Spike in HCV Linked to Opioid Injection Hits Young Adults Hardest

A jump in acute hepatitis C infection (HCV) in the US dovetails with a similar increase in injection of opioids, with young adults hit hardest by the combined health threats, new analysis shows.

Research from the US Centers for Disease Control and Prevention (CDC) found that acute HCV cases rose 133% from 2004 to 2014, while admissions to substance use disorder (SUD) treatment facilities for opioid injections climbed 93%.

Injection drug use (IDU) is the primary risk factor for HCV transmission and the leading cause of incidence in the US, according to the research published in the February 2018 issue of the American Journal of Public Health.

"Taken together, the findings point to a close relationship between the two troubling trends," the CDC noted.

Individuals aged 18 to 29 showed the most extreme increases in rates of injecting heroin and prescription opioid analgesics (POAs) coupled with acute HCV infections. These young adults had a 400% rise in HCV cases, a 603% surge in admissions for heroin injection, and an 817% jump in admissions for injection of POAs.

“Our findings, which reveal national increases in both the number of persons injecting POAs and the number of acute HCV infections, indicate a more widespread problem than previous studies have shown," researchers led by the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) wrote.

Previous studies have shown that people who inject POAs have a higher risk for HCV infection than persons who inject heroin and non-opioids, the authors noted.

Overall, women fared worse than men in new HCV infections. Rates of acute cases of the virus for women jumped almost four-fold, while rates for men increased more than two-fold over the 11-year period.

Women of childbearing age had a marked rise in hepatitis C. That finding is consistent with reports showing the number of infants born to HCV-infected mothers is increasing.

The researchers found a four-fold increase from 2004 to 2014 in overall incident cases of neonatal abstinence syndrome (NAS), which occurs when a baby is exposed to drugs in the womb and goes through withdrawal after birth.

"These trends illustrate the extraordinary burden of the opioid epidemic on the health of women and children in the United States,’’ the authors wrote.

As many as 8% of pregnant women worldwide are infected with HCV, according to the Society for Maternal-Fetal Medicine (SMFM). The society recommends that pregnant women at risk for HCV be screened at their first prenatal visit.

“Obstetric care providers will likely encounter HCV more than they have in the past,” SMFM member Brenna L. Hughes, MD, MSc, told MD Magazine when the screening guidelines were released in November.

The analysis also found a previously unidentified jump in both acute HCV and admissions for POA injection among the US Hispanic population.

While admissions for POA use account for less that 1% of total SUD admissions in this population, there was a 429% surge in admissions for POAs from 2004 to 2014. That compared to the 4% rise for heroin injection admissions, the team found.

The researchers relied on the CDC’s National Notifiable Disease Surveillance System (NNDSS) for hepatitis C data. They analyzed national SUD admissions data from the Substance Abuse and Mental Health Services Administration (SAMHSA.)

A total of 12,953 cases of acute HCV infection were reported in the US from 2004 to 2014. The annual incidence rate increased from 0.3 cases per 100,000 in 2004 to 0.7 cases per 100,000 in 2014. Only 7 states, Delaware, North Dakota, Nevada, Texas, Vermont, South Carolina and Michigan, saw a decline in reported HCV cases.

For drug-injection statistics, the team found an increase of 500% or higher in the number of admissions for POA use in 8 states. Arizona, Florida, New Hampshire, New Mexico, and West Virginia showed rises of 1000% or more.

For heroin admissions, 5 states and the District of Columbia saw increases of 500% or higher. Kentucky, West Virginia and the District of Columbia saw increases of 1000% or greater. No state reported a decrease in admissions for POA injection; Hawaii saw a decline in admissions for heroin injection over the 11-year period.

The CDC cited the need for community opioid prevention services that support treatment and recovery for drug injectors as well as testing, treatment and prevention efforts to counter HCV.

“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,’’ the researchers concluded.

The study, "Increases in Acute Hepatitis C Virus Infection Related to a Growing Opioid Epidemic and Associated Injection Drug Use, United States, 2004 to 2014," was published online in September.

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