Article: Increases in Acute Hepatitis C Virus Infection Related to a Growing Opioid Epidemic and Associated Injection Drug Use, United States, 2004 to 2014—Jon E. Zibbell, PhD, et al.
SOURCE: American Journal of Public Health 108, no. 2 (February 1, 2018): pp. 175-181.
Study Aims and Results: To review and compare the rate of opioid injection drug use with the rate of acute hepatitis C (HCV) infections. This analysis included the type of injection drug (heroin vs. prescription opioid drug), patient characteristics (male/female), and race. The annual surveillance records from 2004 to 2014 were analyzed from drug treatment centers and compared to reported cases of acute HCV.
The rate of acute HCV infection increased more than 2-fold from 2004 to 2014—a 133% increase. Admissions to drug treatment centers due to any injection drug use increased 76%. Admissions for heroin injection use increased 85%, and prescription opioid drug injection use increased 258%.
Conclusions: The findings correlate with the increase of acute HCV infections, the opioid epidemic, and admissions to drug treatment centers.
Editorial Comments: This study provides additional evidence that the opioid epidemic and the second HCV epidemic are linked. To control these twin epidemics more resources will be needed on a local, state and national level.
Among patients in the acute phase of hepatitis C virus (HCV) infection, a portion will spontaneously clear the infection without treatment, and HCV RNA will completely disappear from the serum. Estimates from various studies project that anywhere from 20% to 30% of patients will spontaneously clear HCV, with the biggest factors being sex, ethnicity, immune status, and genetics.
For those who do not clear the infection on their own, direct-acting antiviral (DAA) agents have become available, and over 90% of patients undergoing treatment with these drugs will achieve a cure. The biggest drawback to DAA treatment is the cost, with 1 course of treatment in the United States ranging from $51,000 to $84,000.
The question then remains as to which patients should be targeted to receive treatment with DAAs, with the goal of not just reducing the number of individual HCV infections but also the public health burden of the disease in the future.
Results of a recent study showed a significant correlation between the increase of acute hepatitis C cases in the U.S. and the country’s current opioid epidemic. Acute HCV and admissions for opioid injection drug use increased significantly among individuals aged 18 years to 39 years, both men and women, and specific ethnicities.
“Substantial increases in the number of persons with opioid use disorders who inject drugs have the potential to thwart the nation’s efforts to control morbidity and mortality associated with HCV infection, consequently undermining the National Academies of Sciences, Engineering, and Medicine’s national strategy for the elimination of hepatitis B and C,” Jon E. Zibbell, PhD, from the Behavioral and Urban Health Program, Georgia, and colleagues wrote. “It also challenges the Centers for Disease Control and Prevention’s Viral Hepatitis Strategic Plan for 2016 to 2020, which underscores reductions in HCV infections caused by [injection drug use] behaviors as a priority area.”
Zibbell and colleagues analyzed Treatment Episode Data Set (TEDS) admissions from the Substance Abuse and Mental Health Services Administration (SAMHSA) and laboratory-confirmed cases of acute HCV with associated demographic and risk factors from the National Notifiable Disease Surveillance System.
Hepatitis C incidence is increasing among gay and bisexual men living with HIV in San Diego, according to the largest analysis of its kind done in the United States. Study results were presented this week at the 2017 AASLD Liver Meeting in Washington, DC.
Not surprisingly, the small number of men who reported injecting drug use had a higher likelihood of being newly infected with hepatitis C virus (HCV), but so did the much larger proportion who reported non-injection methamphetamine use.
Starting in the early 2000s researchers in the UK and elsewhere in Europe began to report clusters of apparently sexually transmitted acute HCV infection among HIV-positive men who have sex with men (MSM). Similar outbreaks have since been seen in Australia and the US.
(CHRISTIANSBURG, Va.) – The New River Valley has elevated rates of acute hepatitis C, and numbers are increasing every year.
Antonio Brown Jr., a public health associate from the Centers for Disease Control and Prevention (CDC), works to prevent hepatitis C transmission in the New River Valley. During his two-year fellowship with the New River Health District Academic Health Department and Virginia Tech he will develop a comprehensive hepatitis C prevention plan. His work includes conducting interviews, identifying and investigating new cases and providing prevention education.
“Since 2012, more than 1,000 cases of hepatitis C have been reported in the New River Health District,” said District Health Director Noelle Bissell, M.D. “We have seen significant numbers of cases of acute hepatitis C infection linked to tattoo parlors, the use of homemade tattoo guns at parties and in people who report more than 10 sex partners. We’re also noticing a trend in cases associated with intravenous drug abuse, particularly methamphetamine, and in pregnant women and women of childbearing age.”
Note: This is a frequently asked question at our training workshops! Alan
In acute hepatitis C infection, the amount of time when a patient is virologically positive but IgG antibody (Ab) negative, referred to as the pre-seroconversion window, differs depending on the method used. Researchers from Johns Hopkins School of Medicine and the National Institute of Allergy and Infectious Diseases in Baltimore, Maryland used various assay algorithms to better understand that window period.
The researchers pulled data from studies on commercially available hepatitis C seroconversion panels. They evaluated primary viral infection and subsequent IgG Ab seroconversion and presented their findings were presented at the Conference on Retroviruses and Opportunistic Infections (CROI 2017) in Seattle, Washington.
Laboratory results were gathered from 82 repeat donors, making up 754 visits. Thirty-nine of them were excluded—23 were hepatitis C RNA positive at baseline, 12 remained hepatitis C negative during the study period, and four whose interval to estimate the initial infection date more than 30 days.
Hepatitis C is increasing across central Wisconsin — with one county experiencing six times more cases over a five-year period — and health officials want people in at-risk groups to get tested as soon as possible.
Failure to get tested and treated can have serious consequences, including liver disease and eventually liver cancer from hepatitis C, said Melanie Behr, nursing supervisor for the Portage County Health Department Scott Stokes, director of prevention for the AIDS Resource Center of Wisconsin, said he is a long-term recovering heroin addict who tested positive for hepatitis C. He was working for a drug treatment program after he stopped using heroin when staff members encouraged all participants to get tested for blood-borne illness, Stokes said. Because he had been working with drug addicts and learned the risks of infected needles, Stokes figured there was a good chance he had hepatitis C — so a positive test didn’t surprise him.
“During my drug-using life, we didn’t know anything about needle hygiene,” Stokes said.
RICHMOND, Va. (AP) — Virginia’s top health official is warning that the state soon be dealing with skyrocketing rates of hepatitis C and HIV due to the ongoing opioid epidemic.
The Richmond Times-Dispatch reports state health commissioner Dr. Marissa Levine said at a Virginia Board of Health meeting Thursday that opioid use is spurring on the two deadly infections. She predicted that a “tidal wave of hepatitis C” is coming.
A Virginia Department of Health report says cases of hepatitis C are rising in the state, with the primary infection risk being injection drug use. The infection can lead to liver disease.