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Dennis BB, Babe G, Gayowsky A, Rosic T, Rodrigues M, Bach P, Perez R, de Oliveira C, Samet J, Weaver V, Young S, Dionne J, Ahmed A, Kim D, Thabane L, Samaan Z. Health service utilization, substance use treatment response, and death in patients with opioid use disorder and comorbid hepatitis C findings from prospective cohort study with administrative database linkage. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 167:209524. [PMID: 39341602 DOI: 10.1016/j.josat.2024.209524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 09/10/2024] [Accepted: 09/23/2024] [Indexed: 10/01/2024]
Abstract
BACKGROUND Among patients with opioid use disorder (OUD), high rates of overdose and death have been reported in subgroups with Hepatitis C Virus (HCV). Evidence on the comorbid effect of HCV on clinical and substance use trajectories has been limited by small sample sizes, short follow-up, and heavy reliance on administrative data which lacks granularity on important prognostic factors. Additionally, few studies include populations on substance use treatment. AIM To establish the impact of HCV exposure (antibody positivity) on health care utilization patterns, substance use treatment response, and death in a cohort of patients with OUD on opioid agonist therapy (OAT). METHODS This multi-center prospective cohort study recruited adult patients with OUD on OAT from 57 substance use treatment centers in Ontario, Canada. The study collected substance use outcomes, and classified patients with ≥50 % positive opioid urine screens over one year of follow-up as having poor treatment response. Additional data obtained via linkage with ICES administrative databases evaluated the relationship between HCV status, healthcare service utilization, and death over 3 years of follow-up. Multiple logistic regression models established the adjusted impact of HCV on various outcomes. RESULTS Among recruited participants (n = 3430), 44.10 % were female with a mean age of 38.64 years (Standard deviation: 10.96). HCV was prevalent in 10.6 % of the cohort (n = 365). Methadone was used most often (83.9 %, n = 2876), followed by sublingual buprenorphine (16.2 %, n = 554). Over the three-year follow-up, 5.3 % of patients died (n = 181). Unadjusted results reveal rates of hospitalization (all-cause, mental-health related, critical care) and emergency department visits (mental health-related), were significantly higher among HCV patients. Associations diminished in adjusted models. Active injection drug use exhibited the highest predictive risk for all outcomes. CONCLUSION A high degree of acute physical and mental illness and its resulting health service utilization burden is concentrated among patients with OUD and comorbid HCV. Future research should explore the role for targeted interventions and how best to implement integrated healthcare models to better address the complex health needs of HCV populations who inject drugs.
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Affiliation(s)
- Brittany B Dennis
- British Columbia Centre on Substance Use, Vancouver, BC, Canada; Division of Social Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada.
| | - Glenda Babe
- ICES McMaster, McMaster University, Hamilton, Ontario, Canada
| | | | - Tea Rosic
- Department of Health Research Methods Evidence and Impact, McMaster University, Hamilton, ON, Canada; Department of Psychiatry, University of Ottawa, Ontario, Canada
| | - Myanca Rodrigues
- Department of Health Research Methods Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Paxton Bach
- British Columbia Centre on Substance Use, Vancouver, BC, Canada; Division of Social Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Richard Perez
- ICES McMaster, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Claire de Oliveira
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; ICES, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Jeffrey Samet
- Department of Medicine, Boston University, Boston, USA
| | - Victoria Weaver
- Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Samantha Young
- British Columbia Centre on Substance Use, Vancouver, BC, Canada; Division of Social Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Joanna Dionne
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Aijaz Ahmed
- Department of Gastroenterology and Hepatology, Stanford University, Palo Alto, CA, USA
| | - Donghee Kim
- Department of Gastroenterology and Hepatology, Stanford University, Palo Alto, CA, USA
| | - Lehana Thabane
- Department of Health Research Methods Evidence and Impact, McMaster University, Hamilton, ON, Canada; Biostatistics Unit, Research Institute at St Joseph's Healthcare, Hamilton, Ontario, Canada; Departments of Pediatrics/Anesthesia, McMaster University, Hamilton, Ontario, Canada; Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | - Zainab Samaan
- Department of Health Research Methods Evidence and Impact, McMaster University, Hamilton, ON, Canada; Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada
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Demirchyan A, Mozalevskis A, Sahakyan S, Musheghyan L, Aslanyan L, Muradyan D, Sargsyants N, Ghukasyan G, Petrosyan V. Seroprevalence of Hepatitis C Virus and Factors Associated with It in Armenia, 2021. Viruses 2024; 16:1446. [PMID: 39339922 PMCID: PMC11437486 DOI: 10.3390/v16091446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Accepted: 08/27/2024] [Indexed: 09/30/2024] Open
Abstract
Hepatitis C virus (HCV) infection is among the leading causes of cirrhosis and hepatocellular carcinoma. Knowledge of its prevalence and risk factors can help to effectively fight the virus. This study was the first to investigate the seroprevalence of HCV, its genotypes, and factors associated with it among the general adult population of Armenia selected countrywide via cluster sampling. Anti-HCV antibodies were detected using third-generation immunoassay. Polymerase chain reaction and genotyping was performed among anti-HCV-positive individuals. Shortly after testing, the participants underwent a telephone survey. Logistic regression models were fitted to identify factors associated with anti-HCV antibody positivity and chronic HCV infection. The prevalence of anti-HCV antibodies among 3831 tested individuals was 2% (99% CI 1.4, 2.5), and chronic HCV infection was 0.7% (99% CI 0.4, 1.0), with genotypes 3 and 2 being the most common. The risk factors for chronic HCV infection included self-reported chronic liver disease (95% CI 1.47, 15.28), having tattoos (95% CI 1.34, 10.94), ever smoking (95% CI 1.16, 9.18), and testing positive for hepatitis B virus core antibody (95% CI 1.02, 7.17). These risk factors demonstrate that there could be room for strengthening infection control measures to prevent the transmission of HCV in Armenia.
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Affiliation(s)
- Anahit Demirchyan
- Turpanjian College of Health Sciences, American University of Armenia, 40 Marshal Baghramyan Ave., Yerevan 0019, Armenia; (S.S.); (L.M.); (L.A.); (D.M.); (V.P.)
| | - Antons Mozalevskis
- Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, 1211 Geneva, Switzerland;
| | - Serine Sahakyan
- Turpanjian College of Health Sciences, American University of Armenia, 40 Marshal Baghramyan Ave., Yerevan 0019, Armenia; (S.S.); (L.M.); (L.A.); (D.M.); (V.P.)
| | - Lusine Musheghyan
- Turpanjian College of Health Sciences, American University of Armenia, 40 Marshal Baghramyan Ave., Yerevan 0019, Armenia; (S.S.); (L.M.); (L.A.); (D.M.); (V.P.)
| | - Lusine Aslanyan
- Turpanjian College of Health Sciences, American University of Armenia, 40 Marshal Baghramyan Ave., Yerevan 0019, Armenia; (S.S.); (L.M.); (L.A.); (D.M.); (V.P.)
| | - Diana Muradyan
- Turpanjian College of Health Sciences, American University of Armenia, 40 Marshal Baghramyan Ave., Yerevan 0019, Armenia; (S.S.); (L.M.); (L.A.); (D.M.); (V.P.)
| | - Narina Sargsyants
- National Institute of Health, Ministry of Health, Republic of Armenia, Yerevan 0051, Armenia;
| | - Gayane Ghukasyan
- World Health Organization Country Office in Armenia, Yerevan 0015, Armenia;
| | - Varduhi Petrosyan
- Turpanjian College of Health Sciences, American University of Armenia, 40 Marshal Baghramyan Ave., Yerevan 0019, Armenia; (S.S.); (L.M.); (L.A.); (D.M.); (V.P.)
