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CDC Hepatitis C Coordinators Conference: brief selected highlights. Remember the Alamo.
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I'm in San Antonio at this conference which is a gathering of CDC (Centers for Disease Control) Hepatitis C coordinators. The weather in San Antonio has been overcast & wet but the temperature is warm, in the 50s-60s. Across the street from the conference hotel is the Alamo. Our fight against hepatitis C is a tough battle. Funding from Congress and the Administration is not forthcoming to support hepatitis C needs.
Several hundred coordinators and additional state and local officials and CDC officials are present to discuss and review hepatitis A, B, and C initiatives, research, and plans. The focus is not on broad treatment research reviews but on government programs on local levels, which are related to testing and counseling.
This brief report will report selected highlights of information I think would be of interest to you. Some interesting data has been presented here and some of the discussions have been interesting. The data may not be a surprise for some of you familiar with this subject. At HIV clinics in Texas a survey found that 23% had hepatitis C. 25% of individuals who were HCV+ had normal ALT (liver enzymes). Studies show that perhaps 12% of individuals with normal ALT will have fibrosis of stage 2 or worse. But in coinfected patients a significantly higher percentage of coinfected patients with normal ALT have fibrosis and I have heard from various sources of numbers ranging from about 20% up to as many as 50% of patients with normal ALT have fibrosis. In the Texas study one-third of those surveyed in prison had HCV.
In another study presented by the CDC, among populations with high risk for HBV 20-30% receive HBV vaccine and only 35% are tested for HIV.
There are 17,000 individuals on the transplantation wait list. HCV is the leading cause for liver transplantation.
The Collaborative IDU Study II was conducted from 1997-1999 among persons 18-30 years old. Study results reported HCV prevalence in selected cities: LA 20%; Chicago 30%; New Orleans- 35%; New York 40% in Lower Eastside, 50% in Harlem; Baltimore 55%. Overall HCV prevalence was 36%. Coinfection (HCV/HIV) prevalence was a stunningly low 3%, and so was the HIV prevalence of 4.7%. HBV prevalence was 22%. Another interesting piece of data was that in Harlem, the Lower Eastside in NYC, and Chicago, the 3 areas examined, the incidence (new infections) of HCV among IDUs was 16% per year. This is very interesting because a previous study from Baltimore reported that 80% of IDUs get HCV infected within the first year of injecting. This new data shows new infection occurring at 16% per year suggesting it would take 5 years for IDUs to collectively reach 80% prevalence. This is important because in treatment studies it is presumed that the duration of HCV infection for the study subjects is based on infection within the first year of IVDU. Perhaps, in less densely populated areas than NY & Chicago it might take longer than 5 years for IVDUs to get HCV infected. With the availability of clean syringes, perhaps it might take even longer on average for IVDUs to get HCV infected. There was some discussion regarding why there were low rates for HIV and HCV/HIV coinfection in this study. One contributing plausible reason is wider use of clean syringes from needle exchange programs. In particular, since this study is in younger IDUs the concept of using clean syringes has changed behavior patterns where clean needle programs are available. Coinfection rates are likely higher among older IDUs.
In another study of HCV testing in jails, 1020 interviews were conducted. Among illicit drug users 16% reported IVDU, and among IVDUs 82% had HCV. If a person had HIV they were 3.5 times more likely to have HCV. If the person was an IVDU they were 55 times more likely to have HCV. 34% of the women were IVDUs. There was some discussion in this workshop regarding why women appear to have such high HCV prevalence rates. Women may be more likely to be injected by men after men use a syringe; women may have multiple sex partners who are IVDUs and have HCV; and women may be more likely to share needles more often with multiple men.
The conference ends today and I'm flying back to NYC today.
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