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.

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.