born between 1945 and 1965.
Hepatitis C leads to chronic liver disease in most people who contract it, and some eventually develop cirrhosis and liver cancer. It is spread primarily through the sharing of needles among people who use illicit drugs.
The most rapid increase in cases of acute hepatitis C between 2010 and 2017 was reported among young adults between the ages of 20 and 39 who injected drugs, according to the study. Rates increased especially among Native Americans and Alaska Natives, and non-Hispanic white people.
The risk of sexual transmission of the disease is low, but it increases for people who have multiple partners, who have a sexually transmitted disease or who are infected with H.I.V., according to the Centers for Disease Control and Prevention.
“Some people may not be aware of their risk or they may not want to disclose it to you, so the way to capture the most people is to screen everyone,” said Dr. Douglas K. Owens, chair of the U.S. Preventive Services Task Force and a professor of medicine at Stanford University. “It also helps reduce the stigma.”
Members of the task force are appointed by the federal Department of Health and Human Services, but it operates independently from the department. The task force makes recommendations, based on evidence, about clinical preventive services.
About 2.4 million Americans are living with hepatitis C. A major challenge for health officials is that hepatitis C complications develop over a period of years, and many people who have contracted it have no symptoms and do not know they are infected.
Hepatitis C is associated with more deaths than the other top 60 reportable infectious diseases combined. And yet treatments are highly effective; more than 95 percent of hepatitis C cases are cured with two to three months of daily oral therapy, and few side effects.
Many people who are most at risk of contracting the disease — young people and opioid users — are less likely to seek treatment, said Dr. Robert S. Brown Jr., the director of the Center for Liver Disease and Transplantation at NewYork-Presbyterian/Weill Cornell hospital. Screening enables health officials to find the infection earlier, when it is easier to treat.
“In this new group of younger patients who are predominately white, nonurban, and who are using prescription and nonprescription opioids,” Dr. Brown said, “the only way we’re going to get rid of hepatitis C is to use treatment as prevention and prevent transmission to other high-risk individuals.”
Hepatitis C is a major public health issue. Dr. Brown said the advent of highly effective oral therapies, which revolutionized treatment, led people to believe, incorrectly, that hepatitis C was no longer a significant public health problem. Older therapies were not nearly as effective and sometimes produced debilitating side effects.
Before 1992, the disease spread through blood transfusions and organ transplants, according to the C.D.C. Since then, those sources of infection have been virtually eliminated because of blood supply screening.