Physicians
Test for Hepatitis C Based on Risk Factors but Should Expand Screening
for High-Prevalence Age Group
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| SUMMARY:
Medical
providers seeing patients in a high-risk urban setting
tend to recommend hepatitis C virus (HCV) testing based
on known risk factors such as drug or alcohol use and
having symptoms of liver disease such as cirrhosis or
elevated ALT, according to an analysis published in
the May
20, 2010 advance online edition of the Journal of
Viral Hepatitis. Overall prevalence was high,
however, and the investigators suggested that broader
HCV screening might be useful for people born between
1945 and 1964, even if they do not have other risk factors. |
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By
Liz Highleyman
W.N.
Southern from Albert Einstein College of Medicine and colleagues
examined HCV
testing practices to determine which patient characteristics
are associated with getting tested and with testing HCV positive.
They also sought to determine the prevalence of HCV infection
in a high-risk urban population.
Approximately 3.2 million people in the U.S. have chronic
hepatitis C, the study authors noted as background, but many
are not aware of their infection.
The researchers analyzed all patients seen at the ambulatory care
clinic at Montefiore Medical Center in the Bronx, New York City,
between January 1 and February 29, 2008. In addition, they extracted
demographic information, laboratory data, and ICD-9 diagnostic
codes from electronic medical records of patients seen between
March 1, 1997 and February 29, 2008. All participants were included
in the baseline phase of the Hepatitis C Assessment and Testing
Project (HepCAT), a serial cross-sectional study of HCV screening
strategies.
Results
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Among
the 9579 participants analyzed, 3803 (39.7%) had been tested
for HCV. |
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Of
these, 438 (11.5%) were HCV positive. |
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The
overall prevalence of HCV infection was estimated to be 7.7%,
assuming that untested participants would test positive at
the same rate as tested subjects, based on risk-factors. |
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The
following risk factors were associated with being tested for
HCV, and with being HCV positive: |
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Being
in the high-prevalence birth cohort born during 1945-1964
(roughly age 45 to 65); |
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History
of drug or alcohol abuse; |
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Being
HIV positive; |
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Diagnosis
of cirrhosis; |
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Diagnosis
of end-stage renal (kidney) disease; |
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Elevated
alanine transaminase (ALT). |
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"In
a high-risk urban population, a significant proportion of patients
were tested for HCV and the prevalence of HCV infection was high,"
the study authors concluded. The estimated 7.7% prevalence in
this group of patients is several times higher than the 1.6% rate
for the U.S. general population.
"We found strong evidence that physicians are using a risk-based
screening strategy to identify patients with HCV infection, using
known risk factors and other conditions associated with HCV to
guide testing," they continued in their discussion. However,
they added, broader screening may be indicated for people in the
high-prevalence birth cohort, even those without behavioral or
clinical risk factors.
Expanded testing might be useful given that a considerable proportion
of people with HCV do not know how they became infected. Furthermore,
sexual transmission of HCV is a growing concern among HIV positive
gay men, but sexual behavior is not commonly regarded as a hepatitis
C risk factor. At a recent hepatitis C forum attended by gay men
in San Francisco, several participants said their providers had
refused to test them for HCV because they did not have a history
of injection drug use or other traditional risk factors.
Investigator affiliations: Albert Einstein College of Medicine,
Montefiore Medical Center, New York, NY; School of Public Health,
Boston University, Boston, MA; VA QUERI-HIV/Hepatitis Program,
Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA; Division
of Viral Hepatitis, Centers for Disease Control and Prevention,
National Center for HIV/Viral Hepatitis/STD/TB Prevention, Atlanta,
GA.
6/22/10
Reference
WN
Southern, M-L Drainoni, BD Smith, and others. Hepatitis C testing
practices and prevalence in a high-risk urban ambulatory care
setting. Journal of Viral Hepatitis (Abstract).
May 20, 2010 (Epub ahead of print).
