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Walter LA, Wilson L, Farmer M, Roberson T, Hand DT, Franco R. Sustained virologic response from hepatitis C from an emergency department screening & linkage program: A retrospective review. Am J Emerg Med 2023; 72:178-182. [PMID: 37540919 DOI: 10.1016/j.ajem.2023.07.050] [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: 02/08/2023] [Revised: 06/18/2023] [Accepted: 07/26/2023] [Indexed: 08/06/2023] Open
Abstract
INTRODUCTION The role of the Emergency Department (ED) as a vital constituent in Hepatitis C (HCV) screening has become increasingly evident. A key component of the ED's role in HCV screening is the ability to effectively link HCV-RNA positive patients to definitive, HCV-specific care, to include direct-acting antiviral (DAA) medication with resultant sustained virologic response (SVR). We sought to consider the rate of HCV-specific linkage, DAA initiation, and SVR obtained in HCV patients identified from an ED screening program. METHODS A retrospective chart review was conducted in February of 2022 of all individuals who participated in an opt-out ED-based HCV screening program between January 2018 and December 2019. Data was disaggregated by race, gender, age/birth cohort, insurance status, and achievement of sustained virologic response (SVR). Bivariate analysis using Pearson's chi-square was utilized to compare outcomes based on insurance status, race, sex, and birth cohort. RESULTS Of 66,634 individuals screened for HCV during the study period, 885 (1.33%) patients were RNA-positive. Of those individuals, 121 (13.67%) were linked to HCV-specific care. Of those linked, the majority (66.9%) were male, white (66.1%; 33.1% Black), baby boomers or older (53.7%) and publicly insured (57.9%; private insurance 23.1%, self-pay 19%). Among linked patients, 88 (72.7%) started DAA medication. Mirroring linked demographics, majority were male (64.8%), white (64.8%), baby boomers or older (52.3%), and publicly insured (57.6%). White patients initiated on DAA were more likely to obtain SVR (64.9% versus 41.9% Black; p = .04) and uninsured patients were more likely to obtain SVR (82.4% versus 50.7% insured; p = .02). Bivariate consideration of SVR-patients specifically demonstrates that Black patients tended to be older, with significant overrepresentation of Baby boomers (77.5%) as compared to whites (37.5%; p < .0001). Black patients were also more likely to be publicly insured (82.5%) while white patients were more likely to have private insurance (28.8%) or be uninsured (26.3%) than their Black counterparts (12.5% and 5% respectively; p < .05). CONCLUSION An ED-based HCV screening program can result in successful HCV-specific linkage and care, to include DAA initiation and ultimately, SVR. Among linked patients, specific cohort considerations may demonstrate differences in age and insurance status which may have implications on DAA application and adherence, and therefore, individual ability to achieve SVR.
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Affiliation(s)
- Lauren A Walter
- Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL, United States of America.
| | - Logan Wilson
- Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Madeline Farmer
- University of Alabama at Birmingham, Heersink School of Medicine, United States of America
| | - Tinsley Roberson
- University of Alabama at Birmingham, Heersink School of Medicine, United States of America
| | - Delissa T Hand
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Ricardo Franco
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States of America
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Gudi SK, Eltonsy S, Delaney J, Osiowy C, Taylor C, Kaita K, Alessi-Severini S. Annual trends of hepatitis C virus infection in Manitoba between 1998 and 2018: A focus on special populations. CANADIAN LIVER JOURNAL 2023; 6:249-260. [PMID: 37503521 PMCID: PMC10370720 DOI: 10.3138/canlivj-2022-0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 11/02/2022] [Indexed: 07/29/2023]
Abstract
Background Hepatitis C virus (HCV) infection is a major cause of liver-related morbidity and mortality worldwide. Epidemiological data of HCV infection in the Canadian province of Manitoba are limited. Methods A population-based retrospective study was conducted using data from the Manitoba Centre for Health Policy repository. Using the test results provided by the Cadham provincial laboratory, individuals in Manitoba with a diagnosis of HCV infection were identified. Annual prevalence and incidence rates (crude and standardized) were calculated for the overall population and stratified by sex, regional health authority (RHA), residence area, income quintile, and special population groups (children, older adults, and pregnant persons). Results A total of 8,721 HCV cases were diagnosed between 1998 and 2018 in Manitoba. Overall crude HCV incidence and prevalence were estimated as 0.03% and 0.37% during the study period, respectively. No significant change was observed in the standardized HCV incidence rate (per 100,000) during the study period (54.3 in 1998 and 54.8 in 2018). However, the standardized HCV prevalence (per 100,000) increased from 52.5 (95% CI 39.2-68.7) in 1998 to 655.2 (95% CI 605.9-707.3) in 2018. An overall average incidence rate based on sex, RHA, region, income, and special population groups was observed to be higher in males (40.1), Winnipeg RHA (42.7), urban region (42.3), low-income quintiles (78.5), and pregnant persons (94.3), respectively. Conclusion Although incidence rates of HCV infection in Manitoba appeared to have initially declined, rates showed an upward trend by the end of the study period while prevalence increased steadily.
