Teens with opioid use disorders infrequently screened for HCV, HIV

Issue: November 2018

SAN FRANCISCO — Approximately one-third of teenagers and young adults with recorded opioid use disorders are screened for hepatitis C infection, according to research presented at IDWeek 2018. Researchers said that only a small portion of these patients are also screened for HIV.

“In the current opioid crisis, we have seen rising rates of HCV, yet there is little known about what testing for HCV is occurring in youths, including what percentage of youth are tested and how many youths have been exposed to HCV,” Rachel L. Epstein, MD, MA, a postgraduate research fellow in the section of infectious diseases at Boston Medical Center, said in a press conference.

To better understand the rate of HCV screening among teens and young adults aged 13 to 21 years, the researchers conducted a retrospective cohort study of patients with at least one recorded federally qualified health center between 2012 and 2017.

According to Epstein and colleagues, 269,287 patients in this age range who met inclusion criteria presented at 98 centers in 19 states during the study (54.7% female; 37.6% white; 33.5% Hispanic; 17.6% black; 11.3% other). The average age at these patients’ first screening was 18.5 years.

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During the study, only 2.5% of patients were tested for HCV and 2.2% had reactive HCV testing. More than three-fourths of young people tested for HCV received confirmatory RNA testing, and more than half had detectable RNA.

Although a small number of patients were tested for infection, 35% had recorded opioid use disorders. Only 8.9% of patients with any ICD-9 code for drug use were tested for HCV. Additionally, those who were tested for HCV were infrequently tested for HIV (10.6%).

“We need to be testing in order to diagnose, to find cases and link them to care so we can treat and, in the case of HCV, cure them,” Epstein said. “This is especially true now that we have very effective FDA-approved medications for adolescents with HCV.”

The researchers observed that certain demographics were more likely to be tested for HCV, including older (19-21 years vs. 13-15 years; adjusted OR, 5.64; 95% CI, 5.13-6.19) and black (aOR, 1.88; 95% CI, 1.76-2.00) patients. Furthermore, those with ICD-9 codes for certain substance use disorders, including amphetamine (aOR, 5.82; 95% CI, 5.10-6.64), opioids (aOR, 3.50; 95% CI, 2.92-4.19), cocaine (aOR, 2.90; 95% CI, 2.43-3.47) or cannabis (aOR, 2.46; 95% CI, 2.31-2.62), were more likely to be tested.

Epstein said that in order to reach CDC goals for reducing transmission of HCV among injection drug users and work to control the epidemic, it is vital that testing rates increase among youth and in general. Data regarding testing could be helpful for clinic directors and policy-makers for improving testing rates, she said.

“The proportion of youths reporting any injection use ever [is very similar to] the number of youths in our study who had either a diagnosed opioid or amphetamine use disorder,” Epstein added. “Overall, we are probably significantly underestimating the burden of youth with a known risk factor or any risk factor. Risk factor-based testing, as we have seen with HIV, has not been enough to control the epidemic. I think seeing the prevalence in our study of exposure certainly supports increasing testing to a more universal population. – by Katherine Bortz

Reference:

Epstein R, et al. Abstract 2570. Presented at: IDWeek 2018; October 3-7, 2018; San Francisco, CA.

Disclosures: The authors report no relevant financial disclosures.