293. Hepatitis C is now a Millennial Disease in Response to the Opioid Crisis: A Demographic Shift in Hepatitis C Infection

Abstract Background Previous research has shown millennials represent the fastest growing generation for those infected with the hepatitis C virus (HCV). Millennials are also a key driver in the opioid crisis, particularly in states of the Appalachian region including Kentucky. Despite research demonstrating a change in prevalence from baby boomers (born 1945–1965) to millennials (born 1980–1995), large representative studies providing evidence of the magnitude of this demographic shift are lacking in the United States. Our objective was to assess trends of HCV infection since 2016 in a large healthcare system located in an area of high prevalence of opioid use and HCV infection. Methods All individuals were screened for HCV infection in 2016, 2017, and 2018 within Norton Healthcare per standard risk-based criteria (e.g., injection drug users, baby boomers, etc.) as recommended by CDC, except for pregnant women who were universally screened since 2016. We tested for demographic shifts over time using longitudinal and time series analyses techniques Results A total of 86,243 individuals were screened for HCV infection from 2016 to 2018. Of those, 2,615 (3.0%) individuals screened positive for chronic HCV. The average age of those infected significantly decreased by an average of 3.7 years annually (from 47.3 years in 2016 to 39.9 years in 2018, P < 0.001). We forecast a plateau near the age of 28 years will be observed in just over 7 years. In addition, the proportion of millennials increased over time (33.6% in 2016, 42.4% in 2017 and 51.4% in 2018, P < 0.001), while baby boomers significantly decreased over time (44.0% in 2016, 38.8% in 2017, and 29.3% in 2018, P < 0.001). Lastly, over time, those with chronic HCV were more likely to be male (increasing from 49.6% to 54.4%, P = 0.008) and Hispanic (increasing from 1.6% to 17.7%, P < 0.001) Conclusion Our results suggest that HCV infection has become a predominately millennial disease, skipping a generation. These results correlate with trends seen with the opioid epidemic, which is driven by millennials. We conclude that the opioid crisis has led to a drastic demographic shift, and currently the typical HCV-infected individual is a younger male. Without interventions, this trend will continue for over seven years, plateauing near the demarcation of millennials and generation Z Disclosures All authors: No reported disclosures.

Download Full-text

Treatment of acute hepatitis C infection with interferon-alfa 2b monotherapy prevents development of chronic HCV infection

Gastroenterology ◽

10.1016/s0016-5085(01)82820-1 ◽

2001 ◽

Vol 120 (5) ◽

pp. A567-A567 ◽

Cited By ~ 1

Author(s):

E JAECKEL ◽

M CORNBERG ◽

T SANTANTONIO ◽

J MAYER ◽

H WEDEMEYER ◽

...

Keyword(s):

Hepatitis C ◽

Acute Hepatitis ◽

Interferon Alfa ◽

Hcv Infection ◽

Acute Hepatitis C ◽

Hepatitis C Infection ◽

Chronic Hcv Infection ◽

Chronic Hcv

Download Full-text

Hepatitis C and HIV Co-Infection

10.1093/med/9780199392742.003.0043 ◽

2017 ◽

Author(s):

Jennifer Cohen Price ◽

Priyanka Amin ◽

Antoine Douaihy

Keyword(s):

Hepatitis C ◽

Natural History ◽

The United States ◽

Hcv Infection ◽

Hepatic Decompensation ◽

History Of ◽

Chronic Hcv ◽

Direct Acting ◽

End Stage ◽

Shared Risk

Chronic infection with hepatitis C virus (HCV) is a leading cause of end-stage liver disease and is the most common indication for liver transplantation in the United States. Because of shared risk factors, individuals living with HIV infection are disproportionately affected by HCV. Moreover, co-infection with HIV accelerates the natural history of chronic HCV infection, increasing the risk of cirrhosis, hepatocellular carcinoma, hepatic decompensation, and death. Highly effective medications such as direct-acting antivirals (DAA) to cure HCV are now available and have the potential to profoundly improve the health of HIV-HCV-co-infected individuals. However, addressing the many gaps in the HCV care cascade is necessary to fully achieve the benefits of these drugs. This chapter reviews the natural history of HIV-HCV co-infection, the psychiatric comorbidities associated with HCV infection, the evolution of HCV treatment, and the barriers to care that HIV-HCV-co-infected individuals continue to face.