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Rzymski P, Brzdęk M, Dobrowolska K, Poniedziałek B, Murawska-Ochab A, Zarębska-Michaluk D, Flisiak R. Like a Rolling Stone? A Review on Spontaneous Clearance of Hepatitis C Virus Infection. Viruses 2024; 16:1386. [PMID: 39339862 PMCID: PMC11435954 DOI: 10.3390/v16091386] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Revised: 08/23/2024] [Accepted: 08/29/2024] [Indexed: 09/30/2024] Open
Abstract
Elimination of hepatitis C virus (HCV) without the need for medical intervention, known as spontaneous clearance (SC), occurs at a significantly lower rate than in the case of hepatitis B virus infection and only in selected individuals, such as reportedly in Keith Richards, a guitarist of The Rolling Stones. The present paper provides an updated narrative review of the research devoted to the phenomenon in order to identify and discuss the demographic, lifestyle-related, clinical, viral genotype-related, and host genetic factors underpinning the SC occurrence. The body of evidence indicates that the likelihood of SC is decreased in older individuals, men, Black people, HIV-coinfected subjects, and intravenous drug and alcohol users. In turn, HBV coinfection and specific polymorphism of the genes encoding interferon lambda 3 (particularly at rs8099917) and interferon lambda 4 (particularly at rs12979860) and HLA genes increase the odds of SC. Numerous other host-specific genetic factors could be implicated in SC, but the evidence is limited only to certain ethnic groups and often does not account for confounding variables. SC of HCV infection is a complex process arising from a combination of various factors, though a genetic component may play a leading role in some cases. Understanding factors influencing the likelihood of this phenomenon justifies better surveillance of high-risk groups, decreasing health inequities in particular ethnic groups, and may guide the development of a prophylactic vaccine, which at present is not available, or novel therapeutic strategies. Further research is needed to elucidate the exact mechanisms underlying SC and to explore potential interventions that could enhance this natural antiviral response.
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Affiliation(s)
- Piotr Rzymski
- Department of Environmental Medicine, Poznań University of Medical Sciences, 60-806 Poznań, Poland
| | - Michał Brzdęk
- Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland
| | | | - Barbara Poniedziałek
- Department of Environmental Medicine, Poznań University of Medical Sciences, 60-806 Poznań, Poland
| | | | - Dorota Zarębska-Michaluk
- Department of Infectious Diseases and Allergology, Jan Kochanowski University, 25-317 Kielce, Poland
| | - Robert Flisiak
- Department of Infectious Diseases and Hepatology, Medical University of Białystok, 15-540 Białystok, Poland
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Kamili S, Wester C. Advancing Diagnosis of Current Hepatitis C Virus Infection: A Key to Hepatitis C Elimination in the United States. J Infect Dis 2024; 229:S313-S315. [PMID: 38466750 PMCID: PMC11078305 DOI: 10.1093/infdis/jiae127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 03/02/2024] [Indexed: 03/13/2024] Open
Abstract
More than 2 million adults have hepatitis C virus (HCV) infection in the United States, and new infections continue to increase. Without treatment, HCV infection can lead to advanced liver disease and death. Treatment is recommended for nearly everyone with hepatitis C, resulting in a cure in >95% of people treated and raising the possibility of hepatitis C elimination. Testing is the first step to accessing life-saving treatment. The Centers for Disease Control and Prevention recommends hepatitis C screening for all adults, all pregnant persons, and anyone with risk; yet about one-third of people with hepatitis C remain unaware of their infection. Testing begins with a hepatitis C antibody test, followed, when reactive, by a nucleic acid test to detect HCV RNA. This antibody-first, 2-step testing strategy misses early infections and can result in incomplete diagnoses. Advancements in hepatitis C diagnostics and the US regulatory landscape have created an opportunity to include viral-first testing strategies and improve hepatitis C diagnosis. This journal supplement features 8 articles detailing challenges and opportunities for improving hepatitis C diagnostics in support of advancing hepatitis C elimination in the United States.
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Affiliation(s)
- Saleem Kamili
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Carolyn Wester
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Alarcón J, Dao BL, Santos M, Jewell MP, Donabedian C, Stanley AN, Terashita DM, Balter SE, Gounder P. Hepatitis C virus outbreak at a pain clinic in Los Angeles. Infect Control Hosp Epidemiol 2024; 45:549-550. [PMID: 38268342 PMCID: PMC11110885 DOI: 10.1017/ice.2023.294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Affiliation(s)
- Jemma Alarcón
- Centers for Disease Control and Prevention, Atlanta, Georgia
- Los Angeles County Department of Public Health, Los Angeles, California
| | - Bonnie L. Dao
- Los Angeles County Department of Public Health, Los Angeles, California
| | - Marita Santos
- Los Angeles County Department of Public Health, Los Angeles, California
| | - Mirna P. Jewell
- Los Angeles County Department of Public Health, Los Angeles, California
| | | | | | - Dawn M. Terashita
- Los Angeles County Department of Public Health, Los Angeles, California
| | - Sharon E. Balter
- Los Angeles County Department of Public Health, Los Angeles, California
| | - Prabhu Gounder
- Los Angeles County Department of Public Health, Los Angeles, California
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Pinheiro PS, Jones PD, Medina H, Cranford HM, Koru-Sengul T, Bungum T, Wong R, Kobetz EN, McGlynn KA. Incidence of Etiology-specific Hepatocellular Carcinoma: Diverging Trends and Significant Heterogeneity by Race and Ethnicity. Clin Gastroenterol Hepatol 2024; 22:562-571.e8. [PMID: 37678486 PMCID: PMC10915102 DOI: 10.1016/j.cgh.2023.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/16/2023] [Accepted: 08/06/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND & AIMS The main causes of hepatocellular carcinoma (HCC) include chronic hepatitis C and B viral infections (HCV, HBV), nonalcoholic fatty liver disease (NAFLD), and alcohol-related disease (ALD). Etiology-specific HCC incidence rates and temporal trends on a population-basis are needed to improve HCC control and prevention. METHODS All 14,420 HCC cases from the Florida statewide cancer registry were individually linked to data from the hospital discharge agency and the viral hepatitis department to determine the predominant etiology of each case diagnosed during 2010 to 2018. Age-adjusted incidence rates (AAIRs) were used to assess the intersection between etiology and detailed race-ethnicity. Etiology-specific temporal trends based on diagnosis year were assessed using Joinpoint regression. RESULTS HCV remains the leading cause of HCC among men, but since 2017 NAFLD-HCC is the leading cause among women. HCV-HCC AAIRs are particularly high among U.S.-born minority men, including Puerto Rican (10.9 per 100,000), African American (8.0 per 100,000), and U.S.-born Mexican American men (7.6 per 100,000). NAFLD is more common among all Hispanics and Filipinos and HBV-HCC among Asian and Haitian black men. HCV-HCC surpasses HBV-HCC in Asian women. ALD-HCC is high among specific Hispanic male groups. Population-based HCV-HCC rates experienced a rapid decline since 2015 (-9.6% annually), whereas ALD-HCC (+6.0%) and NAFLD-HCC (+4.3%) are rising (P < .05). CONCLUSIONS New direct acting anti-viral drugs have impacted rates of HCV-HCC, offsetting important increases in both ALD- and NAFLD-HCC. Hispanics may be a group of concern because of higher rates for ALD- and NAFLD-HCC. HCC etiology varies remarkably and may warrant specific interventions by detailed race-ethnicity.
