HCV Screening in Baby Boomers Requires Follow-Through

A recent study published in the journal Hepatology indicates that as many as 11% of baby boomers had a positive test result for presence of anti-HCV antibodies.

A recent study published in the journal Hepatology indicates that as many as 11% of baby boomers had a positive test result for presence of anti-HCV antibodies.

The high rates of hepatitis C virus (HCV) infection in baby boomers (people born between 1945 and 1965) are well known, but implementing screening services for this group of patients remains a challenge.

In the United States, 3 out of every 4 patients with HCV are baby boomers, therefore screening patients in this generation is an important, ongoing public health priority that requires follow-through.1

In a single-center emergency department setting, investigators Galbraith et al studied screening patterns in patients who were assigned to anti-HCV antibody screening. Testing was performed on an opt-out basis, meaning that screening was performed by default, with patients given the option to deny the test.2

Of 2325 patients, 12.7% opted out of the test, and the remaining 1529 patients underwent testing. Of these, 170 patients, or 11.1% of those tested, had a positive test result for anti-HCV antibodies.

On its own, the presence of anti-HCV antibodies does not definitely indicate that a person has HCV infection. People who have had an acute infection of HCV and cleared the infection spontaneously, for example, will have a positive result on HCV antibody tests. Confirmatory testing is necessary after the antibody test is carried out to determine if an individual has chronic HCV infection.2,3

Results of this study suggest some strategies for more targeted screening of patients. For instance, substantially higher rates of anti-HCV antibodies were identified in males than in females (14.7% vs 7.4%; P <.001).

Patients of African descent were more likely to have anti-HCV antibodies than Caucasians (13.3% vs 8.8%; P = .010), as were uninsured or underinsured patients versus insured counterparts (16.8% to 16.9% vs 5.0%; P = .001). A total of 102 cases were confirmed in the 2325-patient study, 100 of whom followed up for further care.2

With the availability of novel interferon-free, ribavirin-free regimens, such as the combination of sofosbuvir and simeprevir, and 3 new medications in near-term approval, recognizing and treating patients with chronic HCV infection has never been more urgent. Based on the results of this study, the rate of anti-HCV positivity in baby boomers who present to the emergency department exceeds 10% in some areas.

Every hospital and treatment center needs a plan of action for screening baby boomers for HCV infection.1,2

References:

  • CDC. Hepatitis C: Why baby boomers should get tested. http://www.cdc.gov/knowmorehepatitis/Media/PDFs/FactSheet-boomers.pdf. Accessed September 4, 2014.
  • Galbraith JW, Franco RA, Donnelly JP, et al. Unrecognized chronic hepatitis C virus infection among baby boomers in the emergency department. Hepatology. 2014.
  • IDSA/AASLD. Recommendations for testing, managing, and treating hepatitis C. http://www.hcvguidelines.org/. Accessed September 4, 2014.