Study: Improvements Needed for Hepatitis C Testing in Youth

The opioid epidemic is fueling an increase in hepatitis C in the Unites States, especially among younger demographics. Data from the Centers for Disease Control and Prevention (CDC) reveal that in 2016, 9.1% of all people with chronic hepatitis C virus (HCV) infection were between the ages of 15 and 24 — up from 3.8% in 2009. Injection drug use is a major risk factor for HCV in young adults. Current guidance recommends HCV testing for people of any age who are at risk, including anyone who has injected drugs, as an important first step in linking patients to care. Treatment options in this age group have improved. The FDA recently approved the first direct-acting antiviral treatment for children 3 to 11 years old, and multiple regimens — which typically last two to three months and involves taking a few pills each day — are available for youth aged 12 to 17. “This is now an easily treatable virus, meaning that HCV elimination is possible,” says Rachel Epstein, MD, MSc, an infectious diseases physician at Boston Medical Center. Now that treatment is feasible for young children, Epstein adds, the discussion between pediatricians and their patients about both substance use and HCV is even more critical. Despite the testing recommendations and available treatments, however, HCV testing practices among youth have not been evaluated, and among increasing incidence among this age group, little is known about how effectively they’re being linked to care. A recent study, led by Epstein and published in the Journal of the American Medical Association, is the first to analyze national data to characterize how adolescents and emerging adults (ages 13 to 21 years) are both tested and treated for HCV. The study uncovered a huge need to improve testing rates for hepatitis C virus (HCV) in young people, specifically those with documented substance use history. Using electronic health record data from the OCHIN network of 57 federally qualified health centers (FQHCs) in 19 states, study investigators identified 269,124 patients, age 13 to 21 years, who’d had at least one health center visit between 2012 and 2017. Of the patients who reported using one or more injectable substances — including opioids, methamphetamine, and cocaine — fewer than 30% were tested for HCV. Among those who were tested, over 7% were positive for HCV antibodies (versus 1.8% in the entire sample), and 45% of patients who had follow-up testing to confirm had a current infection. Only 36% of HCV-infected youth completed genotype testing to determine a personalized approach to treatment based on their specific strain of HCV — and only one individual had documented HCV treatment. “These data are cause for concern — and action — to ensure that patients are not only being tested, but also receiving the treatment necessary to cure the disease,” says Sabrina Assoumou, MD, MPH, senior author of the study. As patients do not always disclose substance use, the researchers note, more universal testing and earlier identification of HCV may be critical to prevent transmission and morbidity from disease progression. “Improving our standards for identifying at-risk populations sooner and for treating those with chronic infection is necessary to improve individual care and ultimately reduce hepatitis C transmission,” says Epstein.