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HCV Testing for HIV+ - Only 50% Are Tested
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• The overall prevalence of testing for hepatitis C in the newly diagnosed persons with HIV was 50% within a year of the index HIV diagnosis.
• Women were less likely than men to get tested for HCV (relative risk [RR], 0.79; 95% CI, 0.77-0.81), as were patients aged 50 to 59 years compared with those aged 20 to 29 years: 40% vs 56%. Receiving care in a rural area equated to a lesser likelihood of HCV testing (RR, 0.85; 95% CI, 0.80-0.91).
In conclusion, hepatitis C testing is suboptimal among commercially insured persons with HIV in the United States as only 50% of newly diagnosed HIV patients were tested for hepatitis C within 12 months of their HIV diagnosis. Although there were increases in hepatitis C testing rates over the study period, there remain missed opportunities to detect and treat HCV infection among people newly diagnosed with HIV. Because HIV infection can accelerate hepatitis C related morbidity and mortality additional efforts are needed to improve hepatitis C testing among people newly diagnosis with HIV.
The new CDC recommendations to implement universal testing among adults 18 and older may impact HCV testing rates. Research shows that only half of people in U.S. were diagnosed and aware of their HCV infection, despite CDC recommendation since 1998 for hepatitis C testing [36-37].
our findings indicate a less than optimal uptake of CDC recommendations and are similar to previously published estimates of hepatitis C testing of persons with HIV.
• These findings underscore the need to implement effective and sustainable interventions to increase hepatitis C testing among people living with HIV, especially in the era of effective hepatitis C direct-acting antiviral agents (DAA) [26]. As such, the low testing rates reported in this study may be the result of limited awareness of hepatitis C testing recommendations among providers caring for commercially insured patients compared to providers caring for persons in the CFAR CNICS cohort.
• Interestingly, there were significant differences in testing rates between age groups and HIV-infected men and women.
• We also found that women were less likely to have been tested for hepatitis C compared to men.
Low testing results from the current study support the need to increase testing in women of childbearing age, including those with HIV.
patients with residence in rural areas were 15% less likely to have been tested compared to patients in urban areas.
Unfortunately, rural areas maybe the most vulnerable to outbreaks of blood born infections like HIV and hepatitis C [34]. These findings demonstrate important missed opportunities for testing of viral hepatitis in rural areas.
During 2006-2012, four rural states (Kentucky, Tennessee, Virginia, and West Virginia) had the greatest combined incidence of new HCV infection (364%) among persons aged ≤30 years [29]. Most persons with HIV live in urban and metropolitan areas and therefore HIV prevention efforts, including testing for hepatitis C, have been focused in urban communities [35]. Although rural populations have lower rates of HCV infections, persons with HIV were less likely to be tested and therefore linked to care for monitoring and effective DAA treatment.
Hepatitis C testing was significantly associated with age group, sex, and MSA (Table 1). Patients aged 20-29 years were more likely to have been tested as those aged 50-59 years of age (RR: 1.25 95% CI 1.20-1.31). Newly diagnosed women with HIV were less likely to have been tested for hepatitis C compared to newly identified men with HIV (RR: 0.79 95% CI 0.77-0.81). Patients with HIV who received care in rural areas were also less likely to have been tested for hepatitis C than persons with HIV in urban areas (RR: 0.85 95% CI 0.80-0.91). Region was statistically significant in the bivariate analysis (p-value=<0.001)) but was removed out of concerns for collinearity and to create a more stable, parsimonious model.
Using 2007-2017 IBM® MarketScan® data, we reported that in this large sample of commercially insured persons, only half of persons with newly diagnosed HIV were tested for hepatitis C within 12 months of their index HIV diagnosis. There was an improvement in 12-month post HIV diagnosis hepatitis C testing rates for those diagnosed 2008 through 2014 but after 2015 the rates leveled off and then began to decline. Males and persons aged 20-29 years had the highest rates of testing compared with all other age groups, including patients in the birth cohort age range (50-65 years). Patients who resided in a rural area were least likely tested for hepatitis C compared to urban area.