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Affiliation(s)
- Sai Krishna Gudi
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sherif Eltonsy
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Joseph Delaney
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Carla Osiowy
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Carole Taylor
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kelly Kaita
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Ambulatory Care for Section of Hepatology, Winnipeg, Manitoba, Canada
- Viral Hepatitis Investigative Unit, Winnipeg, Manitoba, Canada
| | - Silvia Alessi-Severini
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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King H, Soh J, Thompson WW, Brown JR, Rapposelli K, Vellozzi C. Testing for Hepatitis C Virus Infection Among Adults Aged ≥18 in the United States, 2013-2017. Public Health Rep 2022; 137:1107-1117. [PMID: 34606398 PMCID: PMC9574300 DOI: 10.1177/00333549211047236] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2021] [Indexed: 12/09/2022] Open
Abstract
OBJECTIVE Approximately 2.4 million people in the United States are living with hepatitis C virus (HCV) infection. The objective of our study was to describe demographic and socioeconomic characteristics, liver disease-related risk factors, and modifiable health behaviors associated with self-reported testing for HCV infection among adults. METHODS Using data on adult respondents aged ≥18 from the 2013-2017 National Health Interview Survey, we summarized descriptive data on sociodemographic characteristics and liver disease-related risk factors and stratified data by educational attainment. We used weighted logistic regression to examine predictors of HCV testing. RESULTS During the study period, 11.7% (95% CI, 11.5%-12.0%) of adults reported ever being tested for HCV infection. Testing was higher in 2017 than in 2013 (adjusted odds ratio [aOR] = 1.27; 95% CI, 1.18-1.36). Adults with ≥some college were significantly more likely to report being tested (aOR = 1.60; 95% CI, 1.52-1.69) than adults with ≤high school education. Among adults with ≤high school education (but not adults with ≥some college), those who did not have health insurance were less likely than those with private health insurance (aOR = 0.78; 95% CI, 0.68-0.89) to get tested, and non-US-born adults were less likely than US-born adults to get tested (aOR = 0.77; 95% CI, 0.68-0.87). CONCLUSIONS Rates of self-reported HCV testing increased from 2013 to 2017, but testing rates remained low. Demographic characteristics, health behaviors, and liver disease-related risk factors may affect HCV testing rates among adults. HCV testing must increase to achieve hepatitis C elimination targets.
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Affiliation(s)
- Hope King
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - J.E. Soh
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Department of Biostatistics, Emory University, Atlanta, GA, USA
| | - William W. Thompson
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jessica Rogers Brown
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Karina Rapposelli
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Claudia Vellozzi
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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4
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Gordon SC, Teshale EH, Spradling PR, Moorman AC, Boscarino JA, Schmidt MA, Daida YG, Rupp LB, Trudeau S, Zhang J, Lu M. Lower rates of emergency visits and hospitalizations among chronic hepatitis C patients with sustained virological response to interferon-free direct-acting antiviral therapy (2014-2018). Clin Infect Dis 2022; 75:1453-1456. [PMID: 35147184 DOI: 10.1093/cid/ciac124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Indexed: 12/09/2022] Open
Abstract
We compared rates of emergency department (ED) visits and hospitalizations between HCV patients who achieved sustained virological response (SVR) after direct-acting antiviral (DAA) therapy (cases) to matched controls. Among 3049 pairs, cases demonstrated lower rates of liver-related ED visits (P=.01) than controls; all-cause and liver-related hospitalization rates and hospitalized days were also lower in cases (P<.0001).
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Affiliation(s)
- Stuart C Gordon
- Department of Hepatology and Gastroenterology, Henry Ford Health System; and Wayne State University School of Medicine, Detroit MI
| | - Eyasu H Teshale
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Philip R Spradling
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Anne C Moorman
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Mark A Schmidt
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Yihe G Daida
- Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu, HI
| | - Loralee B Rupp
- Center for Health Policy and Health Systems Research, Henry Ford Health System, Detroit MI
| | - Sheri Trudeau
- Department of Public Health Sciences, Henry Ford Health System, Detroit MI
| | - Jiaqi Zhang
- Department of Public Health Sciences, Henry Ford Health System, Detroit MI
| | - Mei Lu
- Department of Public Health Sciences, Henry Ford Health System, Detroit MI
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5
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Khuhro Q, Shaikh H, Washdev, Hashmi S. Depression trends in Hepatitis-C PCR positive and PCR negative patients. Pak J Med Sci 2022; 38:162-166. [PMID: 35035419 PMCID: PMC8713198 DOI: 10.12669/pjms.38.1.4788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/12/2021] [Accepted: 08/28/2021] [Indexed: 11/15/2022] Open
Abstract
Objective: To determine the frequency of depression in Hepatitis-C patients and its association clearance of HCV Methods: It is cross sectional study that was conducted between 1st July to 31st December, 2020, at National Institute of Liver and Gastrointestinal Diseases (NILGID),, Dow University of Health Sciences (DUHS).. Both male and female patients aged 18 to 60 years presenting with Hepatitis-C PCR positive or had received DAA for three months and became PCR negative were included in this cross sectional study. Depression was analyzed by Hamilton Depression Rating Scale (HDRS). Mean and standard deviations were calculated and analyzed. Results: Total 210 patients were included in this study, with mean age 36.06 ± 10.11 years. Depression was present in 118 (56.2%) patients. Among patients with HCV PCR positive depression present in 63 (30.0%) patients while in HCV PCR negative 55 (26.0%) patients. Similarly, depression in HCV PCR positive male patients, aged ≤40 years 80 (38.1%) and in HCV PCR negative 56 (26.7%) patients. Conclusion: Patients with chronic Hepatitis-C commonly suffer from depression. However, our study found no significant difference with change in PCR status at 12 weeks.