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Affiliation(s)
- Paulo S Pinheiro
- Division of Epidemiology & Population Health Sciences, Department of Public Health Sciences, University of Miami School of Medicine, Miami, Florida.
| | - Patricia D Jones
- Division of Hepatology, Department of Medicine, University of Miami School of Medicine, Miami, Florida
| | - Heidy Medina
- Division of Epidemiology & Population Health Sciences, Department of Public Health Sciences, University of Miami School of Medicine, Miami, Florida
| | - Hannah M Cranford
- Division of Epidemiology & Population Health Sciences, Department of Public Health Sciences, University of Miami School of Medicine, Miami, Florida
| | - Tulay Koru-Sengul
- Division of Biostatistics, Department of Public Health Sciences, University of Miami School of Medicine, Miami, Florida
| | - Tim Bungum
- School of Public Health, University of Nevada Las Vegas, Las Vegas, Nevada
| | - Robert Wong
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California
| | - Erin N Kobetz
- Department of Medicine, University of Miami School of Medicine, Miami, Florida
| | - Katherine A McGlynn
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
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7
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Bertisch B, Schaetti C, Schmid P, Peter L, Vernazza P, Isler M, Oppliger R, Schmidt AJ. Chronic hepatitis C virus infections in Switzerland in 2020: Lower than expected and suggesting achievement of WHO elimination targets. J Viral Hepat 2023; 30:667-684. [PMID: 37278311 DOI: 10.1111/jvh.13842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 02/27/2023] [Accepted: 05/06/2023] [Indexed: 06/07/2023]
Abstract
In this multi-method study, we investigated the prevalence of chronic infections with the hepatitis C virus (HCV) in Switzerland in 2020, and assessed Switzerland's progress in eliminating HCV as a public health problem by 2030 with regard to the World Health Organization (WHO) criteria targeting infections acquired during the preceding year ('new transmissions') and HCV-associated mortality. Based on a systematic literature review, the reappraisal of a 2015 prevalence analysis assuming 0.5% prevalence among the Swiss population and data from many additional sources, we estimated the prevalence among subpopulations at increased risk and the general population. For new transmissions, we evaluated mandatory HCV notification data and estimated unreported new transmissions based on subpopulation characteristics. For the mortality estimate, we re-evaluated a previous mortality estimate 1995-2014 based on new data on comorbidities and age. We found a prevalence of ≤0.1% among the Swiss population. Discrepancies to the 2015 estimate were explained by previous (i) underestimation of sustained virologic response numbers, (ii) overestimation of HCV prevalence among PWID following bias towards subgroups at highest risk, (iii) overestimation of HCV prevalence among the general population from inclusion of high-risk persons and (iv) underestimation of spontaneous clearance and mortality. Our results suggest that the WHO elimination targets have been met 10 years earlier than previously foreseen. These advancements were made possible by Switzerland's outstanding role in harm-reduction programmes, the longstanding micro-elimination efforts concerning HIV-infected MSM and nosocomial transmissions, little immigration from high-prevalence countries except Italian-born persons born before 1953, and wealth of data and funding.
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Affiliation(s)
- Barbara Bertisch
- Checkin Zollhaus, Zürich, Switzerland
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Christian Schaetti
- Communicable Diseases Division, Federal Office of Public Health, Bern, Switzerland
| | - Patrick Schmid
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Laura Peter
- Department of International Relations, London School of Economics and Political Science, London, UK
| | | | | | | | - Axel Jeremias Schmidt
- Communicable Diseases Division, Federal Office of Public Health, Bern, Switzerland
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
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Moore MS, Bocour A. Association Between Time to First RNA-Negative Test Result Among People With Hepatitis C Virus Infection and Homelessness or Testing at a Correctional or Substance Use Treatment Facility, New York City. Public Health Rep 2022; 137:1126-1135. [PMID: 34694921 PMCID: PMC9574298 DOI: 10.1177/00333549211049263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Curative treatments for hepatitis C virus (HCV) infection are available, but access and barriers to treatment can delay initiation. We investigated the time to first negative RNA test result among people with HCV infection and examined differences by homeless status and whether people were tested at a correctional facility or substance use treatment facility. METHODS We used surveillance data to identify New York City residents first reported with HCV infection during January 1, 2015-December 31, 2018, with ≥1 positive RNA test result during January 1, 2015-November 1, 2019. We used Kaplan-Meier survival analysis to determine the time from the first positive RNA test result to the first negative RNA test result, with right-censoring at date of death or November 1, 2019. We determined substance use treatment, incarceration, or homelessness by ordering facility name and address or from patient residential address. RESULTS Of 13 952 people with an HCV RNA-positive test result first reported during 2015-2018, 6947 (49.8%) subsequently received an RNA-negative test result. Overall, 25% received an RNA-negative test result within 208 (95% CI, 200-216) days and 50% within 902 (95% CI, 841-966) days. Homelessness, incarceration, or substance use treatment was indicated for 4304 (30.9%) people, among whom 25% received an RNA-negative test result within 469 (95% CI, 427-520) days and <50% received an RNA-negative test result during the study period. CONCLUSIONS Efforts to connect people to treatment should occur soon after diagnosis, especially for people who could benefit from hepatitis C care coordination.
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Affiliation(s)
- Miranda S. Moore
- Viral Hepatitis Program, Bureau of Communicable Disease, New York City Department of Health and Mental Hygiene, Queens, NY, USA
| | - Angelica Bocour
- Viral Hepatitis Program, Bureau of Communicable Disease, New York City Department of Health and Mental Hygiene, Queens, NY, USA
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Chen B, Gao LY, Ma ZH, Chang H, Pei LJ, Zhou Q, Xing WG. The signal-to-cutoff ratios to predict HCV infection among people who inject drugs. Virusdisease 2022; 33:363-370. [PMID: 36278030 PMCID: PMC9579682 DOI: 10.1007/s13337-022-00797-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 10/03/2022] [Indexed: 11/22/2022] Open
Abstract
People who inject drugs (PWIDs) are primarily the high-risk population for HCV infection. This study aims to determine the optimal cut-off values for predicting HCV infection status based on the Signal-to-Cutoff (S/CO) ratio. In this study, a total of 719 PWIDs’ samples were collected, and performed for screening test by ELISA assay, and followed by RIBA assay and NAT assay to detect HCV antibody and HCV RNA levels, respectively. The findings revealed that the prevalence of HCV infection among PWIDs was 54.66% (393/719), and the false-positive rate of HCV antibody detection by ELISA assay among PWIDs was only 3.85% (16/416). In addition, when the optimal cut-off value for S/CO ratio was 2.0, the sensitivity and specificity of HCV antibody were 100.00% and 93.55%, respectively. And when the optimal cut-off value for S/CO ratio was 21.36, the sensitivity and specificity of HCV RNA positive were 89.90% and 72.73%, respectively. In conclusion, the status of HCV infection can be predicted based on the S/CO ratios of the ELISA assay, which can improve diagnosis and facilitate timely treatment to effectively prevent the spread of HCV infection.
