March 8–11, 2020


Conference Dates and Location: 
February 23-26, 2015 | Seattle, Washington
Abstract Number: 

The Burden of Liver Disease Among Persons With Hepatitis C in the United States


Monina Klevens1, Xiaohua Huang2, Anthony E. Yeo2, Mouneer Odeh2, Rick L. Pesano2, John W. Ward1
1 US Centers for Disease Control and Prevention, Atlanta, GA, United States. 2 Informatics, Quest Diagnostics, Madison, NJ, United States.

Abstract Body: 

Background: In the United States, the CDC recommends one-time hepatitis C virus (HCV) antibody testing for persons born from 1945-1965 due to the higher seroprevalence of HCV infection in this group. However, the burden of liver disease among the infected population has not been described.

Methods: Data were from Quest Diagnostics, a CDC partner, which conducts routine HCV tests in all states. For this analysis, all test data were anonymized and de-duplicated at the person level. The sample included all tests for which a first positive HCV RNA result was known for a given year from 2010-2013. Values for AST, platelet count and ALT, were combined with age to calculate FIB-4, a non-invasive scoring system indicative of liver fibrosis. Test data were then examined by year and stage of fibrosis.

Results: During 2010-2013, a total of 273,143 persons had a first positive HCV-RNA test result and known date of birth. Of these, 186,416 (68.2%) were born from 1945-1965. For all years combined, most persons in the birth cohort had moderate fibrosis (42.3%) followed by severe fibrosis (28.7%) and cirrhosis (22.7%). Almost no variation was found over the four-year period by stage of FIB-4 (Table). In 2013, 53.1% of persons born from 1945-1965 had severe fibrosis or cirrhosis; this was higher than among persons born after 1965 (12.4%) but lower than among persons born before 1945 (79.7%).

Conclusions: Alarmingly, about one-half of HCV-infected persons born from 1945-1965 had severe fibrosis or cirrhosis as evidenced by FIB-4 scoring. No decreases were observed in this proportion over time. Persons with this stage of severe HCV-related liver disease are a high priority for treatment. Improved birth cohort screening for HCV and linkage to recommended care and treatment are urgently needed to prevent complications.

Category of fibrosis (mean FIB-4) 2010 2011 2012 2013
No fibrosis (<1.0) 2712 (10%) 2366 (10%) 1625 (9%) 1209 (9%)
Moderate fibrosis (1.0-2.0) 11195 (41%) 10369 (42%) 7460 (40%) 5566 (40%)
Severe (2.0-3.7) 7378 (27%) 6750 (27%) 5310 (28%) 3982 (28%)
Cirrhosis (≥3.8) 5908 (22%) 5140 (21%) 4266 (23%) 3220 (23%)
Total including missing/unknown^ 38471 35458 27315 20687

+ Percentage excluding unknown/missing *Not known to have a previous positive RNA test ^ Includes persons with ≥1 parameter missing

Session Number: 
Session Title: 
Curing HCV: Mission Accomplished
Presenting Author: 
Klevens, Monina
Presenter Institution: 
US Centers for Disease Control and Prevention