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Affiliation(s)
- Qutabuddin Khuhro
- Qutabuddin Khuhro, National Institute of Gastrointestinal Disease, Dow University Hospital, DUHS, Ojha Campus, Karachi, Pakistan
| | - Hafeezullah Shaikh
- Hafeezullah Shaikh, National Institute of Gastrointestinal Disease, Dow University Hospital, DUHS, Ojha Campus, Karachi, Pakistan
| | - Washdev
- Washdev, Institute of Behavioral Sciences, DUHS, Karachi, Pakistan
| | - Shahkamal Hashmi
- Shahkamal Hashmi, School of Public Health, DUHS, Karachi, Pakistan
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6
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Spradling PR, Zhong Y, Moorman AC, Rupp LB, Lu M, Teshale EH, Schmidt MA, Daida YG, Boscarino JA, Gordon SC. The Persistence of Underreporting of Hepatitis C as an Underlying or Contributing Cause of Death, 2011-2017. Clin Infect Dis 2021; 73:891-894. [PMID: 33561187 DOI: 10.1093/cid/ciab108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Indexed: 11/14/2022] Open
Abstract
Using electronic health records, we found that hepatitis C virus (HCV) reporting on death certificates of 2901 HCV-infected decedents from 4 US healthcare organizations during 2011-2017 was documented in only 50% of decedents with hepatocellular carcinoma and less than half with decompensated cirrhosis. National figures likely underestimate the US HCV mortality burden.
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Affiliation(s)
- Philip R Spradling
- Division of Viral Hepatitis, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Yuna Zhong
- Division of Viral Hepatitis, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Anne C Moorman
- Division of Viral Hepatitis, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | | | - Mei Lu
- Henry Ford Health System, Detroit, Michigan, USA
| | - Eyasu H Teshale
- Division of Viral Hepatitis, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Mark A Schmidt
- The Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Yihe G Daida
- The Center for Integrated Health Research, Kaiser Permanente Hawaii, Honolulu, Hawaii, USA
| | - Joseph A Boscarino
- Department of Population Health Sciences, Geisinger Clinic, Danville, Pennsylvania, USA
| | - Stuart C Gordon
- Henry Ford Health System, Detroit, Michigan, USA.,Wayne State University School of Medicine, Detroit, Michigan, USA
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7
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Hall EW, Schillie S, Vaughan AS, Jones J, Bradley H, Lopman B, Rosenberg ES, Sullivan PS. County-Level Variation in Hepatitis C Virus Mortality and Trends in the United States, 2005-2017. Hepatology 2021; 74:582-590. [PMID: 33609308 PMCID: PMC8456961 DOI: 10.1002/hep.31756] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/23/2020] [Accepted: 01/19/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND AIMS Since 2013, the national hepatitis C virus (HCV) death rate has steadily declined, but this decline has not been quantified or described on a local level. APPROACH AND RESULTS We estimated county-level HCV death rates and assessed trends in HCV mortality from 2005 to 2013 and from 2013 to 2017. We used mortality data from the National Vital Statistics System and used a Bayesian multivariate space-time conditional autoregressive model to estimate age-standardized HCV death rates from 2005 through 2017 for 3,115 U.S. counties. Additionally, we estimated county-level, age-standardized rates for persons <40 and 40+ years of age. We used log-linear regression models to estimate the average annual percent change in HCV mortality during periods of interest and compared county-level trends with national trends. Nationally, the age-adjusted HCV death rate peaked in 2013 at 5.20 HCV deaths per 100,000 persons (95% credible interval [CI], 5.12, 5.26) before decreasing to 4.34 per 100,000 persons (95% CI, 4.28, 4.41) in 2017 (average annual percent change = -4.69; 95% CI, -5.01, -4.33). County-level rates revealed heterogeneity in HCV mortality (2017 median rate = 3.6; interdecile range, 2.19, 6.77), with the highest rates being concentrated in the West, Southwest, Appalachia, and northern Florida. Between 2013 and 2017, HCV mortality decreased in 80.0% (n = 2,274) of all U.S. counties with a reliable trend estimate, with 25.8% (n = 803) of all counties experiencing a decrease larger than the national decline. CONCLUSIONS Although many counties have experienced a shift in HCV mortality trends since 2013, the magnitude and composition of that shift have varied by place. These data provide a better understanding of geographic differences in HCV mortality and can be used by local jurisdictions to evaluate HCV mortality in their areas relative to surrounding areas and the nation.
