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