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'Safety net' hospitals need to implement baby boomer HCV screening

The implementation of a hepatitis C virus infection screening system for baby boomers should be a top priority for safety net hospitals, which serve a disproportionate number of low-income and Medicaid patients, according to published findings in Hepatology.

“Baby boomer screening is now a nationally recommended quality of care guideline because three-quarters of the estimated 3 to 4 million HCV-infected persons in the U.S. are baby boomers and approximately half are unaware of having this infection,” Barbara Turner, MD, MSED, MACP, professor of medicine, University of Texas Health Science Center, told Healio.com/Hepatology. “HCV screening needs to be prioritized in clinical settings that serve low income populations because the prevalence of HCV infection is significantly higher in these groups.”

Barbara Turner

Turner and colleagues examined the prevalence and predictors of HCV infection and advanced fibrosis or cirrhosis based on the Fibrosis-4 score of 5,087 baby boomers admitted to University Hospital, Bexar County, Texas, between December 2012 and August 2014. Of these, 90% underwent anti-HCV testing (n = 4,582) and were followed through June 2015.

Of all the patients who underwent anti-HCV testing, 6.7% tested positive (n = 312). The adjusted odds ratios (OR) of testing anti-HCV positive was 2.66 for men compared with women (P < .001), 1.25 for uninsured patients compared with insured (P = .06), 0.7 for Hispanics compared with non-Hispanic Caucasians (P = .005) and 0.93 per year of age (P < .001).

Among 287 patients tested for HCV RNA, which were 91% of all anti–HCV-positive patients, 61% still had virus in their blood, which researchers found to be 5% less likely per year of age (P < .03), according to the research.

Of 148 patients with chronic HCV, noninvasive staging found advanced fibrosis or cirrhosis in 50 of them, with higher adjusted ORs of 3.21 for Hispanics compared with non-Hispanic Caucasians and Asians (P = .02) and 1.18 per year of age (P = .001).

“Overall, 175 patients were newly diagnosed with chronic HCV and unaware that they had this potentially life-threatening disease,” Turner said. “Although Hispanics were significantly less likely to have HCV infection, they were over three times more likely to have evidence of advanced liver disease or cirrhosis at diagnosis compared with non-Hispanic whites.”

Other significant predictors of advanced liver disease or cirrhosis included being overweight or obese, past or current heavy alcohol use, no health care insurance and older age, according to Turner. 

“These data reinforce the need to systematically screen and link chronically infected baby boomers, especially those from low income and minority populations, to highly effective anti-HCV therapies to prevent end-stage liver disease, liver transplantation and death,” Turner said.

The researchers concluded: “This prospective cohort study strongly supports implementation in similar hospital settings serving low-income patients. This hospital infrastructure can facilitate screening and engagement with treatment of persons who have increased risk of HCV infection, but limited access to care.” – by Melinda Stevens

Disclosures: The researchers report no relevant financial disclosures.