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Affiliation(s)
- Eric W. Hall
- Department of EpidemiologyRollins School of Public HealthEmory UniversityAtlantaGA
| | - Sarah Schillie
- Immunization Services DivisionCenters for Disease Control and PreventionAtlantaGA
| | - Adam S. Vaughan
- Division for Heart Disease and Stroke PreventionCenters for Disease Control and PreventionAtlantaGA
| | - Jeb Jones
- Department of EpidemiologyRollins School of Public HealthEmory UniversityAtlantaGA
| | - Heather Bradley
- Department of Epidemiology and BiostatisticsSchool of Public HealthGeorgia State UniversityAtlantaGA
| | - Ben Lopman
- Department of EpidemiologyRollins School of Public HealthEmory UniversityAtlantaGA
| | - Eli S. Rosenberg
- Department of Epidemiology and BiostatisticsSchool of Public HealthUniversity at AlbanyAlbanyNY
| | - Patrick S. Sullivan
- Department of EpidemiologyRollins School of Public HealthEmory UniversityAtlantaGA
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8
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Jordan AE, Cleland CM, Wyka K, Schackman BR, Perlman DC, Nash D. Hepatitis C Virus Incidence in a Cohort in Medication-Assisted Treatment for Opioid Use Disorder in New York City. J Infect Dis 2021; 222:S322-S334. [PMID: 32877567 DOI: 10.1093/infdis/jiz659] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) incidence has increased in the worsening opioid epidemic. We examined the HCV preventive efficacy of medication-assisted treatment (MAT), and geographic variation in HCV community viral load (CVL) and its association with HCV incidence. METHODS HCV incidence was directly measured in an open cohort of patients in a MAT program in New York City between 1 January 2013 and 31 December 2016. Area-level HCV CVL was calculated. Associations of individual-level factors, and of HCV CVL, with HCV incidence were examined in separate analyses. RESULTS Among 8352 patients, HCV prevalence was 48.7%. Among 2535 patients seronegative at first antibody test, HCV incidence was 2.25/100 person-years of observation (PYO). Incidence was 6.70/100 PYO among those reporting main drug use by injection. Female gender, drug injection, and lower MAT retention were significantly associated with higher incidence rate ratios. Female gender, drug injection, and methadone doses <60 mg were independently associated with shorter time to HCV seroconversion. HCV CVLs varied significantly by geographic area. CONCLUSIONS HCV incidence was higher among those with lower MAT retention and was lower among those receiving higher methadone doses, suggesting the need to ensure high MAT retention, adequate doses, and increased HCV prevention and treatment engagement. HCV CVLs vary geographically and merit further study as predictors of HCV incidence.
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Affiliation(s)
- Ashly E Jordan
- Graduate School of Public Health and Health Policy, City University of New York, New York, New York, USA.,Center for Drug Use and HIV Research, New York, New York, USA.,Behavioral Science Training Program in Drug Abuse Research, New York University, New York, New York, USA
| | - Charles M Cleland
- Center for Drug Use and HIV Research, New York, New York, USA.,Division of Biostatistics, Department of Population Health, New York University School of Medicine, New York, New York, USA
| | - Katarzyna Wyka
- Graduate School of Public Health and Health Policy, City University of New York, New York, New York, USA
| | - Bruce R Schackman
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York, USA
| | - David C Perlman
- Center for Drug Use and HIV Research, New York, New York, USA.,Division of Infectious Diseases, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Denis Nash
- Graduate School of Public Health and Health Policy, City University of New York, New York, New York, USA
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Spradling PR, Zhong Y, Moorman AC, Rupp LB, Lu M, Gordon SC, Teshale EH, Schmidt MA, Daida YG, Boscarino JA. Psychosocial Obstacles to Hepatitis C Treatment Initiation Among Patients in Care: A Hitch in the Cascade of Cure. Hepatol Commun 2021; 5:400-411. [PMID: 33681675 PMCID: PMC7917278 DOI: 10.1002/hep4.1632] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/25/2020] [Accepted: 10/12/2020] [Indexed: 12/14/2022] Open
Abstract
There are limited data examining the relationship between psychosocial factors and receipt of direct-acting antiviral (DAA) treatment among patients with hepatitis C in large health care organizations in the United States. We therefore sought to determine whether such factors were associated with DAA initiation. We analyzed data from an extensive psychological, behavioral, and social survey (that incorporated several health-related quality of life assessments) coupled with clinical data from electronic health records of patients with hepatitis C enrolled at four health care organizations during 2017-2018. Of 2,681 patients invited, 1,051 (39.2%) responded to the survey; of 894 respondents eligible for analysis, 690 (77.2%) initiated DAAs. Mean follow-up among respondents was 9.2 years. Compared with DAA recipients, nonrecipients had significantly poorer standardized scores for depression, anxiety, and life-related stressors as well as poorer scores related to physical and mental function. Lower odds of DAA initiation in multivariable analysis (adjusted by age, race, sex, study site, payment provider, cirrhosis status, comorbidity status, and duration of follow-up) included Black race (adjusted odds ratio [aOR], 0.59 vs. White race), perceived difficulty getting medical care in the preceding year (aOR, 0.48 vs. no difficulty), recent injection drug use (aOR, 0.11 vs. none), alcohol use disorder (aOR, 0.58 vs. no alcohol use disorder), severe depression (aOR, 0.42 vs. no depression), recent homelessness (aOR, 0.36 vs. no homelessness), and recent incarceration (aOR, 0.34 vs. no incarceration). Conclusion: In addition to racial differences, compared with respondents who initiated DAAs, those who did not were more likely to have several psychological, behavioral, and social impairments. Psychosocial barriers to DAA initiation among patients in care should also be addressed to reduce hepatitis C-related morbidity and mortality.
