MedicalResearch.com: What is the background for this study?
Response: It is estimated that there are over 3 million people in the United States living with Hepatitis C virus (HCV) infection. Risk factors for infection include, but are not limited to, injection drug use, history of incarceration, HIV coinfection, and blood transfusion prior to July 1992. Several direct acting antiviral medications have recently been approved to treat, and in the majority of cases, cure HCV.
The first step in identifying infected persons so that they may be cured of this infection is a blood test for antibodies to HCV.
The greatest burden of HCV is among persons born from 1945 through 1965; the baby boomer birth cohort. Therefore, in 2012, the Centers for Disease Control and Prevention (CDC) published updated HCV antibody testing recommendations to include one-time testing of persons in the birth cohort. The United States Preventive Services Task Force (USPSTF) published similar recommendations the following year. Additionally, in recent years there has been an increase in HCV infections related to injection drug use among younger people.
We used commercial insurance claims data to describe trends in HCV antibody testing over a 10-year period (2005 – 2014), both to assess the impact of the CDC and USPSTF testing recommendations, and to better understanding how trends varied by gender, age group, and geography.
Hepatitis C virus infection is one of our nation’s most pressing public health concerns for infectious disease specialists and hepatologists. Not only did acute HCV infections increase 250% from 2010 to 2014, a recent report from the CDC shows that more people die of HCV in the United States than any other infectious disease, with a total 19,659 reported HCV–related deaths in 2014. Almost all of these deaths are due to the impact of chronic HCV on the liver (cirrhosis, end-stage liver disease, liver transplantation, and/or hepatocellular carcinoma or primary liver cancer).
Policymakers and clinicians have worked aggressively in the past decade to address the HCV epidemic, developing and implementing new CDC screening recommendations and a sweeping strategic plan, the HHS national viral hepatitis action plan, to identify infected individuals, prevent transmission and reduce mortality by the year 2020. But the most significant obstacle of combatting HCV is that most HCV–infected individuals are asymptomatic, until late in the disease process, with at least half those chronically infected unaware of their status. Given the recent availability of highly curative, all-oral, short-duration antiviral therapies, this is both a tragedy and a major public health challenge.
Increasingly, more clinicians have become aware of the need to find people who are at risk for infection and encourage them to get tested. However, a new study underscores the human consequence if we are unsuccessful.
Recently I went on a first date — a stroll in a city park — that went rather well. We had so much in common, from a love of reading to a history of youthful troublemaking. If I wasn’t convinced already he was someone I could relate to, my new friend shared that he’d been cured of Hepatitis C.
I could hardly believe it. Instead of having to awkwardly explain my medical history, I’d met someone who shares it. It was a first. The only other time I’d met people who’d been cured of Hepatitis C, I was at an event at Johns Hopkins celebrating the first 1,000 successes of the new drugs. Some of my fellow drug program participants had gotten it from blood transfusions, some from vaccinations in the military. Some had no idea how.
In any case, our unicorn status can’t go on much longer. According to the director of the Centers for Disease Control, who spoke that day, one in 30 baby boomers has Hepatitis C. Forty percent of those people will die of the virus, at an average age of 59.