VIRAL HEPATITIS screening plays a crucial role in identifying hepatitis B virus (HBV) and hepatitis C virus (HCV) infections, both of which contribute substantially to global morbidity and mortality. Together, these infections account for around half of all liver cancer cases worldwide and are major drivers of cirrhosis and hepatocellular carcinoma. Effective treatments are available, direct-acting antivirals (DAAs) cure more than 95% of HCV cases, while nucleos(t)ide analogues control HBV in over 90% of patients. Despite this, early detection remains a significant barrier to reducing disease burden.
Shortcomings of Risk-based Hepatitis Testing
Traditionally, most European and Spanish guidelines recommend viral hepatitis screening only in individuals with recognised risk factors or elevated liver enzyme levels. However, the study found that more than half of patients testing positive for HCV or HBV had neither risk factors nor abnormal aminotransferase results. Under current guidance, these patients would not have been tested, leaving their infections undiagnosed.
This aligns with evidence from emergency departments, where large proportions of hepatitis-positive patients reported no known risk factors. Furthermore, the reliance on repeated visits for liver enzyme testing before hepatitis-specific tests are ordered complicates timely diagnosis and delays linkage to care.
Universal Hepatitis Screening Identifies Hidden Infections
In the prospective part of the study, all primary care patients undergoing blood collection were offered HBV and HCV testing. The results showed that universal viral hepatitis screening identified twice as many HCV-positive patients among those without risk factors compared to those with them. Notably, linkage to care rates in this cohort were high, 87.5% for HCV and 92% for HBV, supporting the value of primary care physicians in early detection and referral.
These findings strongly suggest that current risk-based testing misses a significant proportion of cases. Universal screening could uncover hidden infections, improve access to effective therapies, and help achieve the World Health Organization’s goal of eliminating viral hepatitis as a public health threat by 2030.
Reference
Vargas-Accarino E et al. Beyond risk factors: rethinking hepatitis B and hepatitis C screening in primary care. Liver Int. 2025;45(10):e70330. doi:10.1111/liv.70330
