"The USPSTF found insufficient evidence to recommend for or against routine screening for HCV infection in adults at high risk for infection. This is a grade I recommendation." [insufficient evidence]
The USPSTF bases this statement on the lack of long-term data showing that current hepatitis C treatment with pegylated interferon and ribavirin improves long-term health outcomes -- i.e., reducing incidence of cirrhosis, liver cancer and death. They note that "potential harms of screening and treatment include labeling, adverse treatment effects, and unnecessary biopsies, although there is limited evidence to determine the magnitude of these harms."
While technically correct, the USPSTF conclusions go against a range of other groups' recommendations. It will be several years, perhaps a decade, before data on long-term effectiveness of current hepatitis C therapies are available. In the meantime, many people unaware that they have hepatitis C may progress to cirrhosis, missing opportunities for care and treatment. The American Association for the Study of Liver Diseases (AASLD) issued a statement attempting to put the USPSTF recommendations in context, and pointing to their own new guidelines for clincal practice (link to PDF file).
The AASLD recommends routine testing of groups at high risk or with high prevalence of hepatitis C. These groups include current and former injection drug users and people with HIV, consistent with other recommendations.
The impact of the USPSTF recommendations is unclear, but there is a compelling need to expand access to hepatitis C antibody screening and confirmatory HCV RNA testing, particularly for current and former drug users.
Watch this space for "Best Practice" guidelines for hepatitis C screening at needle exchange programs, developed by Narelle Ellendon of the Hepatitis C Harm Reduction Project.