Rastreio das Hepatites
Autor: Luciano Duro | Publicado: 2011-08-01T11:26:00-07:00

Reproduzo aqui um email enviado por Michael Duncan, sobre Screening das Hepatites:


O UptoDate resume as principais recomendações nos EUA sobre rastreamento para hepatite C. Não tem artigo específico para rastreamento de hepatite B, mas no capítulo de rastreamento para DSTs, eles listam como indicações para o seu rastreamento:

Hepatitis B&nbsp;—&nbsp;Hepatitis B is efficiently transmitted by percutaneous or mucous membrane exposure to infected blood or body fluids that contain blood. Hepatitis B screening (hepatitis B surface antigen with anti-HBc or anti-HBs) should be offered to patients with multiple sex partners, MSM, and injection drug users. If the patient is susceptible, vaccination should be offered.

Para a hepatite C, dão mais informações:

Several organizations have provided guidelines for who should be tested. Despite having reviewed similar data and including experts, the various guidelines do not all agree. The following summarizes recommendations from the major organizations.
United States Preventive Services Task Force&nbsp;—&nbsp;The United States Preventive Services Task Force (USPSTF) recommends against routine screening for hepatitis C virus (HCV) infection in asymptomatic adults who are not at increased risk for infection [1]. In addition, they found insufficient evidence to make a recommendation for or against routine screening in adults at high risk for HCV infection. In making this recommendation the USPSTF notes potential harms of screening and treatment including labeling of the patient, adverse treatment effects, and unnecessary liver biopsies.This recommendation should be interpreted as suggesting the need for additional research [2]. A response from the Centers for Disease Control and Prevention to the USPSTF recommendation emphasizes that medical and public health professionals should continue the practice of screening persons for risk factors, and offering testing to those at increased risk [3].Centers for Disease Control and Prevention&nbsp;—&nbsp;The Centers for Disease Control and Prevention recommend that testing for HCV should be routine in patients at increased risk for infection, including those who (www.cdc.gov/mmwr/pdf/rr/rr5203.pdf&nbsp;and&nbsp;http://www.cdc.gov.libproxy.lib.unc.edu/mmwr/preview/mmwrhtml/rr5912a1.htm):Ever injected illegal drugs
Received clotting factors made before 1987
Received blood/organs before July 1992
Were ever on chronic hemodialysis
Have evidence of liver disease (elevated alanine aminotransferase [ALT] level)
Are infected with HIV
Testing should also be performed based upon the need for exposure management including:Healthcare, emergency, and public safety workers after needle stick/mucosal exposure to HCV-positive blood
Children born to HCV-positive women
Routine testing is not recommended (unless an additional risk factor is identified) in:Healthcare, emergency medical, and public safety workers
Pregnant women
Household (non-sexual) contacts of HCV-positive persons
The general population
The need for testing is uncertain in the following groups:Recipients of transplanted tissue after 1992
Intranasal cocaine or other non-injecting illicit drug users
Those with a history of tattooing, body piercing
Those with a history of sexually transmitted diseases or multiple sex partners
Long-term steady sexual partners of HCV-positive persons
National Institutes of Health&nbsp;—&nbsp;The&nbsp;National Institutes of Health (NIH) consensus guidelines&nbsp;are similar to those of the CDC. In addition to the CDC guidelines, the NIH guidelines recommended screening individuals who:Received a blood transfusion or organ transplantation prior to 1990 (rather than 1992)
Have had multiple sexual partners
Are spouses or household contacts of HCV-infected patients
Share instruments for intranasal cocaine use
American Association for the Study of Liver Diseases&nbsp;—&nbsp;A 2009 practice guideline issued by the American Association for the Study of Liver Diseases (AASLD) recommends testing for the following groups [4]:Those who have injected illicit drugs in the recent and remote past, including those who injected only once and do not consider themselves to be drug users
Those with conditions associated with a high prevalence of HCV including patients with HIV infection, those with hemophilia who received clotting factor concentrates before 1987, persons who were ever on hemodialysis, and those with unexplained abnormal aminotransferase levels
Prior recipients of transfusions or organ transplants before July 1992, including those who were notified that they received blood from a donor who later tested positive for HCV infection
Children born to HCV-infected mothers
Healthcare, emergency and public safety workers after a needle stick injury or mucosal exposure to HCV-positive blood
Current sexual partners of HCV-infected persons
Authors' recommendations&nbsp;—&nbsp;Our general approach is consistent with the guidelines recommended by the AASLD. Notably, the presence of an abnormal serum ALT level, any history of injection drug use, or a history of blood transfusion before 1992 identified 85 percent of HCV RNA positive participants between the ages 20 to 59 in the most recent National Health and Nutrition Examination Survey in the United States [5].
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