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