Megan Brooks
March 28, 2012 (New York, New York) — In the United States, testing for hepatitis C virus (HCV) infection is happening most often in the people least likely to be infected with the virus, according to a study presented here at the International Conference on Viral Hepatitis 2012.
"Hepatitis C is primarily a disease of older men, but they aren't the ones actually getting tested. The majority of testing is happening in young women. I'm not sure anyone has ever shown this before," study presenter Camilla S. Graham, MD, MPH, from Vertex Pharmaceuticals in Cambridge, Massachusetts, told Medscape Medical News.
There is a need for targeted age-based guidelines for HCV testing, Dr. Graham said. Roy M. Gulick, MD, from Weill Cornell Medical College in New York City, agrees. "Focused testing for hepatitis C makes sense," he told attendees during his keynote address. HCV testing recommendations are currently being developed by the US Centers for Disease Control and Prevention.
Wrong Sex, Wrong Age Group
An estimated 4.1 million Americans (1.6% of the population) are infected with HCV; the majority of these individuals were born between 1945 and 1965. Dr. Graham said the goal of her study was "to see who exactly is being tested in the United States right now."
She and her colleagues analyzed HCV testing and diagnosis rates in the commercially insured and Medicare populations from 2004 to 2008 using the Thomson Medstat MarketScan commercial database and the Medicare 5% database.
They identified individuals tested for HCV using outpatient claims with Current Procedural Terminology codes for anti-HCV antibody or HCV RNA diagnostic tests. They used International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes to identify individuals diagnosed with HCV infection.
They found that in 2008, the HCV testing rate was 1.1% in the commercially insured population and 1.7% in the Medicare population, which might explain the high proportion of undiagnosed individuals, the researchers say.
"Overall, practically nobody was getting tested, although it went up from 2004 to 2008. There are other data to support this level of testing in the United States," Dr. Graham noted.
Only 32.8% of the tests were performed in baby boomers born between 1945 and 1965, who are at the highest risk for HCV infection; 48.2% of HCV tests were performed in individuals born between 1970 and 1989.
"Eighty-one percent of people with hepatitis C in this country were born between 1945 and 1965, but we found that only a third of the tests were actually happening in that age group," Dr. Graham told Medscape Medical News. "Conversely, younger people had almost half of the tests."
In the younger (commercially insured) population, women were more likely than men to be tested; 62.0% of HCV tests were performed in women, most of whom were in their reproductive years. In the Medicare population, testing was more evenly distributed between men and women.
As expected, rates of diagnosis were consistently higher in the older (Medicare) population — the baby boomers — than in the younger population. They were also higher in men.
Women and men born between 1970 and 1989 had a 0.45% and 1.18% rate, respectively, of HCV diagnosis after testing. "Almost none of these young women had hepatitis C," Dr. Graham noted. "But when you look at the baby boomer men, between 5.7% and 7.4% of them had hepatitis C."
Help on the Way
Dr. Graham noted that "an estimated 800,000 people in the United States have cirrhosis. Within the next 10 years, it will be about 1 million people, and 75% of those people are men. Men are disproportionately likely to have hepatitis C and disproportionately more likely to develop severe fibrosis with hepatitis C."
"Clearly, we need a lot of education on who to test for hepatitis C," Dr. Graham said, adding that the forthcoming age-based screening guidelines for HCV testing should help. "The focus will be on people born between 1945 and 1965 who are at highest risk for the infection. We should have them sometime this year," Dr. Graham said.
Dr. Graham reports being an employee and stock owner of Vertex Pharmaceuticals, which commissioned the study. Dr. Gulick reports financial relationships with Bristol-Myers Squibb, Gilead Sciences, Janssen Pharmaceuticals, Merck & Co., and ViiV Healthcare.
International Conference on Viral Hepatitis (ICVH) 2012: Abstract 79332. Presented March 27, 2012.
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