ED screening identifies previously undiagnosed patients with HCV

WASHINGTON — A screening program implemented in an emergency department resulted in the identification of a large number of previously undiagnosed patients with hepatitis C, according to data presented at The Liver Meeting.

Researchers evaluated the results from an integrated, opt-out HCV screening model implemented at the ED of the University of Alabama at Birmingham. All eligible participants were born between 1945 and 1965, medically and surgically stable and capable of responding to a brief questionnaire assessing whether previous HCV screening had been performed and, if so, the results. The primary endpoint was previously unrecognized HCV infection within this population.

Patients who agreed to screening underwent an HCV antibody assay (Abbott Architect i1000). Those who tested positive underwent a further assessment of HCV RNA, without genotyping. The researchers presented early, 6-week data, collected between Sept. 3 and Oct. 17, 2013, on the results of this screening at the meeting.

During the 6-week period, 1,721 patients responded to the questionnaire. Of these, 1,287 were unaware of their HCV status, and 1,148 consented to testing. Test results were anti-HCV positive in 118 of these patients. At presentation, 20 participants’ HCV RNA results were pending; among those whose results had been obtained, 72.5% tested positive for HCV viremia.

Anti-HCV positivity was significantly more common among males than females (16.5% vs. 7.7%; P<.001). Investigators also noted that patients who were uninsured or had Medicaid or public insurance were significantly more likely to be HCV positive than those with private insurance (P<.001). No statistically significant differences in HCV positivity were observed according to race (P=.54 for white vs. black participants).

Detectable HCV RNA also was more common among HCV-positive males (80% vs. 57.6% of HCV-positive females; P=.02). HCV RNA prevalence did not differ according to race or insurance type.

The researchers estimated that during 1 year the ED would screen up to 8,000 patients within the birth cohort, and consequently could detect anti-HCV positivity in as many as 900 previously undiagnosed patients.

“We identified a high prevalence, 12%, of unaware antibody positive baby boomers and confirmed infection in 8.7% of our population screened overall,” presenter James W. Galbraith, MD, department of emergency medicine, University of Alabama at Birmingham, said. “Males and uninsured/underinsured individuals had disproportionately high prevalence rates. We’ve only been going for 6 weeks, but the implication is that the ED may be an important venue for hepatitis C screening for the baby boomer birth cohort.”

Disclosure: Galbraith reports no relevant financial disclosures.

For more information:

Galbraith JW. LB-6: Late-Breaking Abstract Session: Screening in Emergency Department Identifies a Large Cohort of Unrecognized Chronic Hepatitis C Virus Infection Among Baby Boomers. Presented at: The Liver Meeting 2013; Nov. 1-5, Washington.