One way to manage chronic hepatitis C virus (HCV) is to abandon existing guidelines and screen all people born between 1945 and 1975 for the disease, according to a new paper. 

Chronic HCV is a major public health problem in Canada with serious health effects leading to premature death. In 2013, about 252,000 Canadians were infected with HCV. People born between 1945 and 1975 have the highest rates of HCV, although an estimated 70% of this group have not been tested. 

The guideline, created by the Canadian Association for the Study of the Liver, is aimed at physicians and other health care professionals to help them manage adult patients with chronic HCV infection. "Simplification of treatment regimens and better tolerability allows for expansion of the treater pool to primary care providers in Canada," notes Hemant Shah. The guideline also contains quick-reference boxes and tables that describe who to test, suggested pre-HCV treatment workup, a list of Health Canada-approved direct-acting antivirals and recommended regimens for patients.

It differs significantly from a recent guideline from the Canadian Task Force on Preventive Health Care published in April 2017, which recommended against screening people who are not at high-risk of infection. However, the guideline is broadly consistent with those from other societies in Europe and the United States.

The authors recommend birth cohort screening for people born between 1945 and 1975 based on high rates of HCV in this group, evidence showing cost-effectiveness of detection and recent lower prices for HCV therapy in Canada that make treating HCV less expensive than in the past. In most provinces and territories in Canada, every infected person can now access therapy for Hepatitis C.