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Affiliation(s)
- Philip R Spradling
- Division of Viral HepatitisCenters for Disease Control and PreventionAtlantaGAUSA
| | - Yuna Zhong
- Division of Viral HepatitisCenters for Disease Control and PreventionAtlantaGAUSA
| | - Anne C Moorman
- Division of Viral HepatitisCenters for Disease Control and PreventionAtlantaGAUSA
| | | | - Mei Lu
- Henry Ford Health SystemDetroitMIUSA
| | - Stuart C Gordon
- Henry Ford Health SystemDetroitMIUSA.,Wayne State University School of MedicineDetroitMIUSA
| | - Eyasu H Teshale
- Division of Viral HepatitisCenters for Disease Control and PreventionAtlantaGAUSA
| | - Mark A Schmidt
- Center for Health ResearchKaiser Permanente NorthwestPortlandORUSA
| | - Yihe G Daida
- Center for Integrated Health Care ResearchKaiser Permanente HawaiiHonoluluHIUSA
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10
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Spradling PR, Xing J, Rupp LB, Moorman AC, Gordon SC, Lu M, Teshale EH, Boscarino JA, Schmidt MA, Daida YG, Holmberg SD. Low Uptake of Direct-acting Antiviral Therapy Among Hepatitis C Patients With Advanced Liver Disease and Access to Care, 2014-2017. J Clin Gastroenterol 2021; 55:77-83. [PMID: 32250999 PMCID: PMC10711731 DOI: 10.1097/mcg.0000000000001344] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
GOALS To determine the proportion and characteristics of adults with hepatitis C at health care organizations in 4 US states who initiated direct-acting antivirals (DAAs). BACKGROUND There are almost no data to assess the penetrance of treatment of the hepatitis C population in general US health care settings. STUDY We conducted a prospective observational study using electronic clinical, pharmacy, and mortality data to determine the fraction of patients who initiated DAAs between January 2014 and December 2017, by start date and regimen. We used stepwise multivariate logistic regression analysis to identify sociodemographic and clinical characteristics associated with receipt of DAAs. RESULTS Of 8823 patients, 2887 (32.7%) received DAAs. Quarterly (Q) uptake ranged from 1.1% in Q3 2014 to a high of 5.6% in Q2 2015. Characteristics associated with receipt of DAAs included age 51 to 70 years, higher income, pre-2014 treatment failure, and higher noninvasive fibrosis score (FIB4); however, over one half of patients with FIB4 scores >3.25, consistent with severe liver disease, were not treated. A lower likelihood of initiation was associated with Medicaid coverage. Of 5936 patients who did not initiate treatment, 911 (15.3%) had died and 2774 (46.7%) had not had a clinical encounter in ≥12 months by the end of the study. Fewer than 1% of DAA prescriptions originated from nonspecialty providers. CONCLUSIONS During 4 calendar years of follow-up, one third of patients initiated DAAs. Large fractions of untreated patients had advanced liver disease, died, or were lost to follow-up. Even among patients in integrated health care systems, receipt of DAAs was limited.
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Affiliation(s)
- Philip R. Spradling
- Division of Viral Hepatitis, National Centers for HIV, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Jian Xing
- Division of Viral Hepatitis, National Centers for HIV, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | | | - Anne C. Moorman
- Division of Viral Hepatitis, National Centers for HIV, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Stuart C. Gordon
- Henry Ford Health System, Detroit, Michigan
- Wayne State University School of Medicine, Detroit, MI
| | - Mei Lu
- Henry Ford Health System, Detroit, Michigan
| | - Eyasu H. Teshale
- Division of Viral Hepatitis, National Centers for HIV, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | | | - Mark A. Schmidt
- The Center for Health Research, Kaiser Permanente-Northwest, Portland, Oregon
| | - Yihe G. Daida
- The Center for Health Research, Kaiser Permanente-Hawaii, Honolulu, Hawaii
| | - Scott D. Holmberg
- Division of Viral Hepatitis, National Centers for HIV, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
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Evans ME, Person M, Reilley B, Leston J, Haverkate R, McCollum JT, Apostolou A, Bohm MK, Van Handel M, Bixler D, Mitsch AJ, Haberling DL, Hatcher SM, Weiser T, Elmore K, Teshale EH, Weidle PJ, Peters PJ, Buchacz K. Trends in Indicators of Injection Drug Use, Indian Health Service, 2010-2014 : A Study of Health Care Encounter Data. Public Health Rep 2020; 135:461-471. [PMID: 32633599 PMCID: PMC7383762 DOI: 10.1177/0033354920937284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Hepatitis C virus (HCV) and HIV transmission in the United States may increase as a result of increasing rates of opioid use disorder (OUD) and associated injection drug use (IDU). Epidemiologic trends among American Indian/Alaska Native (AI/AN) persons are not well known. METHODS We analyzed 2010-2014 Indian Health Service data on health care encounters to assess regional and temporal trends in IDU indicators among adults aged ≥18 years. IDU indicators included acute or chronic HCV infection (only among adults aged 18-35 years), arm cellulitis and abscess, OUD, and opioid-related overdose. We calculated rates per 10 000 AI/AN adults for each IDU indicator overall and stratified by sex, age group, and region and evaluated rate ratios and trends by using Poisson regression analysis. RESULTS Rates of HCV infection among adults aged 18-35 increased 9.4% per year, and rates of OUD among all adults increased 13.3% per year from 2010 to 2014. The rate of HCV infection among young women was approximately 1.3 times that among young men. Rates of opioid-related overdose among adults aged <50 years were approximately 1.4 times the rates among adults aged ≥50 years. Among young adults with HCV infection, 25.6% had concurrent OUD. Among all adults with arm cellulitis and abscess, 5.6% had concurrent OUD. CONCLUSIONS Rates of HCV infection and OUD increased significantly in the AI/AN population. Strengthened public health efforts could ensure that AI/AN communities can address increasing needs for culturally appropriate interventions, including comprehensive syringe services programs, medication-assisted treatment, and opioid-related overdose prevention and can meet the growing need for treatment of HCV infection.
