—Lucinda K. Porter, RN
Important note: This month’s HCV Snapshots features selected abstracts from the May 2014 meeting of Digestive Disease Week.
The research presented here came from conference posters and
presentations, representing part of a picture. There are multiple
factors that influence treatment outcomes such as the number of
patients in the study, patient demographics (weight, age, ethnicity),
and study design (inclusion criteria, placebo vs. open label, etc.) to
name a few. Unless and until these studies are published in
peer-reviewed journals, these data and conclusions are considered
Projected Health and Economic Impact of Hepatitis C on the United
States Veterans Administration Health System from 2014 to 2024 – David
B. Rein, et al.
This study gathered data from medical records and
estimated the liver disease stage of 227,563 Veterans Administration
patients with chronic hepatitis C infection (HCV). Using these data,
they forecasted the outcomes if:
- Patients received no treatment (NT)
• Projected deaths in 2014 = 958; 2019 = 1490; 2024 = 1800
- Patients were treated with pegylated interferon and ribavirin (PR)
• Projected deaths in 2014 decreased 7.1%; in 2019 decreased 8%; 2024 decreased 8.9%
- Patients were treated with pegylated interferon, ribavirin, and a protease inhibitor (PRPI)
• Projected deaths in 2014 decreased 10.9%; in 2019 decreased 12.3%; 2024 decreased 13.7%
- Patients were treated with new all oral
hepatitis medications expected to be released in 2014, such as
sofosbuvir and ledipasvir.
• Projected deaths in 2014 decreased 50.2%; in 2019 decreased 56.7%; 2024 decreased 63.1%
The Bottom Line: All oral hepatitis C therapies are anticipated to save lives, and provide other positive health outcomes.
Editorial Comment: Hepatitis
C-related deaths may be under reported. Hepatitis C patients are at
increased risk of premature death from other medical conditions such as
heart disease, stroke, and cancer. Since these factors are not
captured in this analysis, the potential benefits of new hepatitis C
treatments may be greater than what is reported here.
Abstract: The Tip of an Iceberg – Who Is Known to Have Hepatitis C? – W. Ray Kim, et al.
There has been a campaign to implement
recommendations by the Centers for Disease Control and Prevention to
screen Baby Boomers (those born from 1945-1965) for hepatitis C, hoping
to find undiagnosed patients who might otherwise fall through the
cracks. It has been estimated that birth year screening will identify
800,000 Baby Boomers with hepatitis C who might not otherwise be
diagnosed. However, there isn’t strong data on actual hepatitis C
diagnosis in communities. This study, conducted in Olmsted County,
Minnesota, looked at blood samples of residents born from 1954 through
The Bottom Line: The prevalence of
hepatitis C in this rural Midwestern was similar to national data,
confirming that the majority of those with hepatitis C are not yet
diagnosed, including the majority of hepatitis C patients who are
younger, between ages 30 and 49.
Editorial Comment: Hepatitis C is a
growing problem in our youth, and younger adults. Those who are 30 to
49 may be overlooked. This study emphasizes the need to screen
everyone, not just Baby Boomers. In addition to birth year screening,
we also need to ramp up risk-based screening.
the Gap between HCV Screening and Access to Care: Insights from
National Health and Nutrition HCV Follow-up Study, 2001-2010 – Ivo
Ditah, et al.
Of the more than 52,000 participants in the
National Household and Nutrition Examination Survey 2001-2010, 502
(1.3%) tested positive for past or current HCV infection. After
participants were notified of test results, and encouraged to pursue
further care, a follow-up interview was conducted. Approximately 50% of
the participants had not known they were HCV+ prior to notification.
Roughly 80% pursued medical follow-up.
The Bottom Line: The majority of
patients who screen positive for HCV infection do pursue further
HCV-related care. Lack of health insurance was the main reason when
further medical care was not pursued.
Editorial Comment: The hope here
is that health care coverage expansion will increase access to HCV
medical care. Also noteworthy is that the median age of the HCV+
participants was 49, which means that quite a few were born after 1965,
the limit of the age-based testing recommendation.
of Life, Productivity, and Activity Impairment among US Survey
Respondents with Hepatitis C: An Evaluation of HCV and Six Select
Medical Conditions – Jamie B. Forlenza, et al.
This study used data from the 2012 U.S. National
Health and Wellness Survey. Of the 71,157 respondents, 0.9% reported
chronic HCV, 1.3% reported congestive heart failure (CHF), 2.8%
reported myocardial infarction (MI or heart attack), 5% reported
chronic obstructive pulmonary disease (COPD), 10.9% reported diabetes,
14.9 % reported depression, and 17.3% reported osteoarthritis (OA).
The Bottom Line: Compared to the
other six medical conditions, HCV patients were second only to
depression in the mental quality of life component of the survey. HCV
patients were third on physical quality of life. A quarter of the HCV
participants worked full-time, but reported loss of productivity at work
and missed work.
Editorial Comment: Although hepatitis C is largely invisible and silent, it has the power to do significant damage.