Study Highlights Lack of Hepatitis C Screening Despite Growing Prevalence

Jarin Prasa, DO

Credit: LinkedIn

Findings from a recent study of patients seen at a safety net hospital in New York between 2012 and 2019 are calling attention to low hepatitis C virus (HCV) screening rates among patients who met guideline-recommended birth year criteria, a common trend in community health centers across the US.

Among more than 20,000 patients born between 1945 and 1965, 8.5% were screened for hepatitis C, 5.9% tested positive for HCV antibody, and 3.0% had an active infection, suggesting a need for broader screening initiatives and more focused resource allocation to decrease the burden of HCV.¹

“New York is among a few states that have more than 100,000 individuals with HCV,” wrote Jarin Prasa, DO, resident physician at Staten Island University Hospital, and colleagues.¹ “Concerningly, there is limited data on HCV exposure prevalence in local communities, raising concerns if effective screening strategies are in place.”

The US Preventive Service Task Force and the US Centers for Disease Control and Prevention previously recommended screening for individuals born between 1945 and 1965 due to their high hepatitis C burden. However, screening protocols have since changed to include any adult 18 years of age or older, accounting for its growing prevalence across all age groups despite the availability of accurate diagnostic tests and medical treatment. Understanding HCV exposure prevalence is crucial for assessing the effectiveness of screening strategies and allocating additional resources to decrease the burden of HCV if necessary.²

Investigators sought to identify screening rates for hepatitis C and the exposure prevalence and specific demographics of a community in Long Island, New York. To do so, they reviewed electronic medical records for all patients born between 1945 and 1965 seen in a 530-bed level 1 trauma center that has been screening patients within the previous screening age cohort for HCV since 2012. Investigators collected demographic data, history of intravenous drug use, and HIV coinfection status information for HCV-antibody-positive patients between January 1, 2012, and August 31, 2019.¹

Of 21,722 patients born between 1945 and 1965 seen in the hospital’s outpatient medical clinics, surgical clinics, emergency department, or for inpatient hospitalization or psychiatric encounters, 1,858 (8.5%) individuals were screened for hepatitis C. Among them, 109 (5.9%) tested positive for HCV antibody and were subsequently tested for HCV RNA. This further testing showed 56 (3.0%) patients had active HCV infection with detectable RNA.¹

Of the 109 patients who tested positive, 77 (70.6%) were male, 32 (29.4%) were female, 58 (53.2%) were Caucasian, 37 (33.9%) were Black, and 6 (5.5%) were Asian. When looking at other factors related to hepatitis C infection, investigators found 17 (15.6%) patients had a history of intravenous drug use, 4 (3.7%) had HIV coinfection, 5 (4.6%) had received previous treatment for HCV, and 2 (1.8%) had achieved sustained virologic response (SVR).¹

“This study highlights the need for broader screening initiatives and more focused resource allocation to decrease the burden of HCV in our community and likely that of other safety net institutions. National guidelines provided by organizations such as the CDC and USPSTF need to be matched to the local population served, and public health programs should resource communities with a high HCV burden to most effectively diagnose and treat individuals actively infected with HCV before the development of chronic liver disease,” investigators concluded.¹

References:

1. Prasa J, Karim SS, Jacob B, et al. Hepatitis C Prevalence on the Rise but Screening at Safety Net Institutions Lagging behind. International Journal of Hepatology. https://doi.org/10.1155/2023/3650746
2. US Centers for Disease Control and Prevention. Beyond baby boomers: Hepatitis C now heavily impacting multiple generations. NCHHSTP Newsroom. April 9, 2020. Accessed December 8, 2023. https://www.cdc.gov/nchhstp/newsroom/2020/hepatitis-c-impacting-multiple-generations-press-release.html