Testing during pregnancy also becomes more important

According to new U.S. data, the annual rate of acute (recently acquired) hepatitis C virus (HCV) cases tripled from 2008 to 2017.

Moreover, younger people now represent a significant number of those new cases. The highest rates of acute HCV infection were among those between the ages of 20 and 39.

Hepatitis C infection in many individuals frequently went undiagnosed, despite being potentially dangerous if it becomes chronic. Some of the data show that “only 61% of adults with hepatitis C knew they were infected.”

Acute HCV often has no symptoms, which could be one reason for under-diagnosis, but stigma also plays a role in this lack of testing. 

The new findings have led to two new recommendations for HCV testing from the U.S. Centers for Disease Control and Prevention (CDC).

•     Everyone over the age of 18 should test for hepatitis C at least once in their lifetime.

•     A test should be done during each and every pregnancy, regardless of age.

Previously, testing was recommended for people born between 1945–1965, the Baby Boomers, as well as anyone with risk factors for infection.

“Concurrent with the nation’s opioid crisis, however, rapid increases in acute HCV infections among young adults, including reproductive aged persons, have put multiple U.S. generations at risk for chronic HCV infection,” the CDC noted in its new surveillance data report, released in April.

The opioid epidemic is believed to be behind the higher rate of transmission to newborns of mothers with HCV, an increase of 39%.

The new report notes that more than 50% of acute cases progress to a chronic infection, “which can be life-threatening.”

Further, “The number of newly reported chronic infections was approximately equal among younger and older adults in 2018.”

Hepatitis C, the surveillance report noted, can be diagnosed with a blood test and is curable.

According to the report, “The annual rate of reported acute HCV cases per 100,000 population increased fourfold, from 0.3 in 2009 to 1.2 in 2018, and was highest among persons aged 20–29 (3.1) and 30–39 (2.6) in 2018.”

The largest proportion of newly reported chronic HCV cases that year, however, occurred among people 20–39 and 50–69 years old.

As recommended previously, HCV testing should be done on a periodic basis as long as risk factors continue: At least annually for people who inject drugs, as well as for people with selected medical conditions, including those on maintenance hemodialysis.

The new recommendations note that HCV is “a major source” of disease and death in the U.S.

Yet, “[surveys conducted in 2013–2016] indicate only approximately 56% of persons with HCV infections reported having ever been told they had hepatitis. Therefore, strengthened guidance for universal HCV testing is warranted.”

Overcoming barriers to therapy with direct-acting antivirals (DAA) for HCV are needed, the recommendations state. The success of more screening is tied to the availability of treatment.

Stigma within the health care system also needs to be addressed: “Any person who requests HCV testing should receive it regardless of disclosure of risk because many persons might be reluctant to disclose stigmatizing risks.”

Most risk is related to injection drug use (IDU), but there are other risks as well.

“Although HCV infection is primarily associated with IDU, high-risk behaviors (e.g., anal sex without a condom), primarily among persons with HIV, are also important risk factors for transmission. Other possible exposures include sharing personal items contaminated with blood (e.g., razors or toothbrushes), unregulated tattooing, needlestick injuries among health care personnel, and birth to a mother with hepatitis C,” the recommendations state.

The two reports were published in April. This is the first time the CDC has updated its hepatitis C recommendations since 2012.

See the recommendations at cdc.gov/mmwr/volumes/69/rr/rr6902a1.htm.

The surveillance report can be viewed at cdc.gov/mmwr/volumes/69/wr/mm6914a2.htm.

Other groups make hepatitis C testing recommendations, which may differ to some degree: The U.S. Preventative Services Task Force (USPSTF), uspreventiveservicestaskforce.org/uspstf/recommendation/hepatitis-c-screening; the American Association for the Study of Liver Diseases (AASLD), hcvguidelines.org; and the Infectious Diseases Society of America (IDSA), idsociety.org/public-health/hepatitis-c/clinical-guidance.