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10
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Smith CM, Kennedy JL, Evans ME, Person MK, Haverkate R, Apostolou A. Mental Illness in Adults With HIV and HCV Infection: Indian Health Service, 2001-2020. Am J Prev Med 2022; 63:e77-e86. [PMID: 35589441 PMCID: PMC9887638 DOI: 10.1016/j.amepre.2022.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/20/2022] [Accepted: 03/21/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Mental health disorders (MHDs) and substance use disorders (SUDs) in people living with HIV, hepatitis C virus (HCV) infection, and HIV/HCV coinfection are common and result in significant morbidity. However, there are no national prevalence estimates of these comorbidities in American Indian and Alaska Native (AI/AN) adults with HIV, HCV infection, or HIV/HCV coinfection. This study estimates the prevalence of MHD and SUD diagnoses in AI/AN adults diagnosed with HIV, HCV infection, or HIV/HCV coinfection within the Indian Health Service (IHS). METHODS In 2021, a cross-sectional study using data from the National Patient Information Reporting System was completed to identify MHD or SUD diagnoses in AI/AN adults with HIV, HCV infection, or HIV/HCV coinfection within the IHS during fiscal years 2001‒2020. Logistic regression was used to compare the odds of MHD or SUD diagnoses, adjusting for age and sex. RESULTS Of AI/AN adults diagnosed with HIV, hepatitis C virus infection, or HIV/HCV coinfection, the period prevalence of MHD or SUD diagnoses ranged from 57.2% to 81.1%. Adjusting for age and sex, individuals with HCV infection had higher odds of receiving a MHD diagnosis (AOR=1.57; 95% CI=1.47, 1.68) or SUD diagnosis (AOR=3.40; 95% CI=3.18, 3.65) than those with HIV, and individuals with HIV/HCV coinfection had higher odds of receiving a MHD diagnosis (AOR=1.60; 95% CI=1.35, 1.89) or SUD diagnosis (AOR=2.81; 95% CI=2.32, 3.41) than those with HIV. CONCLUSIONS MHD and SUD diagnoses were common in AI/AN adults diagnosed with HIV, HCV infection, or HIV/HCV coinfection, highlighting the need for culturally appropriate screening and treatment programs sensitive to the diverse strengths of AI/AN populations and structural challenges they endure.
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Affiliation(s)
- Colin M Smith
- Department of Medicine, Duke University Medical Center, Durham, North Carolina; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina; Indian Health Service, Rockville, Maryland.
| | - Jordan L Kennedy
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mary E Evans
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Marissa K Person
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
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11
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Wingate H, Sizemore L, Black J, Heth Z, Talley P, Patrick SW, Wester C. Using Public Health Surveillance Data to Determine Hepatitis C Virus Exposure Among Live-Born Infants in Tennessee, 2013-2017. Public Health Rep 2022; 137:860-866. [PMID: 34404285 PMCID: PMC9379847 DOI: 10.1177/00333549211035854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2021] [Indexed: 12/09/2022] Open
Abstract
OBJECTIVE Maternal hepatitis C virus (HCV) infection reported on birth certificates has been shown to underestimate HCV infection. We sought to determine the usefulness of HCV surveillance data for (1) quantifying the number of HCV-positive reproductive-aged women with a live birth, (2) comparing maternal HCV surveillance data with reported HCV infection status on birth certificates, and (3) delineating past versus current maternal infection to identify true perinatal exposures. METHODS We extracted data from January 1, 2013, through December 31, 2017, on birth certificate indication of HCV exposure from the Tennessee Birth Statistical File, and we ascertained indication of HCV exposure by using laboratory data from the Tennessee National Electronic Disease Surveillance System (NEDSS) Base System (NBS). We conducted a sensitivity analysis comparing birth certificate indication of HCV exposure with HCV laboratory data to determine whether true perinatal exposure had occurred. RESULTS During the study period, 6731 mothers with live births in Tennessee reported having HCV infection during pregnancy: 3295 (49.0%) had both laboratory and birth certificate indication of HCV infection, 2130 (31.6%) had indication of HCV infection on the laboratory report only, and 1306 (19.4%) had indication of HCV infection on the birth certificate only. CONCLUSIONS Using data from a public health HCV surveillance system with birth certificate data may improve the identification of HCV-infected pregnant women and perinatally exposed infants. Surveillance systems that include complete reporting of all HCV RNA results can be used to distinguish past from present maternal HCV infection to focus limited public health resources on currently infected mothers and their exposed infants.
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Affiliation(s)
- Heather Wingate
- HIV/STD/Viral Hepatitis Section, Division of Communicable and
Environmental Disease and Emergency Preparedness, Tennessee Department of Health,
Nashville, TN, USA
| | - Lindsey Sizemore
- HIV/STD/Viral Hepatitis Section, Division of Communicable and
Environmental Disease and Emergency Preparedness, Tennessee Department of Health,
Nashville, TN, USA
| | - Jennifer Black
- HIV/STD/Viral Hepatitis Section, Division of Communicable and
Environmental Disease and Emergency Preparedness, Tennessee Department of Health,
Nashville, TN, USA
| | - Zachary Heth
- HIV/STD/Viral Hepatitis Section, Division of Communicable and
Environmental Disease and Emergency Preparedness, Tennessee Department of Health,
Nashville, TN, USA
| | - Pamela Talley
- HIV/STD/Viral Hepatitis Section, Division of Communicable and
Environmental Disease and Emergency Preparedness, Tennessee Department of Health,
Nashville, TN, USA
| | - Stephen W. Patrick
- Vanderbilt Center for Child Health Policy, Departments of
Pediatrics and Health Policy, Vanderbilt University Medical Center, Nashville, TN,
USA
| | - Carolyn Wester
- HIV/STD/Viral Hepatitis Section, Division of Communicable and
Environmental Disease and Emergency Preparedness, Tennessee Department of Health,
Nashville, TN, USA
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Facente SN, Grinstein R, Bruhn R, Kaidarova Z, Wilson E, Hecht J, Burk K, Grebe E, Morris MD. Hepatitis C prevalence and key population size estimate updates in San Francisco: 2015 to 2019. PLoS One 2022; 17:e0267902. [PMID: 35544483 PMCID: PMC9094540 DOI: 10.1371/journal.pone.0267902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 04/18/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND In 2017, San Francisco's initiative to locally eliminate hepatitis C virus (HCV) as a public health threat, End Hep C SF, generated an estimate of city-wide HCV prevalence in 2015, but only incorporated limited information about population HCV treatment. Using additional data and updated methods, we aimed to update the 2015 estimate to 2019 and provide a more accurate estimate of the number of people with untreated, active HCV infection overall and in key subgroups-people who inject drugs (PWID), men who have sex with men (MSM), and low socioeconomic status transgender women (low SES TW). METHODS Our estimates are based on triangulation of data from blood bank testing records, cross-sectional and longitudinal observational studies, and published literature. We calculated subpopulation estimates based on biological sex, age and/or HCV risk group. When multiple sources of data were available for subpopulation estimates, we calculated an average using inverse variance weighting. Plausible ranges (PRs) were conservatively estimated to convey uncertainty. RESULTS The total number of people estimated to have anti-HCV antibodies in San Francisco in 2019 was 22,585 (PR:12,014-44,152), with a citywide seroprevalence of 2.6% (PR:1.4%-5.0%)-similar to the 2015 estimate of 21,758 (PR:10,274-42,067). Of all people with evidence of past or present infection, an estimated 11,582 (PR:4,864-35,094) still had untreated, active HCV infection, representing 51.3% (PR:40.5%-79.5%) of all people with anti-HCV antibodies, and 1.3% (PR:0.6%-4.0%) of all San Franciscans. PWID comprised an estimated 2.8% of the total population of San Francisco, yet 73.1% of people with anti-HCV antibodies and 90.4% (n = 10,468, PR:4,690-17,628) of untreated, active HCV infections were among PWID. MSM comprised 7.8% of the total population, yet 11.7% of people with anti-HCV antibodies and 1.0% (n = 119, PR:0-423) of those with untreated active infections. Low SES TW comprised an estimated 0.1% of the total population, yet 1.4% of people with HCV antibodies and 1.6% (n = 183, PR:130-252) of people with untreated active infections. CONCLUSIONS Despite the above-average number (2.6%) of people with anti-HCV antibodies, we estimate that only 1.3% (PR:0.6%-4.0%) of all San Francisco residents have untreated, active HCV infection-likely a reflection of San Francisco's robust efforts to diagnose infection among high-risk groups and initiate curative treatment with as many people as possible. While plausible ranges of infections are wide, these findings indicate that while the overall number of people with anti-HCV antibodies may have increased slightly, the number of people with active HCV infection may have decreased slightly since 2015. This estimate improves upon the 2015 calculations by directly estimating the impact of curative treatment citywide and in subgroups. However, more research is needed to better understand the burden of HCV disease among other subgroups at high risk, such as Blacks/African Americans, people with a history of injection drug use (but not injecting drugs in the last 12 months), people who are currently or formerly incarcerated, and people who are currently or formerly unhoused.
