Hepatitis C

CDC: 1 Million "High Priority" HCV Cases in the US

An estimated 813,000 Americans living with hepatitis C virus (HCV) meet “high” or “highest” priority status for treatment under current guidelines, according to a new study.

That number rises to over 1 million when undiagnosed individuals, as well as those in prison and the armed forces, are taken into account. 
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Because of the high cost of antiviral treatments for the disease, the American Association for the Study of Liver Diseases recently released guidelines recommending that when resources are limited, treatment should be given to those with advanced fibrosis, compensated cirrhosis, and those who have undergone liver transplants (highest priority) and those with moderate fibrosis and fibrosis with comorbidities (high priority).

Determining Priority Groups

A recent CDC study estimated the number of Americans living with HCV who fall under the “high” or “highest” category, as well as the number of individuals living with the disease who have not been diagnosed.1

Using data from the National Health and Nutrition Examination Survey, researchers estimated that about 2.7 million non-institutionalized Americans are living with chronic HCV. Of those, an estimated 1.35 million have been diagnosed.

With data collected from the Chronic Hepatitis Cohort Study, researchers estimated that 513,000 individuals with the disease have stage F3 or higher fibrosis, and 18,900 had fibrosis and kidney disease—putting 532,000 people in the “highest” priority group.

An additional 405,000 were estimated to have stage F2 fibrosis, and 108,000 estimated to have lower stage fibrosis and comorbidities—putting 513,000 individuals in the “high” priority group.

Screening and Treatment

"For the majority of patients whose HCV infection has been diagnosed, access to HCV treatment immediately or soon is important due to their stage of liver fibrosis or comorbidities," researchers concluded.

Due to the high numbers of estimated undiagnosed individuals in the United States, as well as the recent advent of new treatment options for HCV, representatives of the CDC, World Health Organization, and United States Preventive Services Task Force have all recommended more widespread screening for the disease.

In response, there has been a call for more clinical trials to assess the benefits and harm of increased screening and treatment.2

“If the treatment of hepatitis C is to be scaled up to cover a large portion of the 125-150 million infected people worldwide, regulatory agencies should ensure that drugs have been evaluated by long term follow-up of clinical outcomes (not just surrogate markers) in several thousands of patients,” Koretz et al concluded.2

“The financial cost of treatments have been discussed elsewhere, but given the uncertainty about the validity of the surrogate markers, the lack of evidence regarding clinical outcomes of treatment or of screening strategies, and the adverse events caused by the newer regimens, screening may be premature.”

—Michael Potts

References:

  1. AidsMap. One million people with hepatitis C in the US at high priority for treatment [press release]. December 18, 2014. www.aidsmap.com/One-million-people-with-hepatitis-C-in-the-US-at-high-priority-for-treatment/page/2930646/. Accessed January 20, 2015.
  2. Koretz RL, Lin KW, Ionnidis JPA, Lenzer J. Is widespread screening for hepatitis C justified? BMJ. 2015;350:g7809.