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Who to Screen for Hepatitis C: That is the Question

While India has made major strides in reducing the barrier to care patients with HCV, the identification of patients who should be screened for HCV remains one of the major challenges in the holistic control of HCV infection. Screening is important as patients remain asymptomatic till they progress to advanced cirrhosis and develop clinical decompensation. To attain the goal of HCV elimination by 2030, the pool of HCV infection in the community would need to be decreased by 80–90% to break the cycle of re-infection. There is ample evidence to suggest that patients at high-risk including those with HIV or hepatitis B co-infection, intravenous drug use, on maintenance haemodialysis and those who engage in high-risk sexual practices should be actively screened for HCV. However, there are two important caveats in restricting active screening to only these patients at high-risk. Many patients may not disclose their high-risk behaviour due to fear of social stigma. More importantly, despite the relatively higher prevalence of HCV infection in these high-risk groups, they account for only about 12% of the absolute burden of HCV in the country. The vast majority of infections (around 88%) are present in patients without traditional high-risk factors. The alternate approach of universal screening is likely to be uneconomical and logistically prohibitive in a country with limited health resources like India. It is thus crucial to identify other risk factors that predict the presence of HCV infection among Indians without the traditional high-risk factors so as to devise screening algorithms and permit linkage to care prior to progression to end-stage liver disease or hepatocellular carcinoma.

A systematic review, published in the Journal of Clinical and Experimental Hepatology, evaluated the risk factors for HCV among individuals without the aforementioned high-risk factors in India. Researchers extracted and reviewed the data from 25 studies published as full text which incorporated more than 31,000 individuals. The authors identified unsafe injections, obstetrical procedures, body piercing, unsafe dental procedure, unsafe shaving and tattooing as the predominant risk factors for HCV infection in India.

The full study results can be accessed here.

An accompanying comment is available here.