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CDC - 23-27% with HCV Have Advanced Fibrosis or Cirrhosis - The Burden of Hepatitis C Infection-Related Liver Fibrosis in the United States
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"Among those currently infected, APRI and FIB-4 scores indicated that 23% overall-and 27% among the cohort born during 1945-1965-had advanced fibrosis or cirrhosis at first diagnosis. A total of 54% of infected were in care and 51% of infected with advanced fibrosis or cirrhosis were evaluated for treatment."
Results suggest that among the currently infected, 23% overall and 27% of those born from 1945-1965 had advanced fibrosis or cirrhosis.
The currently infected population overall was more frequently male, aged 40-59 years
Among persons newly diagnosed with HCV, the percentage with advanced fibrosis or cirrhosis was constant over the 4-year period (12% in 2010, 12% in 2011, 13% in 2012, and 12% in 2013; P < .0001). Similarly, among persons born during 1945-1965, the percentage with advanced fibrosis or cirrhosis was higher but constant in the 4-year period (27% in 2010, 26% in 2011, 28% in 2012, and 28% in 2013; P < .0001).
Laboratory testing data suggest that about half of infected persons with advanced fibrosis or cirrhosis were not evaluated for treatment. Given advances in treatment options [12], we expect the proportion of infected persons who are treated to increase over time. Additionally, many of the infected persons not in care were tested for HCV infection by a primary care physician. These findings indicate a need for training of primary care physicians in HCV screening, management, and referral of patients with advanced liver disease to specialists.
Early identification of the estimated 3.5 million US persons with chronic HCV infection and the estimated 800 000 with advanced fibrosis or cirrhosis is critical for prevention of forecasted premature deaths and other complications by 2030 [21]. The findings described in this study support the CDC and USPSTF recommendations for HCV testing and appropriate referral of persons born from 1945-1965 as well as efforts to reduce barriers to care among those who are HCV infected.
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The Burden of Hepatitis C Infection-Related Liver Fibrosis in the United States
R. Monina Klevens,1 Lauren Canary,1 Xiaohua Huang,2 Maxine M. Denniston,1 Anthony E. Yeo,2 Rick L. Pesano,2 John W. Ward,1 and Scott Holmberg1
1Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia; and 2Quest Diagnostics, Madison, New Jersey
Clinical Infectious Diseases Advance Access published August 9, 2016
Abstract
Background. Knowledge of the estimated proportion of hepatitis C virus (HCV)-infected persons with advanced fibrosis or cirrhosis is critical to estimating healthcare needs.
Methods. We analyzed HCV-related testing conducted by Quest Diagnostics from January 2010 through December 2013. Tests included hepatitis C antibody, HCV RNA, HCV genotype (nucleic acid tests [NAT]), liver function tests, and platelet counts; patient age was also determined. Aspartate aminotransferase (AST)-to-platelet ratio (APRI) was calculated as = 100*(aspartate aminotransferase [AST]/upper limit of AST)/platelet. Fibrosis-4 (FIB-4) was calculated as (age x AST)/(platelet x√ alanine aminotransferase [ALT]). Persons were "currently infected" if they had ≥1 positive HCV NAT; "in care" if a positive RNA test was followed <6 months by ≥1 additional NAT(s), or ALT, AST, and platelets <90 days, or any test ordered by an infectious diseases or gastroenterology specialist; and "evaluated for treatment" if they had a genotype test.
Results. Approximately 10 million HCV test results were analyzed, representing 5.6 million unique patients. Of the 2.6 million patients with data to estimate liver disease, 5% were currently infected. Among those currently infected, APRI and FIB-4 scores indicated that 23% overall-and 27% among the cohort born during 1945-1965-had advanced fibrosis or cirrhosis at first diagnosis. A total of 54% of infected were in care and 51% of infected with advanced fibrosis or cirrhosis were evaluated for treatment.
Conclusions. Testing from a large US commercial laboratory indicates that about 1 in 4 HCV-infected persons have levels of liver disease put them at highest risk for complications and could benefit from immediate antiviral therapy.
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