Real-World Data Show Rising HCV Epidemic Among Young Adults

The study authors defined an active HCV infection as having an HCV RNA+ result following a positive AB test
The study authors defined an active HCV infection as having an HCV RNA+ result following a positive AB test

Results from the largest real-world study analyzing hepatitis C virus (HCV) screening practices determined that, although HCV antibody (AB) screening and confirmatory RNA testing rates are improving, the HCV epidemic continues to rise among young adults.

The study included 17,149,480 patients obtained from 2 national laboratory datasets who were screened between 2013 and 2016 based on an AB test. The study authors defined an active HCV infection as having an HCV RNA+ result following a positive AB test. The study authors added, "AB screening rates, AB+ rates, RNA follow-up testing rates, and RNA+ rates were assessed descriptively by year and stratified by baby boomers 48-71 years old and young adults 18-39 years old, to reflect the evolving disease epidemiology."

Results of the study detected a steady increase in the number of people screened annually without observing a decrease in the proportion of people who tested AB+ (4,079,551 [5.3%] in 2013 to 5,152,475 [5.6%] in 2016). An increase in the screening rate per 1000 residents was also seen in states that implemented new screening policies such as Massachusetts, Colorado, California, Connecticut, and New York. 

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The study authors also reported that a decline in AB+ rates was observed from 2013 to 2016 in both male (12.2% to 11.0%) and female (6.4% to 5.7%) baby boomers. On the other hand, AB+ rates in the younger adult cohort were found to increase for both males (4.1% to 5.6%) as well as females (2.2% to 3.0%).        

An increase in the rate of confirmatory RNA testing was also observed in patients who had an AB+ test (45.0% in 2013 to 76.5% in 2016). Additionally, it was found that 64-66% of patients who completed RNA follow-up testing post AB+ screening had an RNA+ result over the study period.

"The number of persons with detected active infection (RNA+ post AB+ test) increased from 28,139 in 2013 to 67,223 in 2016 for baby boomers and from 10,794 to 42,263 for young adults,” the study authors reported. They added, “525,426 patients had HCV RNA+ test and no previous HCV AB test over 2013-2016."

According to the results of this real-world study, both HCV AB screening and confirmatory RNA testing rates are increasing, however, the HCV epidemic continues to rise in young adults. “Revisions to the current recommendations for HCV AB screening should be considered to improve detection of active HCV among younger persons for whom risk behaviors (such as injection drug use) may not be reported due to stigma,” the study authors concluded.

Reference:

Sulkowski MS, Marx S, Manthena SR, Strezewski J, Chirikov VV. National Estimates for HCV Screening and Diagnosis Rates in the United States (2013-2016) Based on Large Real-World Dataset. Presented at AASLD The Liver Meeting 2018. Study number 1565.