Few HCV/HBV infections identified in adults with access to care

Few HCV/HBV infections identified in adults with access to care

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

October 26, 2012

Only a small number of viral hepatitis infections were identified among those who have access to care through health care organizations, according to recent data.

“Even among persons enrolled in large, private-sector health care organizations, relatively little is known about the sociodemographic and clinical characteristics associated with viral hepatitis testing and infection prevalence,” the researchers wrote. “For example, limited data suggest that only a fraction of viral hepatitis infections among patients within large health maintenance organizations — where access to care is relatively favorable — are identified.”

The investigators for the Chronic Hepatitis Cohort Study evaluated characteristics associated with hepatitis testing and prevalence among adults from four participating health care organizations. The adults had at least 12 months of continuous enrollment and at least one hospital admission or outpatient provider, laboratory or emergency department encounter. The researchers collected data from the date of the patient’s health care plan enrollment through 2008. They estimated the number of hepatitis B and hepatitis C infections expected using race-specific and age-specific national prevalence estimates.

The study included more than 1.2 million adults who were enrolled in one of the health care organizations from 2006 to 2008. Among adults who were not previously diagnosed with HBV, 18.8% were tested at least once during the time period. Of these, 1.4% tested positive at least once. Among the adults who were not previously diagnosed with HCV, 12.7% were tested at least once during the time period. Of these, 5.5% tested positive at least once.

Characteristics associated with being tested for HBV included being female, aged 30 to 39 years, black and Asian. For HCV, the characteristics included being aged 30 to 39 years, black, aged 40 to 49 years, aged 50 to 59 years and American Indian/Native Alaskan.

Among adults with more than two abnormal alanine aminotransferase (ALT) levels, 42.2% were tested for HBV and 43.9% were tested for HCV. Among those who were tested, 1.7% were positive for HBV and 8.2% were positive for HCV.

Using data from National Health and Nutrition Examination Survey, the researchers estimated that at least 21.1% of HBV infections remain unidentified and 43.1% of HCV infections remain unidentified.

“Asian race and being middle-aged were independently associated with testing positive for hepatitis B and hepatitis C, respectively,” the researchers wrote. “Thus, 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: The researchers report financial relationships with Abbott Pharmaceuticals, Achillion Pharmaceuticals, Anadys Pharmaceuticals, Bayer, Bristol-Myers Squibb, Conatus, CVS Caremark, Eiger BioPharmaceuticals, Exalenz BioScience, Gilead Pharmaceuticals, GlaxoSmithKline, GlobeImmune, Henry Ford Health System, Intercept Pharmaceuticals, Janssen, Johnson & Johnson, Merck, Pfizer, Roche Pharmaceuticals, Salix Pharmaceuticals, Tibotec Therapeutics, Vertex Pharmaceuticals and ZymoGenetics.

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