Screening in liver disease

Table 1 Characteristics of the most common liver diseases and feasibility of screening

	Hepatitis C	Hepatitis B	Fatty liver	Hemochromatosis
Disease common and causing morbidity/mortality	Yes	Yes	Common, but increased mortality only if advanced NASH	Common, but only 1% of screened population with complications[13]
Target population identifiable	High risk groups	High risk groups	Obese, diabetics	Northern European ancestry
Screening test	HCV Antibody test	HBsAg test	Ultrasound	Transferrin saturation or genetic testing (unsettled)
Performance of test	Good	Good	Low PPV and NPV for fibrosis	Under investigation
Effective therapy	50% cure[14]	4%-24% HBsAg loss, 70% no progression[15,16]	Only lifestyle modification	Yes, but may be unnecessary

Table 2 Indications for screening with anti-HCV antibody

Risk factors for which testing is indicated by all the guidelines	Risk factors for which testing is indicated by some of the guidelines	Additional risk factors for which testing is not formally recommended
Intravenous drug use (past and present)	Populations with high HCV prevalence[12,30]	Injections with reusable glass syringes[32]
Blood transfusion or transplantation before 1992 (or by known HCV positive donor)	Incarceration[12,33]	Heavy marijuana use[34]
Administration of clotting factors before 1997	Hepatitis B virus infection[12,33]	Promiscuous sex[34]
Clinical or biochemical evidence for chronic liver disease	Sharing intranasal cocaine equipment[12,33]	Poverty[34,35]
Percutaneous exposures to HCV	History of sexually transmitted disease[12,33] with genital erosions[28]	History of invasive procedures[36]
Haemophilia	Traumatic sex or vaginal sex during menstruation[14,33]	History of surgery[36]
Children born to HCV + ve mothers	Health Care Workers performing procedures at risk of transmission to the patient[37]	Beauty treatments[38]
HIV positivity
Stable sexual partners of HCV + patients

Table 3 Categories at risk for hepatitis B that should be screened and vaccinated

Immigrants from high prevalence areas (> 8% population) Asia, Pacific Islands, Alaska, Greenland, Africa, Middle East, former USSR, Eastern Europe (except Hungary), Malta, Amazonian areas of Peru, Brazil, Bolivia and Venezuela

Refugees, adopted children, residents for more than 6 mo in the same areas

Blood transfusion before 1973

Drug addicts

Individuals with clinical or biochemical evidence for chronic liver disease

Percutaneous exposures to HBV

Haemophilia

Pregnant women

Haemodyalisis

Household, sexual and needle sharing contacts of HBsAg patients

Sexual partners of HBsAg patients

Health Care Workers