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The Burden of Hepatitis C Infection-Related Liver Fibrosis in the United States
R Monina Klevens1, Lauren Canary1, Xiaohua Huang2
1Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia.
Insights
Approximately 1 in 4 people infected with hepatitis C virus (HCV) have advanced liver disease. This highlights the urgent need for antiviral therapy in those at highest risk of complications.
Area of Science:
- Hepatology
- Infectious Diseases
- Public Health
Background:
- Accurate estimation of advanced fibrosis or cirrhosis in hepatitis C virus (HCV)-infected individuals is crucial for healthcare planning.
- Understanding the prevalence of advanced liver disease in the HCV-infected population is essential for resource allocation and treatment strategies.
Purpose of the Study:
- To determine the proportion of HCV-infected individuals with advanced fibrosis or cirrhosis using laboratory testing data.
- To assess the proportion of HCV-infected patients who are currently in care and evaluated for treatment.
Main Methods:
- Analysis of approximately 10 million HCV-related test results from a large US commercial laboratory (January 2010-December 2013).
- Inclusion of hepatitis C antibody, HCV RNA, HCV genotype, liver function tests, and platelet counts.
- Calculation of Aspartate Aminotransferase (AST)-to-Platelet Ratio (APRI) and Fibrosis-4 (FIB-4) scores to estimate liver disease severity.
Main Results:
- Of 2.6 million patients with evaluable data, 5% were currently infected with HCV.
- Among currently infected individuals, 23% had advanced fibrosis or cirrhosis, with 27% in the 1945-1965 birth cohort.
- 54% of infected individuals were in care, and 51% with advanced fibrosis/cirrhosis were evaluated for treatment.
Conclusions:
- Testing data from a major US laboratory suggests that approximately 25% of HCV-infected individuals have significant liver disease.
- A substantial proportion of HCV-infected persons have advanced fibrosis or cirrhosis, indicating a high risk for complications and a need for prompt antiviral therapy.
Background:
Knowledge of the estimated proportion of hepatitis C virus (HCV)-infected persons with advanced fibrosis or cirrhosis is critical to estimating healthcare needs.
Methods:
We analyzed HCV-related testing conducted by Quest Diagnostics from January 2010 through December 2013. Tests included hepatitis C antibody, HCV RNA, HCV genotype (nucleic acid tests [NAT]), liver function tests, and platelet counts; patient age was also determined. Aspartate aminotransferase (AST)-to-platelet ratio (APRI) was calculated as = 100*(aspartate aminotransferase [AST]/upper limit of AST)/platelet. Fibrosis-4 (FIB-4) was calculated as (age × AST)/(platelet ×√ alanine aminotransferase [ALT]). Persons were "currently infected" if they had ≥1 positive HCV NAT; "in care" if a positive RNA test was followed <6 months by ≥1 additional NAT(s), or ALT, AST, and platelets <90 days, or any test ordered by an infectious diseases or gastroenterology specialist; and "evaluated for treatment" if they had a genotype test.
Results:
Approximately 10 million HCV test results were analyzed, representing 5.6 million unique patients. Of the 2.6 million patients with data to estimate liver disease, 5% were currently infected. Among those currently infected, APRI and FIB-4 scores indicated that 23% overall-and 27% among the cohort born during 1945-1965-had advanced fibrosis or cirrhosis at first diagnosis. A total of 54% of infected were in care and 51% of infected with advanced fibrosis or cirrhosis were evaluated for treatment.
Conclusions:
Testing from a large US commercial laboratory indicates that about 1 in 4 HCV-infected persons have levels of liver disease put them at highest risk for complications and could benefit from immediate antiviral therapy.
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