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Factors Associated with Testing for Hepatitis C Infections Among a Commercially Insured Population of Persons with HIV, United States 2008-2016
06 June 2020
Open Forum Infectious Diseases
Abstract
Background
Hepatitis C virus (HCV) infection is an important public health problem among people living with HIV. People with HIV who are coinfected with HCV infection are at increased risk for cirrhosis, liver failure, and hepatitis C-related mortality, as such national guidelines recommend persons with HIV should be tested for HCV infection.
Methods
Data from the 2003-2017 IBM Watson® Health MarketScan® database were used for this study. We used diagnostic, procedural, and drug codes to identify patients with ≥1 inpatient or outpatient medical claim of HIV diagnosis. Patients with prior HIV or hepatitis C diagnosis were excluded. We calculated hepatitis C testing rates among newly diagnosed HIV-infected persons within 12 months of the initial HIV diagnosis date (January 1, 2008- December 31, 2016). We used Poisson regression to identify the factors associated with hepatitis C testing. Lastly, we assessed hepatitis C testing trends using the Cochran-Armitage test.
Results
The prevalence of testing for hepatitis C in newly identified persons with HIV (N=46, 277) was 50% within 12 months of the index HIV diagnosis. From 2008-2017 the testing rate increased by 13%. Significant predictors of hepatitis C testing were age, sex and urbanicity. Women with HIV were less likely to have been tested compared with men (RR: 0.79 95% CI 0.77-0.81). Only 40% of patients between 50-59 years of age were tested for hepatitis C within 12 months of the index HIV diagnosis, while 56% of persons with HIV aged 20-29 years were tested for hepatitis C.
Conclusions
Overall, 50% of newly diagnosed HIV patients were tested for hepatitis C within 12 months of HIV diagnosis. Although there were increases in hepatitis C testing rates over the study period, there were missed opportunities to detect HCV infection among people newly diagnosed with HIV.
Since 1998, CDC has recommended hepatitis C testing for persons at increased risk for HCV infection, including persons who (a) are currently or have ever injected drugs; (b) were ever on chronic hemodialysis; (c) received blood transfusions or organ transplants before July 1992; (d) received clotting factor concentrates produced before 1987; (e) had a recognized exposure (e.g., healthcare, emergency medical, and public safety workers after needle sticks, sharps, or mucosal exposures and children born to hepatitis C-infected mothers); and (f) had laboratory evidence of liver inflammation (i.e., persistently elevated alanine aminotransferase levels) [18]. In 1999, hepatitis C testing also was recommended for persons with HIV [19]. In 2012, CDC expanded hepatitis C testing recommendations to include one-time testing for persons born during 1945-1965 [20]. Similarly, the American Associations and Society for Liver Disease (AASLD) and United States Preventative Services Task Forces USPTF) recommend hepatitis C testing in person who are at increased risk for hepatitis C and one-time testing for persons born during 1945-1965 [21-22]. Despite these long-standing recommendations, limited studies have assessed hepatitis C testing among HIV infected persons who have initiated HIV care [8]. Therefore, we sought to explore the frequency and rates of hepatitis C testing among a large sample of commercially insured, newly diagnosed HIV-infected individuals. The specific aims of the study were to: (1) determine rates of hepatitis C testing during the 12-month period following the diagnose of HIV and (2) examine demographic, regional, and healthcare related factors associated with hepatitis C testing.
Results
From 2008 through 2016, a total of 46,277 commercially insured persons were identified as newly diagnosed with HIV in the MarketScan® database. The frequency of new HIV diagnoses varied by an average of 728 patients from year to year. The number of new HIV diagnoses ranged from 6,838 in 2011 to 3,464 in 2016 patients. Among those identified across all years, 64% were male (Table 1). Most patients were aged 30-49 years (50%), the mean and median age was 38 years. Most of the persons diagnosed with HIV resided in the Southern region of the U.S. (39%), followed by the Northeast (32%). Only 15% of patients were in the Midwest and 14% were in the Western region. Most patients received care in urban areas (95%).
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