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HCV-related cirrhosis prevalence increases over time

The rate of cirrhosis found among patients with hepatitis C virus infection increased over time, including individuals who were unaware they had hepatitis C, according to published findings.

“The number of Americans who have cirrhosis from chronic HCV infection has increased over time, due to aging of the baby boomers with hepatitis C. These data emphasize that health care providers should practice the CDC recommendation to screen individuals born between 1945 [and] 1965,” W. Ray Kim, MD, professor of medicine, division of gastroenterology and hepatology, Stanford University School of Medicine, told Healio.com/Hepatology.

Kim and colleagues evaluated data of 725 patients with HCV found in the National Health and Nutrition Examination Survey database, to determine the prevalence of cirrhosis among American adults with HCV and those unaware of their HCV infection status between three separate periods: 1988 to 1994, 1999 to 2006 and 2007 to 2012. Advanced fibrosis and cirrhosis status were measured by available Fibrosis-4 (FIB-4) and aspartate aminotransferase to platelet ratio index (APRI) scores.

W. Ray Kim

Based on APRI score, results showed that 6.6% of patients from 1988 to 1994 (95% CI, 2.2–11), 7.6% from 1999 to 2006 (95% CI, 3.4–11.8) and 17% from 2007 to 2012 (95% CI, 8–26) had cirrhosis. Results were comparable when FIB-4 was used, the researchers noted.

Multivariable regression analysis indicated the increase in HCV-related cirrhosis over the different eras was attributable to increasing age (OR = 1.04; 95% CI, 1.02–1.07), presence of diabetes (OR = 2.33; 95% CI, 1.01–5.4) and obesity (OR = 2.96; 95% CI, 1.15–7.57).

Cirrhosis was as common among patients who were unaware of their infection (11.2%) compared with patients who were aware (10.8%; P = .99), indicating the need for screening and treatment for HCV at the population level, according to the researchers. This trend was also evident when using FIB-4: the proportion of high, intermediate and low probability for advanced fibrosis was 15%, 36% and 49% in patients aware of their HCV. For patients unaware of their HCV, the proportion of high probability was 22%, for intermediate probability it was 30% and for low probability it was 48% (P = .48).

“Most patients with chronic hepatitis C infection are asymptomatic,” Kim said. “Importantly, the proportion of people with cirrhosis was the same between hepatitis C positive individuals who were aware of their infection and those who were not,” adding that chronic HCV is now curable, therefore improved outcome can be expected from a prompt screening and appropriate treatments.

The researchers concluded: “These data call for public health efforts to reduce the burden of HCV infection by ensuring adherence to the screening recommendations followed by systematic assessment for liver fibrosis and implementation of antiviral therapy in appropriate patients for primary and secondary prevention of cirrhosis and its complications.” – by Melinda Stevens 

Disclosure: Kim reports consulting and advising for Bristol-Myers Squibb and Gilead Sciences. All other researchers report no relevant financial disclosures.