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Is screening baby boomers for HCV enough? A call to screen for hepatitis C virus in persons from countries of high endemicity

Hepatitis C virus (HCV) has a current global prevalence rate of approximately 2–3%, representing approximately 130–180 million infected individuals (1, 2). Persons chronically infected with HCV are at risk of chronic hepatitis and of developing serious hepatic complications such as cirrhosis, hepatocellular carcinoma (HCC), or liver failure. Several data suggest that the prevalence of HCV is higher in countries located in Asia (2.1%, 83 millions) and Africa (3.2%, 28 millions), while a lower prevalence is found in North America, Europe and Australia (1, 2). (Fig. 1). The highest prevalence of HCV, 15%, is found in Egypt, while the lowest reported prevalences are <1.0% in both the UK and Scandinavia. However, only limited country-specific estimates of HCV prevalence are available to guide decision making. In the USA and Europe, HCV is the leading cause of cirrhosis and hepatocellular carcinoma, and the major cause of end-stage liver disease leading to liver transplantation. Data from death certificates show that HCV-related deaths now outpace deaths because of HIV in the USA and many European countries (3, 4). Despite progress in antiviral treatment with directacting antivirals (5), screening and access to treatment has been low. A recent report commissioned by the Institute of Medicine (IOM) of the National Academies estimates that up to 75% of HCV-infected persons have not been diagnosed (6). Several HCV management guidelines have been provided (7–9) (Table 1). Prior risk-factor based HCV screening guidelines have demonstrated limited effectiveness, identifying only approximately 25% of chronically infected individuals in the USA. In an effort to identify more cases of HCV-infected persons, the CDC recently updated their screening guidelines to include one-time testing for all adults born during the period of 1945–1965 (9). Several studies suggest that HCV screening and treating among the 1945–1965 birth cohort at a prevalence of approximately 3% would be cost-effective (10, 11). Despite the differences in geographical distribution of HCV prevalence worldwide, there are currently no recommendations in the USA or Europe to screen persons who originate from countries with high HCV