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Affiliation(s)
- Mary E. Evans
- Division of Unintentional Injury Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Marissa Person
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Brigg Reilley
- Northwest Portland Area Indian Health Board, Portland, OR, USA
| | - Jessica Leston
- Northwest Portland Area Indian Health Board, Portland, OR, USA
| | | | | | - Andria Apostolou
- Indian Health Service, Rockville, MD, USA
- SciMetrika LLC, McLean, VA, USA
| | - Michele K. Bohm
- Division of Unintentional Injury Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Michelle Van Handel
- National Centers for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Danae Bixler
- Division of Viral Hepatitis, National Centers for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Andrew J. Mitsch
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Dana L. Haberling
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sarah M. Hatcher
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Northwest Portland Area Indian Health Board, Portland, OR, USA
| | | | - Kim Elmore
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Eyasu H. Teshale
- Division of Viral Hepatitis, National Centers for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Paul J. Weidle
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Philip J. Peters
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kate Buchacz
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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12
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Crismale JF, Ahmad J. Expanding the donor pool: Hepatitis C, hepatitis B and human immunodeficiency virus-positive donors in liver transplantation. World J Gastroenterol 2019; 25:6799-6812. [PMID: 31885421 PMCID: PMC6931007 DOI: 10.3748/wjg.v25.i47.6799] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 11/26/2019] [Accepted: 11/29/2019] [Indexed: 02/06/2023] Open
Abstract
Liver transplantation (LT) remains the best option for patients with end-stage liver disease but the demand for organs from deceased donors continues to outweigh the available supply. The advent of highly effective anti-viral treatments has reduced the number of patients undergoing LT for hepatitis C (HCV) and hepatitis B (HBV) related liver disease and yet the number of patients waiting for LT continues to increase, driven by an increase in the patients listed with a diagnosis of cirrhosis due to non-alcoholic steatohepatitis and alcohol-related liver disease. In addition, human immunodeficiency virus (HIV) infection, which was previously a contra-indication for LT, is no longer a fatal disease due to the effectiveness of HIV therapy and patients with HIV and liver disease are now developing indications for LT. The rising demand for LT is projected to increase further in the future, thus driving the need to investigate potential means of expanding the pool of potential donors. One mechanism for doing so is utilizing organs from donors that previously would have been discarded or used only in exceptional circumstances such as HCV-positive, HBV-positive, and HIV-positive donors. The advent of highly effective anti-viral therapy has meant that these organs can now be used with excellent outcomes in HCV, HBV or HIV infected recipients and in some cases uninfected recipients.
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Affiliation(s)
- James F Crismale
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Jawad Ahmad
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
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13
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Blackwell JA, Rodgers JB, Franco RA, Cofield SS, Walter LA, Galbraith JW, Hess EP. Predictors of linkage to care for a nontargeted emergency department hepatitis C screening program. Am J Emerg Med 2019; 38:1396-1401. [PMID: 31836342 DOI: 10.1016/j.ajem.2019.11.034] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 11/18/2019] [Accepted: 11/18/2019] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE We implemented a nontargeted, opt-out HCV testing and linkage to care (LTC) program in an academic tertiary care emergency department (ED). Despite research showing the critical role of ED-based HCV testing programs, predictors of LTC have not been defined for patients identified through the nontargeted ED testing strategy. In order to optimize health outcomes for patients with HCV, we sought to identify predictors of LTC failure. METHODS This was a retrospective cohort study of adult patients who were tested for HCV in the ED between August 2015 and September 2018 and were confirmed to have chronic HCV infection through RNA testing. We used logistic regression to assess the relationship between candidate predictors and the primary outcome, LTC failure, which was defined as a patient not being seen by an HCV treating provider after discharge from the ED. RESULTS Of 53,297 patients tested, 1,674 (3.1%) had HCV on confirmatory testing, and 355 (21%) linked to care. Predictors of LTC failure included younger age (OR 0.96, 95% CI 0.95-0.97), white race (OR 1.65, 95% CI 1.23-2.22), homelessness (OR 1.91, 95% CI 1.19-3.08), substance use (OR 1.77, 95% CI 1.34-2.34), and comorbid psychiatric illness (OR 2.16, 95% CI 1.59-2.94). Patients with significant medical comorbidities (OR 0.57, 95% CI 0.41-0.78) or HIV co-infection (OR 0.11, 95% CI 0.03-0.46) were less likely to experience LTC failure. CONCLUSIONS One in five HCV-infected patients identified by ED-based nontargeted testing successfully linked to an HCV treating provider. Predictors of LTC failure may guide the development of targeted interventions to improve LTC success.