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Affiliation(s)
- Shelley N. Facente
- Facente Consulting, Richmond, CA, United States of America
- Vitalant Research Institute, San Francisco, CA, United States of America
| | - Rachel Grinstein
- San Francisco Department of Public Health, San Francisco, CA, United States of America
| | - Roberta Bruhn
- Vitalant Research Institute, San Francisco, CA, United States of America
| | - Zhanna Kaidarova
- Vitalant Research Institute, San Francisco, CA, United States of America
| | - Erin Wilson
- San Francisco Department of Public Health, San Francisco, CA, United States of America
| | - Jennifer Hecht
- San Francisco AIDS Foundation, San Francisco, CA, United States of America
- Springboard HealthLab, Berkeley, CA, United States of America
| | - Katie Burk
- Facente Consulting, Richmond, CA, United States of America
- San Francisco Department of Public Health, San Francisco, CA, United States of America
| | - Eduard Grebe
- Vitalant Research Institute, San Francisco, CA, United States of America
- University of California, San Francisco, San Francisco, CA, United States of America
- South African Centre for Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
| | - Meghan D. Morris
- University of California, San Francisco, San Francisco, CA, United States of America
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Moradi G, Soheili M, Rashti R, Dehghanbanadaki H, Nouri E, Zakaryaei F, Amini EE, Baiezeedi S, Ahmadi S, Moradi Y. The prevalence of hepatitis C and hepatitis B in lesbian, gay, bisexual and transgender populations: a systematic review and meta-analysis. Eur J Med Res 2022; 27:47. [PMID: 35346371 PMCID: PMC8962539 DOI: 10.1186/s40001-022-00677-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 03/14/2022] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES This study aimed to systematically review the literature on the prevalence of hepatitis C virus (HCV) and hepatitis B virus (HBV) infections in transgender and LGBT people and determine their pooled estimates worldwide. METHODS Databases (PubMed, Scopus, Web of Science, Embase, Ovid, Cochrane, PsycInfo) were searched from April 2000 to July 2021. The analyses were executed using the random-effects model in Stata 16. RESULTS Ten studies, including eight studies on four transgender people and two studies on 2150 LGBTs, were included. The pooled prevalence of HCV and HBV in all transgender populations globally were 9% (95% CI 3-15%) and 11% (95% CI 2-20%), respectively. The corresponding prevalence in male-to-female transgender people were estimated as 5% (95% CI 1-9%) and 6% (95% CI 3-10%), respectively. These estimates in American transgenders were 10% (95% CI 5-25%) and 16% (95% CI 8-23%), respectively. CONCLUSION This study was identified the overall prevalence of HBV and HCV infections in transgender people, which were higher than those in the general population.
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Affiliation(s)
- Ghobad Moradi
- Social Determinant of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, 6617713446 Sanandaj, Iran
| | - Marzieh Soheili
- Faculty of Medicine, Kermanshah University of Medical Sciences, 6714415153 Kermanshah, Iran
| | - Roya Rashti
- Social Determinant of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, 6617713446 Sanandaj, Iran
| | - Hojat Dehghanbanadaki
- Endocrinology, and Metabolism Research Centre, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, 1416753955 Tehran, Iran
| | - Elham Nouri
- Social Determinant of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, 6617713446 Sanandaj, Iran
| | - Farima Zakaryaei
- Department of Emergency Medicine, Kurdistan University of Medical Sciences, 6617713446 Sanandaj, Iran
| | - Elnaz Ezzati Amini
- Social Determinant of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, 6617713446 Sanandaj, Iran
| | - Sheno Baiezeedi
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, 1449614535 Tehran, Iran
| | - Sanaz Ahmadi
- Social Determinant of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, 6617713446 Sanandaj, Iran
| | - Yousef Moradi
- Social Determinant of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, 6617713446 Sanandaj, Iran
- Department of Epidemiology and Biostatistics, Faculty of Medicine, Kurdistan University of Medical Sciences, 6617713446 Sanandaj, Iran
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Universal screening for hepatitis C - in for a penny, in for a pound. Eur J Clin Microbiol Infect Dis 2022; 41:341-347. [PMID: 35022892 DOI: 10.1007/s10096-021-04395-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 12/06/2021] [Indexed: 12/09/2022]
Abstract
Infection with hepatitis C virus (HCV) is a major public health problem. In fact, chronic HCV is a leading cause of cirrhosis, hepatocellular carcinoma, and death from liver disease in most countries. The advent of highly effective oral direct-acting antiviral therapy is the most significant advance in the treatment of HCV in decades and now allows us to cure chronic HCV. However, a large number of infected patients have not been diagnosed since hepatitis C is a largely asymptomatic disease. Thus, it is fundamental to improve the screening system in order to identify individuals who are currently infected and to treat them. Risk-based hepatitis C testing and birth cohort screening have had limited success and many patients living with the infection are not aware of their status. Universal screening for HCV is a tremendous improvement compared with the previous strategies. Indeed, global screening leads to the appropriate identification and treatment of all individuals chronically infected with HCV and prevents the progression of liver disease and the associated morbidity and mortality. In addition, universal HCV testing appears to be cost-effective. In this article, we review the current barriers to HCV eradication and the different strategies for HCV infection screening.
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Kermani FR, Hosseini KM, Kafi-Abad SA, Maghsudlu M, Sharifi Z, Mansournia MA. Quantification of hepatitis C virus in viremic blood donors in Iran: Need to reinforce post-donation follow up. Transfus Apher Sci 2022; 61:103353. [DOI: 10.1016/j.transci.2022.103353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/29/2021] [Accepted: 01/10/2022] [Indexed: 10/19/2022]
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16
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Kaufman HW, Bull-Otterson L, Meyer WA, Huang X, Doshani M, Thompson WW, Osinubi A, Khan MA, Harris AM, Gupta N, Van Handel M, Wester C, Mermin J, Nelson NP. Decreases in Hepatitis C Testing and Treatment During the COVID-19 Pandemic. Am J Prev Med 2021; 61:369-376. [PMID: 34088556 PMCID: PMC8107198 DOI: 10.1016/j.amepre.2021.03.011] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 03/10/2021] [Accepted: 03/12/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The COVID-19 pandemic has disrupted healthcare services, reducing opportunities to conduct routine hepatitis C virus antibody screening, clinical care, and treatment. Therefore, people living with undiagnosed hepatitis C virus during the pandemic may later become identified at more advanced stages of the disease, leading to higher morbidity and mortality rates. Further, unidentified hepatitis C virus-infected individuals may continue to unknowingly transmit the virus to others. METHODS To assess the impact of the COVID-19 pandemic, data were evaluated from a large national reference clinical laboratory and from national estimates of dispensed prescriptions for hepatitis C virus treatment. Investigators estimated the average number of hepatitis C virus antibody tests, hepatitis C virus antibody-positive test results, and hepatitis C virus RNA-positive test results by month in January-July for 2018 and 2019, compared with the same months in 2020. To assess the impact of hepatitis C virus treatment, dispensed hepatitis C virus direct-acting antiretroviral medications were examined for the same time periods. Statistical analyses of trends were performed using negative binomial models. RESULTS Compared with the 2018 and 2019 months, hepatitis C virus antibody testing volume decreased 59% during April 2020 and rebounded to a 6% reduction in July 2020. The number of hepatitis C virus RNA-positive results fell by 62% in March 2020 and remained 39% below the baseline by July 2020. For hepatitis C virus treatment, prescriptions decreased 43% in May, 37% in June, and 38% in July relative to the corresponding months in 2018 and 2019. CONCLUSIONS During the COVID-19 pandemic, continued public health messaging, interventions and outreach programs to restore hepatitis C virus testing and treatment to prepandemic levels, and maintenance of public health efforts to eliminate hepatitis C infections remain important.
