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Chou R, Cottrell EB, Wasson N, et al. Screening for Hepatitis C Virus Infection in Adults [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2012 Nov. (Comparative Effectiveness Reviews, No. 69.)
This publication is provided for historical reference only and the information may be out of date.
| Key Question | Number of Studies | Quality (Good, Fair, Poor) | Consistency (High, Moderate, Low) | Directness (Direct or indirect) | Precision (High, Moderate, Low) | Number of Subjects | Strength of Evidence |
|---|---|---|---|---|---|---|---|
| 1a. Does screening for HCV infection in non pregnant adults without known abnormal liver function tests reduce mortality and morbidity due to HCV infection, affect quality of life, or reduce incidence of HCV infection? | No studies | No studies | No studies | No studies | No studies | No studies | Insufficient |
| 1b. Does screening for HCV infection during pregnancy reduce vertical transmission of HCV or improve mortality or morbidity for the mother or child? | No studies | No studies | No studies | No studies | No studies | No studies | Insufficient |
| 2a. What is the effectiveness of different risk- or prevalence-based methods for screening for HCV infection on clinical outcomes? | No studies | No studies | No studies | No studies | No studies | No studies | Insufficient |
| 2b. What is the sensitivity and number needed to screen to identify one case of HCV infection of different risk- or prevalence-based methods for screening for HCV infection? | 5 studies (4 cross-sectional, one case-control) | Poor | High | Direct | High | 8,044 | Low |
| 3. What are the harms associated with screening for HCV infection, including adverse effects such as anxiety, labeling, and impact on relationships? | 5 (1 cross-sectional, 3 intervention series and 1 Controlled Trial) | Poor | Unable to assess (assessed different outcomes) | Direct | Low | 288 | Insufficient |
| 4a. What is the comparative effectiveness and comparative diagnostic accuracy of various tests and strategies for the work-up to guide treatment decisions in patients who are HCV positive?a | |||||||
| Clinical outcomes | 1 cohort study | Fair | Unable to assess (one study) | Direct | Low | 156 | Insufficient |
| Diagnostic accuracy: Platelet counts vs. liver biopsy | 15 studies of diagnostic accuracy | Fair | Moderate | Direct | Low | 2,836 (AUROC for fibrosis) and 2,311 (AUROC for cirrhosis) | Low |
| Diagnostic accuracy: Age-platelet index vs. liver biopsy | 6 studies of diagnostic accuracy | Fair | High | Direct | Moderate | 1,121 (AUROC for fibrosis) and 1,113 (AUROC for cirrhosis) | Moderate |
| Diagnostic accuracy: APRI vs. liver biopsy | 58 studies of diagnostic accuracy | Fair | High | Direct | High | 13,999 (AUROC for fibrosis) and 13,077 (AUROC for cirrhosis) | High |
| Diagnostic accuracy: AAR vs. liver biopsy | 27 studies of diagnostic accuracy | Fair | High | Direct | High | 3,798 (AUROC for fibrosis) and 3,708 (AUROC for cirrhosis) | High |
| Diagnostic accuracy: CDS (also Bonacini Index) vs. liver biopsy | 8 studies of diagnostic accuracy | Fair | High | Direct | Moderate | 1,139(AUROC for fibrosis) and 1,991 (AUROC for cirrhosis) | Moderate |
| Diagnostic accuracy: ELF or Simplified ELF vs. liver biopsy | 7 studies of diagnostic accuracy | Fair | High | Direct | Moderate | 1,217 (AUROC for fibrosis) and 754 (AUROC for cirrhosis) | Moderate |
| Diagnostic accuracy: FIB-4 vs. liver biopsy | 15 studies of diagnostic accuracy | Fair | High (two studies) | Direct | Moderate | 4,227(AUROC for severe fibrosis) | Moderate |
| Diagnostic accuracy: FibroIndex vs. liver biopsy | 4 studies of diagnostic accuracy | Fair | High | Direct | Low | 803 (AUROC for fibrosis) and 803 (AUROC for cirrhosis) | Moderate |
| Diagnostic accuracy: Fibrometer vs. liver biopsy | 8 studies of diagnostic accuracy | Fair | High | Direct | Moderate | 2,667 (AUROC for fibrosis) and 3,729 (AUROC for cirrhosis) | Moderate |
