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The Burden of Liver Disease among Persons with Hepatitis C in the United States...."the need is urgent to identify HCV-infected persons & link them to management & care" screening
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Reported by Jules Levin
CROI 2015 Feb 23-26, Seattle, WA
Monina Klevens1, Xiaohua Huang2, Anthony E. Yeo2, Mouneer Odeh2,
Rick L. Pesano2, John W. Ward1
1. Division of Viral Hepatitis, US Centers for Disease Control and Prevention (CDC)
2. Informatics, Quest Diagnostics
"About one-half of HCV-infected persons born from 1945-1965 had severe fibrosis or cirrhosis as measured by FIB-4 scoring (but of all infected persons combined about 40% had severe fibrosis or cirrhosis.....among older persons <1945....74% had severe fibrosis or cirrhosis...11% in younger persons >1965).....However, the measurement of the Burden in the population of infected persons infected persons with advanced fibrosis and compensated cirrhosis is unknown in the US [from Jules: which is why we need widespread HCV screening/linkage to care programs, there is little federal funding to support this]
.......Of all persons with severe fibrosis or cirrhosis, 81% were born from 1945-1965 .....Proportions were consistent over time
Need is urgent to
Ğidentify [screening] HCV-infected persons
Ğlink them to management and care"
"Persons at highest risk for severe complications are a priority for treatment (AASLD/IDSA/IAS-USA HCV Guidelines).......However, the measurement of the Burden in the population of infected persons infected persons with advanced fibrosis and compensated cirrhosis is unknown in the US ........therefore our objective was to To estimate frequency and distribution of HCV-related liver fibrosis in the US using commercial testing data. .......tests conducted from 2010- 2013 ......we used FIB-4 to measure stage of liver fibrosis because it is available using serologic markers.....using QUEST Labs data.......FIB-4 is a strong correlate of biopsy results in a US cohort (see Table below).......9.7 million records were obtained.....465,000 had a positive HCV RNA test result representing 273,000 persons.....of these 125,000 persons had the 3 serologic parameters within 30 days of their 1st RNA test in order to calculate the FIB-4 score.....[of note] 68% were "baby boomers"("screening birth cohort") (born between 1945-65.....of all infected individuals combined about 40% had severe fibrosis or cirrhosis......among younger persons (>1965) 11% had severe fibrosis or cirrhosis......among those in the "screening birth cohort almost half 47% had severe fibrosis or cirrhosis combined.....and among older persons (<1945) almost three-quarters 74% had severe fibrosis or cirrhosis......among persons with a positive/chronic (+HCV RNA) and staged with severe fibrosis or cirrhosis 81% each were born in the screening birth cohort (see Table below).......as an important surveillance technique an an indicator that over time screening identifies persons earlier in the stage of liver fibrosis in each year 2010, 2011, 2012 and 2013 the percentages were very stable with no apparent trend with 27-28% in each year having severe fibrosis and 22/23% cirrhosis......although FIB-4 is not the gold standard for staging liver fibrosis, however its best use has been to distinguish severe from mild fibrosis and we have done this at the population level not at the individual level".....
The Burden of Liver Disease among Persons with Hepatitis C in the United States
Reported by Jules Levin
CROI 2015 Feb 23-26, Seattle, WA
Monina Klevens1, Xiaohua Huang2, Anthony E. Yeo2, Mouneer Odeh2,
Rick L. Pesano2, John W. Ward1
1. Division of Viral Hepatitis, US Centers for Disease Control and Prevention (CDC)
2. Informatics, Quest Diagnostics
Webcast:
http://www.croiwebcasts.org/console/player/25802?mediaType=slideVideo&
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