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Affiliation(s)
| | - Lara Bull-Otterson
- Division of Health Informatics and Surveillance, Center for Surveillance, Epidemiology, and Laboratory Services, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Mona Doshani
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - William W Thompson
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ademola Osinubi
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mohammed A Khan
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Aaron M Harris
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Neil Gupta
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michelle Van Handel
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Carolyn Wester
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jonathan Mermin
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Noele P Nelson
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
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Nikiforuk AM, Karim ME, Patrick DM, Jassem AN. Influence of chronic hepatitis C infection on the monocyte-to-platelet ratio: data analysis from the National Health and Nutrition Examination Survey (2009-2016). BMC Public Health 2021; 21:1388. [PMID: 34256707 PMCID: PMC8278694 DOI: 10.1186/s12889-021-11267-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 06/09/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) causes life-threatening chronic infections. Implementation of novel, economical or widely available screening tools can help detect unidentified cases and facilitate their linkage to care. We investigated the relationship between chronic HCV infection and a potential complete blood count biomarker (the monocyte-to-platelet ratio) in the United States. METHODS The analytic dataset was selected from cycle years 2009-2016 of the National Health and Nutrition Examination Survey. Complete case data- with no missingness- was available for n = 5281 observations, one-hundred and twenty-two (n = 122) of which were exposed to chronic HCV. The primary analysis used survey-weighted logistic regression to model the effect of chronic HCV on the monocyte-to-platelet ratio adjusting for demographic and biological confounders in a causal inference framework. Missing data and propensity score methods were respectively performed as a secondary and sensitivity analysis. RESULTS In the analytic dataset, outcome data was available for n = 5281 (n = 64,245,530 in the weighted sample) observations of which n = 122 (n = 1,067,882 in the weighted sample) tested nucleic acid positive for HCV. Those exposed to chronic HCV infection in the United States have 3.10 times the odds of a high monocyte-to-platelet ratio than those not exposed (OR = 3.10, [95% CI: 1.55-6.18]). CONCLUSION A relationship exists between chronic HCV infection and the monocyte-to-platelet ratio in the general population of the United States. Reversing the direction of this association to predict chronic HCV infection from complete blood counts, could provide an economically feasible and universal screening tool, which would help link patients with care.
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Affiliation(s)
- Aidan M Nikiforuk
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, V6T 1Z4, Canada
- British Columbia Centre for Disease Control Public Health Laboratory, Virology, Provincial Health Services Authority, Vancouver, British Columbia, V5Z 4R4, Canada
| | - Mohammad Ehsanul Karim
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, V6T 1Z4, Canada
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care, Vancouver, British Columbia, V6Z 1Y6, Canada
| | - David M Patrick
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, V6T 1Z4, Canada
- British Columbia Centre for Disease Control, Communicable Diseases and Immunization Services, Provincial Health Services Authority, Vancouver, British Columbia, V5Z 4R4, Canada
| | - Agatha N Jassem
- British Columbia Centre for Disease Control Public Health Laboratory, Virology, Provincial Health Services Authority, Vancouver, British Columbia, V5Z 4R4, Canada.
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, V6T 1Z4, Canada.
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Koepke R, Akhtar WZ, Kung VM, Seal DW, Salisbury-Afshar E, Westergaard RP. Hepatitis C Treatment Knowledge and Practice Among Family Medicine Physicians in Wisconsin During the Current Hepatitis C Epidemic. WMJ : OFFICIAL PUBLICATION OF THE STATE MEDICAL SOCIETY OF WISCONSIN 2021; 120:106-113. [PMID: 34255949 PMCID: PMC9595867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Curative treatment for hepatitis C virus (HCV) exists, making elimination of HCV possible. However, most people with HCV have not received treatment. One barrier is limited access to treatment providers. HCV treatment can be effectively provided by primary care providers and, since 2017, Wisconsin Medicaid allows nonspecialists to prescribe treatment. We surveyed family medicine physicians in Wisconsin to evaluate capacity for the provision of HCV treatment. METHODS We mailed a survey to family medicine physicians in Wisconsin from June 25, 2018 through September 7, 2018. Physicians were asked whether they prescribe HCV treatment and about their knowledge regarding HCV treatment and relevant statewide Medicaid policy. Using multivariable logistic regression, we evaluated physician characteristics associated with prescribing HCV treatment. RESULTS Of 1,333 physicians surveyed, 600 (45%) responded. Few respondents reported prescribing HCV treatment independently (1%; n = 4) or in consultation with a specialist (6%; n = 35). Only 6% (n = 36) reported having a "great deal" of knowledge about HCV treatment. Most (86%; n = 515) were not aware that family medicine physicians can now prescribe HCV treatment covered by Medicaid. Physicians who practiced in offices affiliated with health systems were less likely to prescribe HCV treatment than physicians who practiced in an independent office or a Rural Health Clinic. CONCLUSIONS Among family medicine physicians in Wisconsin, experience with and knowledge of HCV treatment was limited. Developing knowledge and skills among primary care providers is needed to expand treatment access and make progress toward HCV elimination. Studies are needed to evaluate treatment access in primary care offices affiliated with health systems.
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Affiliation(s)
- Ruth Koepke
- Wisconsin Department of Health Services, Madison, WI, USA,University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Wajiha Z Akhtar
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Vanessa M. Kung
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - David W. Seal
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | | | - Ryan P. Westergaard
- Wisconsin Department of Health Services, Madison, WI, USA,University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Park JS, Wong J, Cohen H. Hepatitis C virus screening of high-risk patients in a community hospital emergency department: Retrospective review of patient characteristics and future implications. PLoS One 2021; 16:e0252976. [PMID: 34111200 PMCID: PMC8191914 DOI: 10.1371/journal.pone.0252976] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 05/26/2021] [Indexed: 11/19/2022] Open
Abstract
Background Chronic hepatitis C virus infection (HCV) is a common infectious disease that affects more than 2.7 million people in the US. Because the emergency department (ED) can present an ideal opportunity to screen patients who may not otherwise get routine screening, we implemented a risk-based screening program for ED patients and established a system to facilitate linkage to care. Methods and findings A risk-based screening algorithm for HCV was programmed to trigger an alert in Epic electronic medical record system. Patients identified between August 2018 and April 2020 in the ED were tested for HCV antibody reflex to HCV RNA. Patients with a positive screening test were contacted for the confirmatory test result and to establish medical care for HCV treatment. Patient characteristics including age, sex, self-awareness of HCV infection, history of previous HCV treatment, history of opioids use, history of tobacco use, and types of insurance were obtained. A total of 4,525 patients underwent a screening test, of whom 131 patients (2.90%) were HCV antibody positive and 43 patients (0.95%) were HCV RNA positive, indicating that only 33% of patients with positive screening test had chronic HCV infection. The rate of chronic infection was higher in males as compared to females (1.34% vs 0.60%, p = 0.01). Patients with history of opioid use or history of tobacco use were found to have a lower rate of spontaneous clearance than patients without each history (opioids: 48.6% vs 72.0%, p = 0.02; tobacco: 56.6% vs 80.5%, p = 0.01). Among 43 patients who were diagnosed with chronic hepatitis C, 26 were linked to a clinical setting that can address chronic HCV infection, with linkage to care rate of 60.5%. The most common barrier to this was inability to contact patients after discharge from the ED. Conclusions A streamlined EMR system for HCV screening and subsequent linkage to care from the ED can be successfully implemented. A retrospective review suggests that male sex is related to chronic HCV infection, and history of opioid use or history of tobacco use is related to lower HCV spontaneous clearance.
