HCV Prevalence Booming Among Younger Injection Drug Users

Testing and treatment programs should focus on populations driving new cases of hepatitis C virus.

Despite curative treatments for hepatitis C virus (HCV) and prevention programs, the prevalence of infections has been growing exponentially among younger individuals.

Traditionally, the HCV patient population has been thought to be older individuals who were exposed to the virus during blood transfusions and other medical procedures. This significant shift calls for novel approaches to targeting this population, according to a session presented at the National Association of Specialty Pharmacy (NASP) Annual Meeting and Educational Conference.

“We’re starting to see a large, upward swing largely among younger people who inject drugs,” Laura J. Pegram, MSW, MPH, manager, Drug User Health, NASTAD, said during the session. “Between 2010 and 2015, there was a nearly 300% increase in HCV in America.”

Additionally, current estimates indicate that one-third of people who inject drugs (PWID) aged 18 to 30 years have HCV, while up to 90% of older PWID have the infection. Pegram said that in her work, she has found that nearly all older PWID have HCV, although official estimates vary.

More than 70% of new HCV cases are attributable to injection drug use, making this group of patients an important target, according to the session. Pegram also said that 30% of people with HIV also have an HCV co-infection, which indicates that a community may be involved with risky behaviors.

It is estimated that more than 3.5 million patients have chronic HCV. Since incidence is still largely driven by baby boomers, newer programs are targeting this population to receive testing and treatment, if necessary.

However, Pegram urges expanding testing protocols to account for the other groups with HCV—PWID, those who have been incarcerated, and those who have received unsanitary tattoos.

Between 2006 and 2012, 34 states saw increases in HCV infections. Notably, these states were not primarily located on the coasts and urban areas where HCV outbreaks were localized in the 1980s, according to the session.

The CDC projected that areas vulnerable to an HCV/HIV outbreak are rural areas, non-urban, Appalachian region, and those that do not have vast access to resources. The National Strategy for the Elimination of Hepatitis B and C reports that implementing testing protocols and syringe exchanges in these areas may help prevent outbreaks.

Syringe exchange programs provide PWID with sterile equipment as a way to reduce the potential harms associated with injection drug use, according to the session. These programs also educates patients about overdoses, infectious diseases, testing, and treatment referrals.

A syringe access program implemented in Boston, MA, 25 years ago coincided with a 95% reduction in HCV cases among PWID, according to the session.

“The biggest takeaway is that all the research shows syringe access programs are proven to make communities safer,” Pegram said. “They are also a platform to talk to people about services—getting them preventive care, social services, and treatment if they are ready for it.”

Pegram also said that access to both non-medication- and medication-assisted treatment is also crucial to driving down HCV incidences.

Unfortunately, syringe access and treatment programs may not be currently offered in places with a high population of PWID. Expanding access to these programs and testing efforts for PWID, especially for younger populations driving new cases of HCV, could achieve significant progress towards eradicating the disease, according to the session.