Education And Debate

Controversies in Management: Screening asymptomatic people at high risk for hepatitis C: The case against

BMJ 1996; 312 doi: https://doi.org/10.1136/bmj.312.7042.1349 (Published 25 May 1996) Cite this as: BMJ 1996;312:1349
  1. Miles C Allison, consultant physician and gastroenterologista,
  2. Peter R Mills, consultant physician and gastroenterologistb
  1. a Royal Gwent Hospital, Newport NP9 2UB
  2. b Gartnavel General Hospital, Glasgow G12 0YN

    The case against

    The hepatitis C virus is usually transmitted parenterally through blood products or shared needles. Most infected people develop mild chronic hepatitis, which tends to pursue an asymptomatic course over years or decades.1 It is not known how many of those affected will eventually develop clinical sequelae from liver disease.

    Risk groups

    Screening blood donations for antibodies to the hepatitis C virus has led to a considerable reduction in the incidence of transfusion associated hepatitis.2 The United Kingdom's National Blood Transfusion Service has introduced a hepatitis C “lookback” programme to identify and screen those known to have received infected blood before testing of donations began in 1991. Other individuals at risk include injecting drug users, people with haemophilia, and health care workers. According to one estimate there may be 200 000 people with chronic hepatitis C in the United Kingdom.3 Should asymptomatic individuals belonging to these groups be offered screening for hepatitis C? This question raises both medical and ethical issues which share an analogy with screening for infection with HIV.

    A positive test result for hepatitis C comes as a devastating blow to a healthy person. Concerns are raised about the mode of viral acquisition, risk of transmission to close contacts, marriage, employment and life insurance prospects, and the future risk of cirrhosis and hepatoma. …

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