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Affiliation(s)
- Ji Seok Park
- Department of Gastroenterology, Hepatology and Clinical Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
- Department of Internal Medicine, Englewood Health, Englewood, New Jersey, United States of America
- * E-mail:
| | - Judy Wong
- Department of Emergency Medicine, Englewood Health, Englewood, New Jersey, United States of America
| | - Hillary Cohen
- Department of Emergency Medicine, Englewood Health, Englewood, New Jersey, United States of America
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Holtzman D, Asher AK, Schillie S. The Changing Epidemiology of Hepatitis C Virus Infection in the United States During the Years 2010 to 2018. Am J Public Health 2021; 111:949-955. [PMID: 33734844 PMCID: PMC8034015 DOI: 10.2105/ajph.2020.306149] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Hepatitis C virus (HCV) infection remains an important cause of morbidity and mortality throughout the world, leading to serious health problems among those who are chronically infected. Since 1992, the Centers for Disease Control and Prevention has been collecting data on the incidence of HCV infection in the United States. In 2018, more than 50 000 individuals were estimated to have acute HCV infection.The most recently reported data on the prevalence of infection indicate that approximately 2.4 million people are living with hepatitis C in the United States. Transmission of HCV occurs predominantly through sharing contaminated equipment for injecting drugs.Two major events have had a significant impact on the incidence and prevalence of hepatitis C in the past few decades: the US opioid crisis and the discovery of curative treatments for HCV infection. To better understand the impact of these events, we examine reported trends in the incidence and prevalence of infection.
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Affiliation(s)
- Deborah Holtzman
- Deborah Holtzman was previously with the Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA. She was retired at the time the study was undertaken and the article was prepared. Alice K. Asher is with the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC. At the time of the study, Sarah Schillie was with the Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC. Note. The contents of this report on behalf of authors A. K. Asher and S. Schillie do not necessarily represent the official views of the CDC
| | - Alice K Asher
- Deborah Holtzman was previously with the Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA. She was retired at the time the study was undertaken and the article was prepared. Alice K. Asher is with the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC. At the time of the study, Sarah Schillie was with the Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC. Note. The contents of this report on behalf of authors A. K. Asher and S. Schillie do not necessarily represent the official views of the CDC
| | - Sarah Schillie
- Deborah Holtzman was previously with the Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA. She was retired at the time the study was undertaken and the article was prepared. Alice K. Asher is with the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC. At the time of the study, Sarah Schillie was with the Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC. Note. The contents of this report on behalf of authors A. K. Asher and S. Schillie do not necessarily represent the official views of the CDC
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Icer Baykal PB, Lara J, Khudyakov Y, Zelikovsky A, Skums P. Quantitative differences between intra-host HCV populations from persons with recently established and persistent infections. Virus Evol 2020; 7:veaa103. [PMID: 33505710 PMCID: PMC7816669 DOI: 10.1093/ve/veaa103] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Detection of incident hepatitis C virus (HCV) infections is crucial for identification of outbreaks and development of public health interventions. However, there is no single diagnostic assay for distinguishing recent and persistent HCV infections. HCV exists in each infected host as a heterogeneous population of genomic variants, whose evolutionary dynamics remain incompletely understood. Genetic analysis of such viral populations can be applied to the detection of incident HCV infections and used to understand intra-host viral evolution. We studied intra-host HCV populations sampled using next-generation sequencing from 98 recently and 256 persistently infected individuals. Genetic structure of the populations was evaluated using 245,878 viral sequences from these individuals and a set of selected features measuring their diversity, topological structure, complexity, strength of selection, epistasis, evolutionary dynamics, and physico-chemical properties. Distributions of the viral population features differ significantly between recent and persistent infections. A general increase in viral genetic diversity from recent to persistent infections is frequently accompanied by decline in genomic complexity and increase in structuredness of the HCV population, likely reflecting a high level of intra-host adaptation at later stages of infection. Using these findings, we developed a machine learning classifier for the infection staging, which yielded a detection accuracy of 95.22 per cent, thus providing a higher accuracy than other genomic-based models. The detection of a strong association between several HCV genetic factors and stages of infection suggests that intra-host HCV population develops in a complex but regular and predictable manner in the course of infection. The proposed models may serve as a foundation of cyber-molecular assays for staging infection, which could potentially complement and/or substitute standard laboratory assays.
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Affiliation(s)
- Pelin B Icer Baykal
- Department of Computer Science, Georgia State University, 25 Park Place, Atlanta, GA 30302, USA
| | - James Lara
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA 30329, USA
| | - Yury Khudyakov
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA 30329, USA
| | - Alex Zelikovsky
- Department of Computer Science, Georgia State University, 25 Park Place, Atlanta, GA 30302, USA
| | - Pavel Skums
- Department of Computer Science, Georgia State University, 25 Park Place, Atlanta, GA 30302, USA
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Nontargeted Hepatitis C Screening in an Urban Emergency Department in New York City. J Emerg Med 2020; 60:299-309. [PMID: 33213988 DOI: 10.1016/j.jemermed.2020.09.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/18/2020] [Accepted: 09/12/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Previously the Centers for Disease Control and Prevention (CDC) recommended targeted hepatitis C virus (HCV) screening for adults born between 1945 and 1965 and individuals with HCV risk factors. In April 2020, the CDC updated their recommendations to now include all individuals 18 years of age and older in settings with HCV prevalence > 0.1%. Few emergency departments (EDs) currently employ this nontargeted screening approach. OBJECTIVES We examined how a shift from targeted to nontargeted screening might affect HCV case identification. We hypothesized that nontargeted screening could improve HCV case identification in our ED. METHODS Retrospective review of prospectively collected nontargeted screening data from June 6, 2018 to June 5, 2019 in a large urban academic ED. Patients 18 years of age and older, triaged to the adult or pediatric ED and able to provide consent for HCV testing, were eligible for study inclusion. RESULTS There were 83,864 ED visits and 40,282 unique patients deemed eligible for HCV testing. Testing occurred in 10,630 (26.4%) patients, of which 638 (6%) had positive HCV antibody (Ab+) tests and 214 (2%) had a positive viral load (VL+). Birth cohort-targeted screening would have identified 48% of the patients with Ab+ tests and 47% of those who were VL+. Risk-based targeted screening would increase the number of Ab+ patients to 67% and VL+ to 72%. CONCLUSIONS Nontargeted ED-based HCV screening can identify a large number of patients with HCV infection. A shift from targeted to nontargeted screening may result in fewer missed infections but requires further study.
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Javanbakht M, Archer R, Klausner J. Will prior health insurance authorization for medications continue to hinder hepatitis C treatment delivery in the United States? Perspectives from hepatitis C treatment providers in a large urban healthcare system. PLoS One 2020; 15:e0241615. [PMID: 33147293 PMCID: PMC7641373 DOI: 10.1371/journal.pone.0241615] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 10/16/2020] [Indexed: 12/13/2022] Open
Abstract
Background The recent introduction of direct acting antivirals for the treatment of hepatitis C virus (HCV) has dramatically improved treatment options for HCV infected patients. However, in the United States (US) treatment uptake has been low and time to initiation of therapy has been long. We sought to examine provider perspectives of facilitators and barriers to HCV treatment delivery. Methods From June to August 2019, we conducted in-depth, semi-structured interviews with medical staff providing HCV care as part of a university medical center in Los Angeles, CA. In order to understand the HCV treatment process, we interviewed key staff members providing care to the majority of HCV patients seeking care at the university medical center, including hepatologists and infectious disease specialists as well as key nursing and pharmacy staff. The interviews focused on workload and activities required for HCV treatment initiation for non-cirrhotic, treatment naïve patients. Results Providers noted that successful HCV treatment delivery was reliant on a care model involving close collaboration between a team of providers, in particular requiring a highly coordinated effort between dedicated nursing and pharmacy staff. The HCV care team overwhelmingly reported that the process of insurance authorization was the greatest obstacle delaying treatment initiation and noted that very few patient level factors served as a barrier to treatment uptake. Conclusions In the US, prior authorization for HCV treatment is a requirement for most public and private insurance plans. In an era with access to therapies that allow for a cure—and until revocation of prior authorization for HCV treatment is a reality—implementing strategies that can expedite authorization to accelerate treatment access are critical. Not only will this benefit patients, but it has the potential to help expand treatment to settings that are otherwise too resource strained to successfully deliver HCV care.
