Many young people with HCV remained untreated in 2019

In 2019, only 32% of children and youth who had tested positive for hepatitis C in British Columbia, Canada, had initiated treatment, according to data presented at The Liver Meeting Digital Experience.

“The specific clinical and treatment experiences of young people living with HCV infection are limited in HCV research, so care cascades are a useful tool that can visualize the journey of individuals across the stages of illness, care and treatment. And these are useful for identifying gaps in progress across the stages of care and ultimately can inform public health programming to optimize care services,” Dahn Jeong, MSc, a PhD candidate at the School of Population and Public Health at the University of British Columbia said during a presentation. “The aim of this study was first to construct the HCV cascade of care for persons aged younger than 30 years living in British Columbia in 2019, and we also aimed to characterize the progression of young people along the cascade.”

Jeong and colleagues analyzed data from the British Columbia Hepatitis Testers Cohort, which includes all individuals tested for or reported as an HCV case in British Columbia since 1990, on people aged younger than 30 years in 2019 who had been diagnosed with HCV. These data were also linked with administrative data on medical visits and prescription drugs from the British Columbia Ministry of Health databases . The HCV cascade of care was defined as estimated HVC prevalence, antibody diagnosis, RNA testing, genotyping, treatment initiation and sustained virologic response (SVR). The proportion of children and youth were estimated in each stage.

In 2019, an estimated 1,800 children and youth were living with chronic HCV in British Columbia. Of these, 1,350 tested positive for HCV antibodies, 1,110 subsequently received a confirmatory HCV RNA test and 673 were HCV RNA-positive. Among HCV RNA-positive patients, 538 had their HCV genotyped. However, of those genotyped, only 217initiated treatment. By the end of 2019, 456 of the 673 patients aged younger than 30 who tested positive for HCV RNA remained untreated.

Notably, only 32% of HCV RNA-positive patients younger than 30 accessed treatment in 2019, as compared with 61% of those aged 30 or older.

Of the 138 patients with SVR data available, 121 achieved SVR.

Researchers found that a significant percentage of children and youth who tested positive for HCV RNA lived in urban areas (89.6%) and had access to opioid agonist therapy at least once in their lifetime (65.4%). The study also showed that 47.3% of this population were living with comorbidities.

“The prevalence of mood and anxiety disorder was particularly high, with over 60% of people younger than 30 with positive HCV RNA being diagnosed with a mood and anxiety disorder,” Jeong said. “This is very high compared with the overall [British Columbia] prevalence of mood and anxiety disorders among young people, which was about 27% for those between 20 to 34 years old in 2019.”

Researchers concluded that children and youth diagnosed with HCV may benefit from having HCV services co-located with other health and social services, such as mental health and harm reduction services.

“This analysis showed the importance of large population-based administrative data in uncovering the gaps that exist in public health programming. With the approval of direct-acting antivirals for young children and youth, there's a huge opportunity for providing treatment to young people living with HCV. Comprehensive services are needed to meet the needs of young people and their families, and timely transfer of knowledge could increase the treatment initiation to prevent long term liver and non-liver damages related to HCV and to promote overall quality of life,” Jeong said.