about a third of adolescents and young adults diagnosed with opioid use
disorder in the United States are screened for hepatitis C virus (HCV) or HIV,
even though injection drug use is one of the main risk factors for
transmission, according to a study presented at IDWeek 2018 earlier this month in San
tested, 11% of opioid users were found to be HCV antibody positive, with lower
rates among amphetamine and cocaine users.
baby boomers born between 1945 and 1965 have had the highest rate of hepatitis
C in the US, but the incidence of acute HCV infection has been rising among
younger age groups in conjunction with the ongoing opioid epidemic. HCV
infection rates have also risen among pregnant women and their babies.
Epstein of Boston Medical Center reported findings from a study of hepatitis C
testing and subsequent care in a large nationally representative sample of adolescents
and young adults (age 13-21 years) seen at US Federally Qualified Health
Centers, which provide comprehensive healthcare to underserved communities.
retrospective cohort study looked at electronic medical records from more than
a quarter of a million young people who had at least one outpatient visit at 340
participating clinics in 19 states between January 2012 and September 2017.
Those with pre-existing HCV infection were excluded.
269,124 eligible young people, 55% were female, 38% were white, 18% were black
and 34% were Hispanic or Latino, with 11% identifying as other racial/ethnic
categories. About a third each were age 19-21 (36%), 16-18 (34%) and 13-15
this group, 23,237, or 9%, had been diagnosed with a substance use disorder and
were included in the HCV analysis. By far the most common 'disorder' was
cannabis use, affecting 7.5% of the full study population and accounting for
more than 80% of all substance use diagnoses. Smaller numbers had diagnoses
involving alcohol and amphetamines (0.6% each) and opioids and cocaine (0.3%
269,124 participants, just 6812 (2.5%) were tested for HCV. This included 36%
of those with an opioid use diagnosis (just under 300), 37% with a cocaine use
diagnosis (just over 300) and 33% with an amphetamine use diagnosis (nearly
600). Those with alcohol (11%) and cannabis (9%) use disorders were less likely
to be screened for HCV.
participants in the 19-21 and 16-18 age groups were more likely to be tested
for HCV than those in the 13-15 age group (4.3%, 2.3% and 0.6%, respectively).
Black youth were more likely to be tested (3.7%) than other racial/ethnic
groups (all 2.3%). Young men and women were equally likely to be screened. Surprisingly,
only 11% of youth tested for HCV were also tested for HIV, even though the two
viruses have overlapping risk factors.
6812 youth who were tested, a total of 122, or 1.8% overall, were HCV antibody
positive. (People who spontaneously clear the virus or are successfully treated
remain antibody positive even when they no longer have HCV RNA in their blood.)
rates differed substantially according to what substances they used, with drugs
that are frequently injected conferring a higher risk. By subgroup, 11% of
opioid users, 3% of cocaine users and 6% of amphetamine users tested HCV
positive. Opioid use was associated with a 20-fold higher risk and amphetamine
with a 9-fold higher risk of having HCV. The only other significant risk factor
was older age.
122 youth who tested positive, 92 (75%) underwent follow-up HCV viral load
testing, 42 (46%) had detectable HCV RNA and 15 (37%) received an HCV genotype
test. HCV genotyping has traditionally been used to guide treatment selection
and predict prognosis, but the newest combination regimens are highly effective
regardless of genotype.
data provide evidence for the need to improve HCV and HIV testing in youth, the
"We’re missing an opportunity to
identify and treat young people who are at risk for this deadly infection,"
Epstein said in an IDWeek
news release. "The issue is complicated by the fact that not
enough at-risk youth are screened for opioid or other drug use for a variety of
reasons, including lack of time, comfort level between clinician and patient,
and privacy and stigma concerns. And even when drug use is identified, there’s
a belief that youth are less likely to test positive for hepatitis C, which
isn’t necessarily the case as we show in our study."
young people with HCV is particularly relevant now, as the first treatment
regimens for adolescents, sofosbuvir/ledipasvir
(Harvoni) and sofosbuvir (Sovaldi) plus
ribavirin, were approved
last year for adolescents aged 12 to 17. The pangenotypic glecaprevir/pibrentasvir
combos are not yet approved for this age group.
"Screening for opioid use disorder
and other drug use, and then testing for hepatitis C in those at high risk, can
help us do a better job of eliminating this serious infection, especially now
that very effective hepatitis C medications are approved for teenagers,"