HCV in Children Spikes as Substance Abuse Spreads

Ravi Jhaveri, MD

A growing number of children are being hospitalized with hepatitis C virus (HCV) infection, coinciding with the increase in substance abuse in the US and the disproportionately greater rates in the northeast and southern regions.

The results highlight disturbing trends in children with HCV that mirror those reported in adults both nationally and in the Appalachian States, wrote principle investigator, Ravi Jhaveri, MD, Division of Infectious Diseases, Department of Pediatrics, University of North Carolina (UNC) School of Medicine, Chapel Hill, NC and colleagues.

"They demonstrate that the current epidemic of new HCV cases has not spared children, and in particular, adolescents," researchers wrote. "These results also likely represent a significant underestimate of the true burden, because children would likely not manifest symptoms from HCV and would not require hospitalization."

Jhaveri and colleagues accessed the Kids' Inpatient Database (KID), a part of the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality (AHRQ), to examine patient- and hospital-level discharge data across 44 states in 3-year increments from 2006, 2009 and 2012.

The investigators reported that the rate of hospitalizations of children with HCV has increased by 37% in the period between 2006 (2.69 per 10,000 hospitalizations) to 2012 (3.69 per 10,000).

The median age was 17.6 years, and the HCV cases in patients between 10 to 20 years of age represented 68% of the total HCV diagnoses. The prevalence of substance abuse diagnosis in admissions increased among children with HCV from 25% in 2006 to 41% in 2012.

The investigators compared the demographics of those with HCV against a control group admitted for appendicitis, selecting this condition as a common pediatric medical problem not bound by geographic or demographic boundaries and with a relatively stable incidence over time.

In comparison to the appendicitis group, children hospitalized with HCV comprised more females, more whites, more from the South, and more from the lowest zip code median income quartile. Substance abuse was found in 33% of those with HCV, compared with 0.2% of those hospitalized for appendicitis.

The work shines a brighter light on the impact that the opioid epidemic has had on society, Jhaveri told MD Magazine.

“Adolescents have not been an age group that has received a lot of attention regarding Hepatitis C," Jhaveri said. "Our findings show that they are suffering too and they present us with an opportunity to think broadly about HCV treatment."

The study lead author, Sidney Barritt, IV, MD, MSCR, Division of Gastroenterology, Department of Medicine at UNC, told MD Magazine that this increase of HCV in hospitalized children is “just the tip of the iceberg and is very likely a conservative estimate of the real burden of disease.”

"Adolescents aren't screened systematically for HCV and many/most cases go undetected,” Barritt said. “Curing and eliminating HCV is no longer a question of highly effective medications, it is now an issue of case identification and access to care.”

The study, "Increasing Prevalence of Hepatitis C among Hospitalized Children Is Associated with an Increase in Substance Abuse," was published online in The Journal of Pediatrics last month.

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