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Affiliation(s)
- Joshua A Blackwell
- University of Alabama School of Medicine, 1670 University Blvd, Birmingham, AL 35233, USA; UAB School of Public Health, 1665 University Blvd, Birmingham, AL 35233, USA.
| | - Joel B Rodgers
- Department of Emergency Medicine, UAB School of Medicine, Old Hillman Building #251, 619 South 19th Street, Birmingham, AL 35249, USA
| | - Ricardo A Franco
- Division of Infectious Diseases, Department of Medicine, UAB School of Medicine, 1900 University Boulevard, THT 229, Birmingham, AL 35294, USA
| | - Stacey S Cofield
- Department of Biostatistics, University of Alabama at Birmingham, 1665 University Blvd #327, Birmingham, AL 35294, USA
| | - Lauren A Walter
- University of Alabama School of Medicine, 1670 University Blvd, Birmingham, AL 35233, USA; Department of Emergency Medicine, UAB School of Medicine, Old Hillman Building #251, 619 South 19th Street, Birmingham, AL 35249, USA
| | - James W Galbraith
- Department of Emergency Medicine, University of Mississippi Medical Center, 2500 N. State Street, Jackson, MS 39216, USA
| | - Erik P Hess
- University of Alabama School of Medicine, 1670 University Blvd, Birmingham, AL 35233, USA; Department of Emergency Medicine, UAB School of Medicine, Old Hillman Building #251, 619 South 19th Street, Birmingham, AL 35249, USA
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14
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What is killing people with hepatitis C virus infection? Analysis of a population-based cohort in Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 72:114-122. [PMID: 31229445 DOI: 10.1016/j.drugpo.2019.06.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 05/23/2019] [Accepted: 06/06/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Persons with hepatitis C virus (HCV) infection are at risk of mortality from both chronic liver disease and HCV acquisition risk activities. We compared causes of death among HCV positive and negative individuals to characterize contributions of acquisition risks and viral sequelae. METHODS The British Columbia (BC) Hepatitis Testers Cohort (BC-HTC) includes all individuals tested for HCV or reported as a HCV case since 1992, linked to health administrative data. ICD-10 codes were used to classify deaths as: 1) liver-related (LR); 2) HCV acquisition risk-related (AR); and 3) other causes. Mortality proportions and trends were assessed among HCV positive and negative individuals overall and by birth cohort (born <1945, 1945-64 and ≥1965). RESULTS As of December 31, 2018, of 1,300,204 HCV-tested individuals, 20,049 (27.5%) HCV positive and 132,999 (10.2%) HCV negative individuals had died (median age at death: 56.4 vs. 74.5 years, respectively). HCV positive individuals were more likely than negatives to die from both AR (24.7%/4.2%) and LR (23.4%/6.2%) causes. Deaths among older HCV positive individuals were more likely to be LR while younger individuals were more likely AR: 1) birth cohort <1945 (25.3%/2.7%); 2) 1945-64 (26.5%/23.7%) and ≥1965 (7.7%/59.9%). Among HCV positives, LR mortality increased from 1992 to 2014, then declined sharply, coinciding with the introduction and uptake of direct-acting antiviral drugs. AR mortality increased from 1992 to 2000, declined slowly until 2013, then rapidly increased, coinciding with the recent surge in opioid overdose deaths. CONCLUSIONS Curative HCV treatments reduce LR mortality, but typically will not impact AR mortality. This will need to be addressed if the World Health Organization 2030 HCV mortality reduction goals are to be achieved.
