HCV Prevalence Is 60 Times Higher in Urban Areas

The prevalence of hepatitis C virus (HCV) is 60 times higher among patients in urban emergency departments (EDs) compared with the general population, according to a recent study.

Findings were presented at ID Week 2017, which is taking place from October 4 to 8, 2017, in San Diego, California.
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The Centers for Disease Control and Prevention (CDC) estimated that there were 30,500 new HCV infections in the United States in 2014, with HCV incidence ranging from 2 to 400 per 1000 person-years (PYs) in high-risk groups. Although it is well known that the seroprevalence of the HCV antibody and any evidence of HCV infection ever are high in urban ED patients, little is known about the recent prevalence of HCV in these patients.

For their study, the researchers evaluated 302 patients at a single ED using an ED-based HCV screening program. The researchers subsequently conducted a secondary analysis from a seroprevalence study of patients who visited an ED between December 10, 2015, and January 21, 2016. Patients included in the secondary analyses had at least 2 HCV antibody tests performed during 2 separate visits at the study hospital from 2003 to 2016.

A total of 60% of patients were female, 79% were African American, and 60% were age 35 years or older. Furthermore, 56% of patients had a commercial insurance payor, and 36% had Medicaid or Medicare. A total of 34 patients (11%) had human immunodeficiency virus (HIV) infection, and 7 (2%) were injection drug users.

The interval between 2 HCV antibody tests was used to calculate follow-up time in PYs for each patient. The researchers defined time of HCV seroconversion as the midpoint between the negative and positive HCV antibody test.

Ultimately, the researchers found that the incidence of HCV in urban ED patients was significantly higher than in the general population. Results indicated that overall, 6 patients had HCV seroconversion over 971.1 PYs, which resulted in an HCV prevalence of 6.2 per 1000 PYs.

The researchers noted that the prevalence of HCV differed significantly by race (30.9/1000 PYs in whites and 2.9/1000 PYs in African Americans) and by injection drug use (192.3/1000 PYs in users and 4.2/1000 PYs in non-users). However, this prevalence did not vary significantly by HIV status or birth cohort.

“The HCV incidence in urban ED patients was over 60 times higher than the general US population and even higher in some high-risk groups, indicating ED is a critical venue for identifying high risk individuals for HCV prevention and detecting HCV-infected Americans for treatment,” the researchers concluded.

—Christina Vogt

Reference:

Patel A, Rothman R, Thomas D, Hsieh YH. High incidence of hepatitis C virus (HCV) infection among an urban emergency department (ED) patients 2003-2016. Paper presented at: IDWeek 2017; October 4-8, 2017. San Diego, CA. https://idsa.confex.com/idsa/2017/viewsessionpdf.cgi.