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| BMJ
2000;320:512 ( 19 February )
Letters Accuracy of perceptions of hepatitis B and C status - Value of screening for hepatitis C is still debatableRupert Suckling EDITOR - Best et al
encourage clinicians to test all injecting drug misusers for
hepatitis B and hepatitis C as a "catalyst for
further intervention."1 Routine
immunisation against hepatitis B in injecting drug
misusers is now national policy, and screening for
hepatitis B is therefore a sensible first step, but whether to
screen for hepatitis C in injecting drug misusers is much more debatable.
Best et al have not given their proposal sufficient critical
consideration. When the proposal is examined more critically,
serious potential problems are clear. Firstly, it is usually best
that an effective and acceptable treatment is available
for the condition being screened for. Treatment efficacy
itself is only about 40% with dual treatment (which is not
currently funded), and the merit of prescribing
potentially toxic drugs to patients with disordered lifestyles
is unclear. The second potential disadvantage of screening is
the probable lack of provision of counselling. Some patients have
committed suicide because they were unable to cope with the implications,
real or perceived, of the diagnosis. Wider resource implications
should also be debated - not least the scale of potential costs.
In Sheffield alone there may be around 10 000 injecting drug
users. If only half were found to be positive for hepatitis C
virus - a very conservative estimate - specialist services would
be severely overburdened. We agree that clinicians must be more vigorous in
encouraging drug users to reduce risk behaviours, but screening is
not a prerequisite if patients are not suitable for
treatment. In view of the potential harms that screening
may cause we do not believe, on balance, that clinicians
should offer routine screening for hepatitis C until
resources for management are available. At the least, a
fuller debate is needed nationally and locally before such
screening is instituted. The arguments for routine screening will
become stronger as more effective treatment emerges, and we
welcome the inclusion of dual treatment in the proposed programme
of work for the United Kingdom's National Institute for
Clinical Effectiveness (NICE). Best D, Noble A, Finch E, Gossop M,
Sidwell C, Strang J. Accuracy of perceptions of hepatitis B
and C status: cross sectional investigation of opiate addicts
in treatment. BMJ 1999; 319: 290-291
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