| Diagnostic accuracy: FibroSpect II vs. liver biopsy | 4 studies of diagnostic accuracy | Fair | High | Direct | Low | 590 (AUROC for fibrosis) and 108 (AUROC for cirrhosis) | Low |
| Diagnostic accuracy: Fibrotest vs. liver biopsy | 28 studies of diagnostic accuracy | Fair | High | Direct | High | 8,272 (AUROC for fibrosis) and 6,516 (AUROC for cirrhosis) | High |
| Diagnostic accuracy: Forns’ Index vs. liver biopsy | 16 studies of diagnostic accuracy | Fair | High | Direct | High | 5,867 (AUROC for fibrosis) and 4,128 (AUROC for cirrhosis) | High |
| Diagnostic accuracy: Hepascore vs. liver biopsy | 11 studies of diagnostic accuracy | Fair | High | Direct | High | 3,787 (AUROC for fibrosis) and 3,437 (AUROC for cirrhosis) | High |
| Diagnostic accuracy: Lok Index vs. liver biopsy | 8 studies of diagnostic accuracy | Fair | High | Direct | Moderate | 3,215 (AUROC for cirrhosis) | Moderate |
| Diagnostic accuracy: Pohl Index vs. liver biopsy | 10 studies of diagnostic accuracy | Fair | High (two studies) | Direct | Low | 490 (AUROC for fibrosis) and 718 (AUROC for fibrosis) | Low |
| APRI vs. Fibrotest | 16 studies of diagnostic accuracy | Fair | High | Direct | Moderate | 6,399(excluding overlapping populations) | Moderate |
| AST/ALT ratio vs. other indices | 14 studies of diagnostic accuracy | Fair | High | Direct | Moderate | 3,991 | Moderate |
| 4b. What proportion of patients with screen-detected HCV infection receives treatment? | 3 intervention series | Fair | High | Direct | Moderate | 18,580 | Moderate |
| 5. What are the harms associated with the work-up for guiding treatment decisions? | 6 intervention series (1 of patients specifically undergoing liver biopsy for evaluation of HCV infection) | Fair | High | Direct | High | 88,587 | Moderate |
| 6a. How effective is counseling or immunizations of patients with HCV infection at improving health outcomes or reducing the spread of HCV? | 1 randomized controlled trial | Fair | Unable to assess (one study) | Direct | Low | 137 | Insufficient |
| 6b. Does becoming aware of positive HCV infection status decrease high risk behaviors? | 5 (2 prospective before-after studies, 3 retrospective post-intervention series) | Fair | Moderate | Direct | Moderate | 1,660 | Low |
| 6c. How effective is counseling or immunizations of patients with HCV infection at improving intermediate outcomes, including change in high risk behaviors? | 4 (2 RCTs, 2 before-after studies) | Fair | High | Direct | Low | 1,369 | Insufficient |
| 7. Do any interventions decrease or increase the vertical transmission of HCV during delivery or in the perinatal period? | |||||||
| Elective cesarean vs. vaginal delivery | 4 cohort studies | Fair | Moderate | Direct | Low | 2,080 | Low |
| Any cesarean vs. vaginal delivery | 11 cohort studies | Fair | High | Direct | Low | 2,308 | Moderate |
| Internal fetal monitoring vs. no internal fetal monitoring | 3 cohort studies | Fair | Moderate | Direct | Low | 928 | Insufficient |
| Prolonged rupture of membranes vs. less prolonged rupture of membranes | 2 cohort studies | Fair | High | Direct | Low | 245 | Low |
| Breastfeeding vs. no breastfeeding | 14 cohort studies | Fair | High | Direct | High | 2,971 | Moderate |
Abbreviations: APRI, aspartate transaminase-platelet ratio index; AAR, aspartate transaminase-alanine transaminase ratio; CDS, Cirrhosis Discriminant Score; ELF, Enhanced Liver Fibrosis Index; HCV, hepatitis C virus.
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Not all studies of diagnostic accuracy reported the area under the receiver operating curve (AUROC). Sensitivity and specificity at different cutoffs are summarized in the Results.
- Overall Strength of Evidence: Summary of Grading Domains - Screening for Hepatit...Overall Strength of Evidence: Summary of Grading Domains - Screening for Hepatitis C Virus Infection in Adults
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