Study: HCV Underdiagnosed with Current HCV Screening Guidelines

Existing federal guidelines for hepatitis C virus (HCV) screening may miss as many as one-quarter of HCV infections, according to a new Johns Hopkins Hospital-led study.

In order to determine the burden of undocumented HCV infection, the researchers evaluated 4713 patients, aged 17 and older, presenting to the Johns Hopkins Hospital emergency department between June and August 2013. Among these patients, 652 were HCV-antibody–positive. Of these patients, 204 had undocumented HCV infection. Among this group, 99, or 48.5%, would have been diagnosed based on birth cohort testing, and another 54 (26.5%) would be identified by risk-based testing, according to the authors. Given an estimated 7727 unique emergency department patients with HCV infection in a 1-year span, birth cohort plus risk-based testing would identify 1815 undocumented infections, and universal testing would identify an additional 526 HCV-infected persons, the researchers note.
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Patients born between 1945 and 1965 had an HCV prevalence of roughly 25%, while those born outside this range had an HCV prevalence of 7%, according to the investigators, who also found that these participants demonstrated a higher prevalence of undocumented HCV compared with the 2.6% of other adults tested. The Johns Hopkins team also found that, among the 204 emergency department patients with an undocumented hepatitis C infection, 63% were in the group born between 1945 and 1965, while 45, or 22%, were injection drug users, and 10 (5%) were acknowledged as being infected with HIV.

“Birth cohort-based testing would augment identification of undocumented HCV infections in this ED 2-fold, relative to risk-based testing only,” the authors write. “However, our data demonstrate that one-quarter of infections would remain undiagnosed if current CDC birth-cohort recommendations were employed, suggesting that, in high-risk urban ED settings, a practice of universal one-time testing might be more effective.”

—Mark McGraw

Reference

Hsieh Y, Rothman R, et al. Evaluation of the centers for disease control and prevention recommendations for hepatitis c virus testing in an urban emergency department [published online February 21, 2016]. Clinical Infectious Diseases. doi:10.1093/cid/ciw074.