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15
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Jafri S, Gordon SC. Epidemiology of Hepatitis C. Clin Liver Dis (Hoboken) 2018; 12:140-142. [PMID: 30988931 PMCID: PMC6385933 DOI: 10.1002/cld.783] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 11/07/2018] [Indexed: 02/06/2023] Open
Affiliation(s)
- Syed‐Mohammed Jafri
- Department of Gastroenterology and HepatologyHenry Ford Health SystemDetroitMI
| | - Stuart C. Gordon
- Department of Gastroenterology and HepatologyHenry Ford Health SystemDetroitMI
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16
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Rosenberg ES, Rosenthal EM, Hall EW, Barker L, Hofmeister MG, Sullivan PS, Dietz P, Mermin J, Ryerson AB. Prevalence of Hepatitis C Virus Infection in US States and the District of Columbia, 2013 to 2016. JAMA Netw Open 2018; 1:e186371. [PMID: 30646319 PMCID: PMC6324373 DOI: 10.1001/jamanetworkopen.2018.6371] [Citation(s) in RCA: 128] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
IMPORTANCE Infection with hepatitis C virus (HCV) is a major cause of morbidity and mortality in the United States, and incidence has increased rapidly in recent years, likely owing to increased injection drug use. Current estimates of prevalence at the state level are needed to guide prevention and care efforts but are not available through existing disease surveillance systems. OBJECTIVE To estimate the prevalence of current HCV infection among adults in each US state and the District of Columbia during the years 2013 to 2016. DESIGN, SETTING, AND PARTICIPANTS This survey study used a statistical model to allocate nationally representative HCV prevalence from the National Health and Nutrition Examination Survey (NHANES) according to the spatial demographics and distributions of HCV mortality and narcotic overdose mortality in all National Vital Statistics System death records from 1999 to 2016. Additional literature review and analyses estimated state-level HCV infections among populations not included in the National Health and Nutrition Examination Survey sampling frame. EXPOSURES State, accounting for birth cohort, biological sex, race/ethnicity, federal poverty level, and year. MAIN OUTCOMES AND MEASURES State-level prevalence estimates of current HCV RNA. RESULTS In this study, the estimated national prevalence of HCV from 2013 to 2016 was 0.84% (95% CI, 0.75%-0.96%) among adults in the noninstitutionalized US population represented in the NHANES sampling frame, corresponding to 2 035 100 (95% CI, 1 803 600-2 318 000) persons with current infection; accounting for populations not included in NHANES, there were 231 600 additional persons with HCV, adjusting prevalence to 0.93%. Nine states contained 51.9% of all persons living with HCV infection (California [318 900], Texas [202 500], Florida [151 000], New York [116 000], Pennsylvania [93 900], Ohio [89 600], Michigan [69 100], Tennessee [69 100], and North Carolina [66 400]); 5 of these states were in Appalachia. Jurisdiction-level median (range) HCV RNA prevalence was 0.88% (0.45%-2.34%). Of 13 states in the western United States, 10 were above this median. Three of 10 states with the highest HCV prevalence were in Appalachia. CONCLUSIONS AND RELEVANCE Using extensive national survey and vital statistics data from an 18-year period, this study found higher prevalence of HCV in the West and Appalachian states for 2013 to 2016 compared with other areas. These estimates can guide state prevention and treatment efforts.
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Affiliation(s)
- Eli S. Rosenberg
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Rensselaer
| | - Elizabeth M. Rosenthal
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Rensselaer
| | - Eric W. Hall
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Laurie Barker
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Megan G. Hofmeister
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Patrick S. Sullivan
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Patricia Dietz
- Office of the Director, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jonathan Mermin
- Office of the Director, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - A. Blythe Ryerson
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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17
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Moore MS, Bocour A, Tran OC, Qiao B, Schymura MJ, Laraque F, Winters A. Effect of Hepatocellular Carcinoma on Mortality Among Individuals With Hepatitis B or Hepatitis C Infection in New York City, 2001-2012. Open Forum Infect Dis 2018; 5:ofy144. [PMID: 30019001 PMCID: PMC6041961 DOI: 10.1093/ofid/ofy144] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 06/15/2018] [Indexed: 02/07/2023] Open
Abstract
Background Hepatocellular carcinoma (HCC) is a complication of chronic hepatitis B and C virus (HBV and HCV) infection. New York City (NYC) has a high prevalence of HBV and HCV, and infected persons likely face increased mortality from HCC and other causes. We describe the mortality profile of NYC residents with HBV or HCV, emphasizing the contributions of HCC and HIV coinfection. Methods Two existing data sets were combined to examine all individuals diagnosed with HBV or HCV in NYC first reported to the Health Department during 2001-2012 and their HCC, HIV, and vital status. Logistic regression was used to calculate the odds of HCC diagnosis by viral hepatitis status, whereas Cox proportional hazard regression was used to estimate the hazard of death by HCC/HIV status. Results In total, 120 952 and 127 933 individuals were diagnosed with HBV or HCV, respectively. HCV-infected individuals had 17% higher odds of HCC diagnosis than HBV-infected individuals and 3.2 times higher odds of HIV coinfection. Those with HCV were twice as likely to die during the study period (adjusted hazard ratio, 2.04; 95% confidence interval, 1.96-2.12). The risk of death increased for those with HIV or HCC and was highest for those with both conditions. Conclusions HCC and HIV represent substantial risks to survival for both HBV- and HCV-infected individuals. Individuals with HBV need close monitoring and treatment, when indicated, and routine HCC screening. Those with HCV need increased, timely access to curative medications before developing liver disease.
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Affiliation(s)
- Miranda S Moore
- Viral Hepatitis Program Surveillance Unit, Bureau of Communicable Disease, Queens
| | - Angelica Bocour
- Viral Hepatitis Program Surveillance Unit, Bureau of Communicable Disease, Queens
| | - Olivia C Tran
- Division of Disease Control, New York City Department of Health and Mental Hygiene, Queens
| | - Baozhen Qiao
- Bureau of Cancer Epidemiology, New York State Department of Health, Albany
| | - Maria J Schymura
- Bureau of Cancer Epidemiology, New York State Department of Health, Albany
| | - Fabienne Laraque
- Viral Hepatitis Program, Bureau of Communicable Disease, New York City Department of Health and Mental Hygiene, Queens, New York
| | - Ann Winters
- Viral Hepatitis Program, Bureau of Communicable Disease, New York City Department of Health and Mental Hygiene, Queens, New York
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