Hepatitis Central

  GASTROENTEROLOGY 1998;114:869-870

Hepatitis C "Lookback" Effort Misguided, Critics Charge

As many as 250,000 Americans who received blood transfusions as long ago as 1987 will be notified that they may have been infected with Hepatitis C (HCV).

Under the "targeted HCV lookback" program approved by Secretary of Health and Human Services Donna Shalala, individuals who received blood that subsequently tested positive for Hepatitis C, using an effective test that was developed in 1992, will be contacted and urged to get tested for the virus.

The lookback program will involve thousands of hospital workers at a cost that could exceed $200 million, according to Frederic Shaw, editor of Hepatitis Control Report, a quarterly publication devoted to news on the control of viral hepatitis.

"Shalala's move marks a turning point in federal blood policy and culminates 9 years of debate about HCV lookback in the public health and blood banking communities," Shaw says.

Although Shalala agreed with the congressional Subcommittee on Human Resources and Health and Human Services advisory panel that persons exposed to HCV through blood transfusions have a right to know of the exposure, Shaw points out that many critics of the initiative believe it is a misguided effort.

"Even before 1992, 95% of Hepatitis C was totally unrelated to transfusions," says one such critic, Paul Holland of the Sacramento Blood Center. "We should be focusing on a public health campaign aimed at the vast majority of cases that are not transmitted by transfusions. Instead, with an estimated 4 million people out there with the virus, we're spending an enormous amount of time and money trying to identify a handful of people who may have been infected, and who probably aren't going to spread it since they're not typically the ones sharing needles or having multiple sex partners."

Proponents of lookback argue that improvements in HCV therapy make notification of the transfusion recipients worthwhile. But Holland notes that the treatment is expensive. "Who's going to pay for it?" he asks. "There's no impetus to appropriate the millions of dollars it's going to take."

GASTROENTEROLOGY 1998;114:869-870

© 1998 by The American Gastroenterological Association

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