Hepatitis C: Testing Recommendations Ensure Patient Treatment

Today, the Hepatitis C virus is the most common blood borne chronic viral infection in the United States. An estimated 5.2million persons are chronically infected with the Hepatitis C virus (HCV)and 75 percent of patients are unaware of their infection.1Experiencing a lack of symptoms that a chronically ill patient would typically encounter is one reason the infection has been referred to as “the silent killer.”

Prior to 2012, the Centers for Disease Control and Prevention (CDC) recommended HCV screening for only individuals with a previous history of certain behaviors or health indicators that are associated with HCV infection, such as injection drug use, hemodialysis, or abnormal liver function tests1,2. But in August 2012, the CDC published “Recommendations for the Identification of Chronic Hepatitis C Virus Infection Among Persons Born During 1945–1965” recommending an important expansion of the target groups to include the baby boomer generation. The new recommendation came in response to the widespread presence of HCV infection among baby boomers (those born between 1945 and 1965), approximately 80 million individuals. The CDC estimates that one out of every 30 baby boomers is living with HCV infection.

In June 2013, the U.S. Preventative Services Task Force (USPSTF) also revised its testing recommendations to include baby boomers, giving both HCV screening for at-risk individuals and age-cohort screening a ‘B’ grade. The new recommendations entitled “Screening for Hepatitis C Virus Infection in Adults: U.S. Preventive Services Task Force Recommendation Statement” similarly marked a dramatic expansion of the USPSTF's previous recommendation of screening for HCV. The USPSTF recommendations are particularly important in light of the Affordable Care Act. Under the Affordable Care Act, preventive services that have received an ‘A’ or ‘B’ grade from the USPSTF must be covered by insurance policies without cost-sharing and be part of the essential health benefits for those individuals eligible for Medicare.

Hepatitis C Today

The prevalence of HCV is highest in middle-aged, non-Caucasian men.3. Despite improved testing recommendations, up to 75 percent of patients with chronic HCV are still unaware of their HCV infection status4. As a result, the burden of disease and death continues to grow despite recent advances in antiviral therapies.

There are many reasons why patients with chronic HCV are not diagnosed, including:

  • Asymptomatic patients without any other medical problems may not seek medical attention
  • Many primary care physicians lack knowledge about risk factors and testing for HCV
  • Patients may be reluctant to reveal risk factors
  • Patients may be outside healthcare system (young, poor, drug addicts)

If left undetected and untreated, HCV can cause liver damage and liver failure. In fact, according to the CDC, HCV is the leading cause of liver cancer and the leading cause of liver transplants in the United States. The total medical costs for patients with HCV are expected to more than double over the next 20 years – from $30 billion to $85 billion in 2024 according to the Millman Report entitled “Consequences of Hepatitis C Virus (HCV): Costs of a Baby Boomer Epidemic of Liver Disease.”

Advantages of Rapid Testing

If HCV is detected early, successful treatments can eliminate the virus from the body. Current testing options, including rapid tests have continued to make testing easy and accessible. CLIA-waived rapid HCV tests may be administered in physician offices or public health facilities and clinics, thus offering the advantage of allowing immediate discussion with HCV positive patients about follow up testing and care.5

The immediate delivery of results, particularly for transient populations, is one of the most critical advantages rapid testing methods pose over lab based testing. In most instances, lab based testing involves an extended waiting period for results, which places patients who are waiting for their results at a disadvantage. Additionally, rapid testing methods allow numerous patients to be batch tested at once, and the delivery of more results in a shorter time span leads to increased workflow productivity.

In many public health facilities and clinics that have implemented rapid HCV testing into their programs, the use of a rapid finger prick method over a blood draw has resulted in increased patient satisfaction, particularly for settings that are testing at risk populations.

Now that the new testing recommendations are in place, it is critical to ensure they are being followed. Educational programs aimed at primary care providers can increase awareness of HCV risk factors (including birth cohort screening) that will lead to more HCV testing. Testing for HCV in primary care setting with establishing linkages to HCV providers can improve the likelihood of linking patients to appropriate care.

References:

1 CDC. Hepatitis C Testing Baby Boomers Saves Lives. CDC Vital Signs May 2013

2 Alter MJ, Seeff LB, Bacon BR, et al. Testing for hepatitis C virus infection should be routine for persons at increased risk for infection. Ann. Intern. Med. 2004;141:715-717

3 http://www.cdc.gov/ncidod/diseases/hepatitis/resource/dz_burden02.htm Accessed 11/28/11

4 Armstrong GL, Wasley A, et al. The prevalence of hepatitis C infection in the United States, 1999 through 2002. Ann Intern Med 2006; 144(10):705-714

5 Colvin HM, Mitchell AE. Hepatitis and liver cancer: A national strategy for prevention and control of hepatitis B and C. Washington, DC: The National Academies Press; 2010 http://www.orasure.com/products-infectious/products-infectious-oraquick-hcv.asp