New data shared by the CDC demonstrates the ongoing challenges of getting people with hepatitis C into the continuum of care.
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Despite the national hepatitis C elimination goals for 2030 to achieve at least 80% of persons with hepatitis C to achieve viral clearance, the goals across states is consistently falling under. In fact, analysis of data collected during 2013–2022 from a national laboratory found that HCV clearance or cure proportions among persons with virus by state was between 10% to 51%.1
This data was published in the Centers for Disease Control’ and Prevention’s (CDC) MMWR late last week.
Among states, the median percentages of persons demonstrating viral clearance was 29%. The clearance goal was well below both the Health and Human Services (HHS) hepatitis C viral clearance goal for 2025 of at least 58%.
Table. The viral testing percentage represents the percentage of persons with evidence of past or current HCV infection who underwent complete viral testing. And the viral clearance percentage indicates the percentage of diagnosed HCV-infected individuals who achieved sustained viral clearance.
Table Credit: Microsoft Bing Copilot
Challenges of Care
The lowest rate of viral clearance among persons with diagnosed HCV infection was 10% in West Virginia and on the end it went up to 51% in Connecticut. There are also large disparities for testing, with the range being from 51% in Hawaii to 99% in South Dakota for estimates that included a criteria of evidence of past or current HCV infection according to the investigators.
This provides further evidence about the challenges of getting people with HCV into the continuum of care, especially as there is a HCV cure rate of approximately ≥95%.
According to the investigators, from January 2017 to March 2020, approximately 2 million adults in the US were estimated to be infected with HCV, and new infections approximately doubled from 2013–2022, primarily in association with injection drug use. For people who inject drugs (PWID), this population may often be using health care marginally or not at all. Some might be homeless or underinsured, and they are likely not having provider encounters to catch the virus.
Additionally, HCV is called the silent killer, and people with the infection can remain asymptomatic for years, and it can often be found for unrelated reasons.
“Most of the time people don’t even realize they have hepatitis C because they present asymptomatic,” said Tracy Gowan MSN, APRN, FNP-C, Hep C Center, University of Louisville Hospital. “So a lot of times this is found with the incidental finding on lab work, or perhaps an ER visit.”2
[Read More: The Means for Curative Hepatitis C Care are Available, But Many Still Don’t Utilize]
Data Means, Other Findings
The investigators collected 10 years of data from January 1, 2013 through December 31, 2022 utilizing information from the national laboratory company, Quest Diagnostics.They analyzed patients from all 50 states and the District of Columbia.
They used the following criteria from published CDC guidance: “1) ever infected (having received any positive HCV test result [reactive anti-HCV, detectable HCV RNA or HCV genotype] during January 1, 2013–December 31, 2021 [index period]); 2) received viral testing (having had an HCV RNA test performed during January 1, 2013–December 31, 2022, among persons categorized as ever infected [follow-up period]); 3) diagnosis of initial infection (having a detectable HCV RNA test result during the follow-up period for any person with viral testing); 4) cured or cleared (having received a subsequent undetectable HCV RNA test result during the follow-up period among any person with an initial infection); and 5) persistent infection or reinfection (having received a subsequent detectable HCV RNA test result during the follow-up period in any person categorized as cured or cleared).”
In extrapolating more data, they found in 37 states the clearance/cure rate was less than the estimated national average of 35%. And 5 of the 7 with the lowest cured or cleared rates were in southern Appalachia (West Virginia) or the north or central United States including Michigan, Minnesota, Nebraska, and Ohio.
Lastly, in the populations that were cured, the percentage with persistent infection or reinfection ranged from the low end of the spectrum of 2% in Oklahoma and Maine to 11% in California.
To learn more about what they are doing for testing and clinical care in a high-risk population in Oklahoma, read the story here.
References
1.Tsang CA, Tonzel J, Symum H, et al. State-Specific Hepatitis C Virus Clearance Cascades – United States, 2013-2022. MMWR Morb Mortal Wkly Rep. 2024;73(21):495-500. Published 2024 May 30. doi:10.15585/mmwr.mm7321a4
2. Parkinson J. The Means for Curative Hepatitis C Care are Available, But Many Still Don’t Utilize. Contagion. May 22, 2024. Accessed June 3, 2024.
https://www.contagionlive.com/view/the-means-for-curative-hepatitis-c-care-are-available-but-many-still-don-t-utilize