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Affiliation(s)
- Marjan Javanbakht
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, California, United States of America
- * E-mail:
| | - Roxanne Archer
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, California, United States of America
| | - Jeffrey Klausner
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, California, United States of America
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, California, United States of America
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Moorman AC, de Perio MA, Goldschmidt R, Chu C, Kuhar D, Henderson DK, Naggie S, Kamili S, Spradling PR, Gordon SC, Russi MB, Teshale EH. Testing and Clinical Management of Health Care Personnel Potentially Exposed to Hepatitis C Virus - CDC Guidance, United States, 2020. MMWR Recomm Rep 2020; 69:1-8. [PMID: 32701942 PMCID: PMC8631757 DOI: 10.15585/mmwr.rr6906a1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Exposure to hepatitis viruses is a recognized occupational risk for health care personnel (HCP). This report establishes new CDC guidance that includes recommendations for a testing algorithm and clinical management for HCP with potential occupational exposure to hepatitis C virus (HCV). Baseline testing of the source patient and HCP should be performed as soon as possible (preferably within 48 hours) after the exposure. A source patient refers to any person receiving health care services whose blood or other potentially infectious material is the source of the HCP's exposure. Two options are recommended for testing the source patient. The first option is to test the source patient with a nucleic acid test (NAT) for HCV RNA. This option is preferred, particularly if the source patient is known or suspected to have recent behaviors that increase risk for HCV acquisition (e.g., injection drug use within the previous 4 months) or if risk cannot be reliably assessed. The second option is to test the source patient for antibodies to hepatitis C virus (anti-HCV), then if positive, test for HCV RNA. For HCP, baseline testing for anti-HCV with reflex to a NAT for HCV RNA if positive should be conducted as soon as possible (preferably within 48 hours) after the exposure and may be simultaneous with source-patient testing. If follow-up testing is recommended based on the source patient's status (e.g., HCV RNA positive or anti-HCV positive with unavailable HCV RNA or if the HCV infection status is unknown), HCP should be tested with a NAT for HCV RNA at 3-6 weeks postexposure. If HCV RNA is negative at 3-6 weeks postexposure, a final test for anti-HCV at 4-6 months postexposure is recommended. A source patient or HCP found to be positive for HCV RNA should be referred to care. Postexposure prophylaxis of hepatitis C is not recommended for HCP who have occupational exposure to blood and other body fluids. This guidance was developed based on expert opinion (CDC. Updated U.S. Public Health Service guidelines for the management of occupational exposures to HBV, HCV, and HIV and recommendations for postexposure prophylaxis. MMWR Recommend Rep 2001;50[No. RR-11]; Supplementary Figure, https://stacks.cdc.gov/view/cdc/90288) and reflects updated guidance from professional organizations that recommend treatment for acute HCV infection. Health care providers can use this guidance to update their procedures for postexposure testing and clinical management of HCP potentially exposed to hepatitis C virus.
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Schillie S, Wester C, Osborne M, Wesolowski L, Ryerson AB. CDC Recommendations for Hepatitis C Screening Among Adults - United States, 2020. MMWR Recomm Rep 2020; 69:1-17. [PMID: 32271723 PMCID: PMC7147910 DOI: 10.15585/mmwr.rr6902a1] [Citation(s) in RCA: 306] [Impact Index Per Article: 76.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Hepatitis C virus (HCV) infection is a major source of morbidity and mortality in the United States. HCV is transmitted primarily through parenteral exposures to infectious blood or body fluids that contain blood, most commonly through injection drug use. No vaccine against hepatitis C exists and no effective pre- or postexposure prophylaxis is available. More than half of persons who become infected with HCV will develop chronic infection. Direct-acting antiviral treatment can result in a virologic cure in most persons with 8-12 weeks of all-oral medication regimens. This report augments (i.e., updates and summarizes) previously published recommendations from CDC regarding testing for HCV infection in the United States (Smith BD, Morgan RL, Beckett GA, et al. Recommendations for the identification of chronic hepatitis C virus infection among persons born during 1945-1965. MMWR Recomm Rec 2012;61[No. RR-4]). CDC is augmenting previous guidance with two new recommendations: 1) hepatitis C screening at least once in a lifetime for all adults aged ≥18 years, except in settings where the prevalence of HCV infection is <0.1% and 2) hepatitis C screening for all pregnant women during each pregnancy, except in settings where the prevalence of HCV infection is <0.1%. The recommendation for HCV testing that remains unchanged is regardless of age or setting prevalence, all persons with risk factors should be tested for hepatitis C, with periodic testing while risk factors persist. Any person who requests hepatitis C testing should receive it, regardless of disclosure of risk, because many persons might be reluctant to disclose stigmatizing risks.
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Affiliation(s)
- Sarah Schillie
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC
| | - Carolyn Wester
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC
| | - Melissa Osborne
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC
| | - Laura Wesolowski
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC
| | - A. Blythe Ryerson
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC
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Ryerson AB, Schillie S, Barker LK, Kupronis BA, Wester C. Vital Signs: Newly Reported Acute and Chronic Hepatitis C Cases - United States, 2009-2018. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2020; 69:399-404. [PMID: 32271725 PMCID: PMC7147907 DOI: 10.15585/mmwr.mm6914a2] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Introduction Hepatitis C is a leading cause of death from liver disease in the United States. Acute hepatitis C infection is often asymptomatic, and >50% of cases will progress to chronic infection, which can be life-threatening. Hepatitis C can be diagnosed with a blood test and is curable, yet new cases of this preventable disease are increasing. Methods National Notifiable Diseases Surveillance System data were analyzed to determine the rate of acute hepatitis C cases reported to CDC by age group and year during 2009–2018 and the number and rate of newly reported chronic cases in 2018 by sex and age. The proportion of adults aged ≥20 years with hepatitis C who reported having ever been told that they had hepatitis C was estimated with 2015–2018 National Health and Nutrition Examination Survey data. Results During 2018, a total of 3,621 cases of acute hepatitis C were reported, representing an estimated 50,300 cases (95% confidence interval [CI] = 39,800–171,600). The annual rate of reported acute hepatitis C cases per 100,000 population increased threefold, from 0.3 in 2009 to 1.2 in 2018, and was highest among persons aged 20–29 (3.1) and 30–39 years (2.6) in 2018. A bimodal distribution of newly reported chronic hepatitis C cases in 2018 was observed, with the highest proportions among persons aged 20–39 years and 50–69 years. Only 60.6% (95% CI = 46.1%–73.9%) of adults with hepatitis C reported having been told that they were infected. Conclusions and Implications for Public Health Practice Increasing rates of acute hepatitis C among young adults, including reproductive-aged persons, have put multiple generations at risk for chronic hepatitis C. The number of newly reported chronic infections was approximately equal among younger and older adults in 2018. The new CDC hepatitis C testing recommendations advise screening all adults and pregnant women, not just persons born during 1945–1965, and those with risk factors.
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Affiliation(s)
- A Blythe Ryerson
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC
| | - Sarah Schillie
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC
| | - Laurie K Barker
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC
| | - Benjamin A Kupronis
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC
| | - Carolyn Wester
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC
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