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Severe fibrosis, cirrhosis prevalent in birth cohort of HCV patients

SEATTLE — Many adults with hepatitis C virus born between 1945 and 1965 had severe fibrosis or cirrhosis, according to data presented at CROI 2015.

“Our objective was to estimate the frequency and distribution of HCV-related liver fibrosis in the U.S. using commercial testing data,” Monina Klevens, DDS, MPH, of the division of viral hepatitis at the CDC, said during her presentation.

Monina Klevens

Klevens and colleagues, as well as medical experts from Quest Diagnostics, analyzed data collected by Quest Diagnostics on HCV-related tests performed across the United States between 2010 and 2013. The tests included data from HCV RNA, alanine transaminase, aspartate aminotransferase and platelet counts, which were then combined with age to calculate Fibrosis-4 (FIB-4) score. Researchers then examined the data by year and stage of fibrosis.

Between 2010 and 2013,  Klevens said 273,207 adults tested positive for HCV RNA, according to the presentation. Forty-six percent of patients with HCV RNA had the serologic parameters within 30 days of first RNA test to allow calculation of a FIB-4 score, according to Klevens, and 68% were born in the screening birth cohort (between 1945-1965).

“Of all infected individuals about 40% combined had severe fibrosis or cirrhosis; among younger persons, about 11% had severe fibrosis or cirrhosis; among persons in the screening birth cohort, almost half had severe fibrosis or cirrhosis combined; and among older persons, almost three-quarters had severe fibrosis or cirrhosis,” Klevens said.

Approximately 81% of patients in the screening birth cohort had severe fibrosis and 81% had cirrhosis, the highest percentages of fibrosis and cirrhosis among all the cohorts, according to the presentation.

Klevens presented data that showed the number and percentage of persons born in the screening birth cohort by year of first positive RNA test and severe fibrosis or cirrhosis.

“The percentage by year was stable with no apparent trend,” Klevens said. “This is an important indicator for surveillance to determine whether over time, screening identifies persons earlier in the stage of liver fibrosis.”

The data indicated that among those with chronic infection, 27% to 28% had severe fibrosis each of these years and an additional 21% to 23% had cirrhosis, according to Klevens.

“Our analysis found that about one-half of HCV-infected persons born from 1945 to 1965 had severe fibrosis or cirrhosis as measured by FIB-4 scoring,” Klevens said. “Of all infected persons with severe fibrosis or cirrhosis, 81% of each were born from 1945 to 1965. The proportions of persons in the screening cohort and with severe fibrosis or cirrhosis were consistent over time.

“There is an urgent need to identify HCV-infected persons to link them to management and care,” she said. – by Melinda Stevens      

Reference:

Klevens M, et al. Abstract 145.  Presented at: Conference on Retroviruses and Opportunistic Infections; Feb. 23-26, 2015; Seattle.

Disclosure: The study was funded through an investigator-initiated grant from AbbVie to the National Foundation for the Centers for Disease Control and Prevention Inc.