Many HBV, HCV infections remain unidentified in US

Spradling PR. Clin Infect Dis. 2012;55:1047-1055.

October 3, 2012

Almost half of HCV infections and more than 20% of HBV infections may go undiagnosed among people with comprehensive health care, according to a recent study

In an observational cohort study, researchers evaluated data from 867,589 members of four health care organizations (HCOs) throughout the United States between January 2006 and December 2008 who had one or more clinic visits and at least 12 months of continuous follow-up. This cohort included 866,886 participants with no previous HBV-related diagnoses and 865,659 with no prior HCV-related diagnoses. Investigators compared the number of infections reported in the cohort with a projected number based on National Health and Nutrition Examination Survey (NHANES) data.

Among patients who had no prior HBV diagnosis, 18.8% underwent HBV testing, with positive results seen in 1.4% of cases. Among those with no previous HCV diagnosis, 12.7% were tested, with 5.5% testing positive. Estimates from NHANES data indicated that at least 43.1% of those with HCV and 21.1% of those with HBV in the cohort had not been tested or diagnosed.

HCV infection was more common among patients aged 50 to 59 years (adjusted OR=6.04, 5.38-6.77, compared with patients younger than 30 years), while positive HBV test results were significantly more common among Asian (adjusted OR=6.33, 5.53-7.24) and Hawaiian/Pacific Islander (aOR=3.64, 2.99-4.42) patients than white participants (95% CI for all).

Among 65,778 patients with two or more elevated alanine aminotransferase ( ALT) levels, 42.2% were tested for HBV (1.7% positive), and 43.9% were tested for HCV (8.2% positive). These patients were more likely to test positive for HBV (aOR=2.16; 95% CI, 1.58-2.96) or HCV (aOR=2.96; 95% CI, 2.54-3.45).

“Even in these HCOs, which provided comprehensive care, many who had two or more elevated ALT levels were not tested for HBV and HCV infection,” the researchers wrote. “Although implementation of the health care reform legislation of 2010 may improve access to care, more aggressive policies in hepatitis testing to identify all infected persons are warranted.”

Disclosure: See the study for a full list of relevant disclosures.

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