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Only half of HCV patients with advanced liver disease receive treatment
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Researchers estimated that more than 800,000 people in the United States with chronic hepatitis C virus infection may have advanced fibrosis or cirrhosis and need care. However, laboratory testing data indicated that only half of these patients were evaluated for antiviral treatment.
“Persons with advanced fibrosis and cirrhosis are at highest risk of HCV-related complications and urgently require care,” R. Monina Klevens, DDS, MPH, of CDC’s Division of Viral Hepatitis, and colleagues wrote in Clinical Infectious Diseases. “Clearly, multiple barriers to treatment exist in the United States. Cost and restricted access to care may be the greatest barriers to treatment, despite evidence that treating infected persons early is cost effective.”
According to the researchers, the number of hepatitis C virus (HCV)-related deaths has steadily increased in the United States. Identifying asymptomatic infections early and linking patients to care could prevent more than 320,000 deaths associated with HCV-related complications between 2010 and 2060.
The CDC partnered with Quest Diagnostics to assess the burden of HCV-related liver disease in the U.S. The researchers analyzed data from patients undergoing HCV testing at Quest Diagnostics from January 2010 through December 2013 to evaluate the state of fibrosis at the time of diagnosis and to determine whether patients were in care and evaluated for HCV treatment.
During the 4-year study period, nearly 10 million HCV tests were performed on more than 5.6 million people. Among them, 292,681 were currently infected with HCV. Klevens and colleagues estimated that 23% of all infected patients — and 27% born from 1945 to 1965 who are recommended by the CDC and the US Preventative Services Task Force (USPSTF) to be screened for HCV — had advanced fibrosis or cirrhosis at the time of diagnosis. When applying the overall percentage rate to the estimated 3.5 million people with HCV, the researchers projected that more than 800,000 people may be in “urgent need of medical management.”
Fifty-four percent of infected patients met the researchers’ criteria for being in care, which was defined as having at least one additional test ordered within 6 months of diagnosis. Among those with advanced liver disease, 50.6% had at least one genotype test indicating they were being assessed for antiviral treatment. Many patients not receiving care were tested by a primary care physician, underscoring the need to train PCPs on HCV screening, management and referral of patients with advanced liver disease to specialists, according to the researchers.
“Early identification of the estimated 3.5 million U.S. persons with chronic HCV infection and the estimated 800,000 with advanced fibrosis or cirrhosis is critical for the prevention of forecasted premature deaths and other complications by 2030,” Klevens and colleagues concluded. “The findings described in this study support the CDC and USPSTF recommendations for HCV testing and appropriate referral of persons born from 1945-1965, as well as efforts to reduce barriers to care among those who are HCV infected.” – by Stephanie Viguers
Disclosures: The study was supported by a grant from AbbVie. One researcher was an employee of Quest Diagnostics.
Perspective
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Carol L. Brosgart
One of the tragedies of chronic HCV is that because it has very few recognizable symptoms, half of those living with HCV are generally unaware that they are infected until disease has advanced. This research from Quest Diagnostics and CDC shows the value of proactive laboratory screening for HCV for both Baby Boomers and at-risk individuals, to identify individuals who are chronically infected and get them linked to care and into treatment as quickly as possible. Had these patients in this study been identified earlier, perhaps they could have been cured of the infection before it caused long-term liver damage and/or liver cancer.
Disclosure: Brosgart report no relevant financial disclosures.
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