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Increases in acute HCV correlate with growing opioid epidemic in US

Results of a recent study showed a significant correlation between the increase of acute hepatitis C cases in the U.S. and the country’s current opioid epidemic. Acute HCV and admissions for opioid injection drug use increased significantly among individuals aged 18 years to 39 years, both men and women, and specific ethnicities.

“Substantial increases in the number of persons with opioid use disorders who inject drugs have the potential to thwart the nation’s efforts to control morbidity and mortality associated with HCV infection, consequently undermining the National Academies of Sciences, Engineering, and Medicine’s national strategy for the elimination of hepatitis B and C,” Jon E. Zibbell, PhD, from the Behavioral and Urban Health Program, Georgia, and colleagues wrote. “It also challenges the Centers for Disease Control and Prevention’s Viral Hepatitis Strategic Plan for 2016 to 2020, which underscores reductions in HCV infections caused by [injection drug use] behaviors as a priority area.”

Zibbell and colleagues analyzed Treatment Episode Data Set (TEDS) admissions from the Substance Abuse and Mental Health Services Administration (SAMHSA) and laboratory-confirmed cases of acute HCV with associated demographic and risk factors from the National Notifiable Disease Surveillance System.

Acute HCV

The researchers found 12,953 acute HCV cases reported between 2004 and 2014 in the U.S. The annual rate increased from 0.3 cases per 100,000 in 2004 to 0.7 cases per 100,000 in 2014 (P < .001) for an overall rate increase of 133%.

While the annual acute HCV rates increased among all ages, sexes and ethnicities, the researchers observed significant increased rates among individuals aged 18 years to 29 years (400%) and 30 years to 39 years (325%), non-Hispanic whites, Hispanics and both men and women (P < .001).

Of the 40 states with reported data, 15 states showed a 500% increase in acute HCV. Kansas, Maine, New Jersey, Wisconsin, Ohio and Massachusetts showed an increase of 1,000% or higher. Delaware, North Dakota, Nevada, Texas, Vermont, South Carolina and Michigan showed decreased rates of acute HCV.

Injection drug use

From 2004 to 2014, admissions attributed to any injection drug use increased by 76%. Use of any injected opioids increased by 93% over the same period (10% to 19%; P < .001). Specifically, heroin injection increased by 85% and prescription opioid analgesic (POA) use increased by 258%.

Admission for opioid, heroin or POA injection increased significantly among individuals aged 12 years to 17 years (103%, 97% and 194%, respectively), those aged 18 years to 29 years (817%, 622% and 603%, respectively) and those aged 30 years to 39 years (83%, 77% and 169%, respectively).

Admission for opioid, heroin or POA injection increased significantly among both men (99%, 89% and 263%, respectively) and women (89%, 83% and 249%, respectively) and non-Hispanic whites (134%, 126% and 248%, respectively). POA injection increased by 167% among non-Hispanic blacks and by 429% among Hispanics.

Of the 50 states with reported data from 2004 to 2014, and Washington D.C., admissions for prescription opioid analgesic injection increased by over 500% in eight states and by 1,000% or higher in Arizona, Florida, New Hampshire, New Mexico and West Virginia. Additionally, admissions for heroin injection increased by 500% in five states and Washington D.C. and by 1,000% or higher in Kentucky and West Virginia.

Associated increase

In their final analysis, the researchers found that injection drug use was indicated almost every year in 60% or more of acute HCV cases that included risk factor data and in 75% of cases each year from 2011 to 2014.

Results from a scatterplot showed a positive correlation between injection drug use admissions and cases of acute HCV, especially in an analysis of 2009 (R² = 0.001) and 2014 (R² = 0.024;).

“Integrated health services that include syringe service programs, medication-assisted treatment, and comprehensive HCV testing and linkage to care and treatment of HCV-infected [people who inject drugs (PWID)] are essential to reduce prevalence and incidence among the population,” the researchers wrote. “Increasing access to curative HCV treatment is also a key component of a comprehensive program. These efforts will require evidence-based strategies to effectively recruit and engage PWID into treatment for both [substance use disorder (SUD)] and HCV infection. A coordinated response among federal, state and local health departments is essential to address the syndemic of opioid use and misuse and HCV infection on a national scale.” – by Talitha Bennett

Disclosure: Healio.com/Hepatology was unable to determine relevant financial disclosures at the time of publication.