Download Full-text

Interferon treatment for chronic hepatitis C infection in hemophiliacs-- influence of virus load, genotype, and liver pathology on response

Blood ◽

10.1182/blood.v87.5.1704.bloodjournal8751704 ◽

1996 ◽

Vol 87 (5) ◽

pp. 1704-1709 ◽

Cited By ~ 1

Author(s):

JP Hanley ◽

LM Jarvis ◽

J Andrew ◽

R Dennis ◽

PC Hayes ◽

...

Keyword(s):

Chronic Hepatitis ◽

Hepatitis C ◽

Chronic Hepatitis C ◽

Early Stage ◽

Hcv Infection ◽

Hcv Rna ◽

Interferon Treatment ◽

Hepatitis C Infection ◽

Virus Load ◽

Chronic Hcv

In this study, we assessed the effectiveness of interferon treatment in 31 hemophiliacs with chronic hepatitis C virus (HCV) infection. Interferon alfa-2a (3 MU three times weekly) was administered for 6 months. Response was assessed by both serial alanine transaminase (ALT) and HCV RNA levels measured by a sensitive semiquantitative polymerase chain reaction (PCR) method. HCV genotype was determined by restriction fragment length polymorphism (RFLP), and evidence of changing genotypes during interferon therapy was sought. Severity of liver disease was assessed by both noninvasive and invasive methods, including laparoscopic liver inspection and biopsy. Sustained normalization of ALT levels occurred in eight patients (28%), and seven (24%) became nonviremic as assessed by PCR (<80 HCV/mL). Responders universally cleared HCV RNA within 2 months of starting interferon. Genotype 3a was associated with a favorable response to interferon. No evidence was found for a change in circulating genotype in patients who failed to respond to interferon or who relapsed. This study confirms that response rates to interferon are low in hemophiliacs as compared with other groups with chronic HCV infection. We have also demonstrated that virus load measurement over the first 8 to 12 weeks of treatment is an extremely useful method to identify responders at an early stage.

Download Full-text

Assessing County-Level Vulnerability for Opioid Overdose and Rapid Spread of Human Immunodeficiency Virus and Hepatitis C Infection in South Dakota

The Journal of Infectious Diseases ◽

10.1093/infdis/jiaa231 ◽

2020 ◽

Vol 222 (Supplement_5) ◽

pp. S312-S321

Author(s):

Chelsea A Wesner ◽

Weiwei Zhang ◽

Sandra Melstad ◽

Elizabeth Ruen ◽

Cassandra Deffenbaugh ◽

...

Keyword(s):

Human Immunodeficiency Virus ◽

Hepatitis C ◽

South Dakota ◽

Composite Index ◽

Hcv Infection ◽

Opioid Overdose ◽

County Level ◽

Hepatitis C Infection ◽

Immunodeficiency Virus ◽

Chronic Hcv

Abstract Background Key indicators of vulnerability for the syndemic of opioid overdose, human immunodeficiency virus (HIV), and hepatitis C virus (HCV) due to injection drug use (IDU) in rural reservation and frontier counties are unknown. We examined county-level vulnerability for this syndemic in South Dakota. Methods Informed by prior methodology from the Centers for Disease Control and Prevention, we used acute and chronic HCV infections among persons aged ≤40 years as a proxy measure of IDU. Twenty-nine county-level indicators potentially associated with HCV infection rates were identified. Using these indicators, we examined relationships through bivariate and multivariate analysis and calculated a composite index score to identify the most vulnerable counties (top 20%) to this syndemic. Results Of the most vulnerable counties, 69% are reservation counties and 62% are rural. The county-level HCV infection rate is 4 times higher in minority counties than nonminority counties, and almost all significant indicators of opioid-related vulnerability in our analysis are structural and potentially modifiable through public health interventions and policies. Conclusions Our assessment gives context to the magnitude of this syndemic in rural reservation and frontier counties and should inform the strategic allocation of prevention and intervention services.

Download Full-text

Factors predicting staging and treatment initiation for patients with chronic hepatitis C infection: insurance a key predictor

Journal of Public Health ◽

10.1093/pubmed/fdaa276 ◽

2021 ◽

Author(s):

Janet Lin ◽

Cammeo Mauntel-Medici ◽

Anjana Bairavi Maheswaran ◽

Sara Baghikar ◽

Oksana Pugach ◽

...

Keyword(s):

Chronic Hepatitis ◽

Hepatitis C ◽

Liver Fibrosis ◽

Chronic Hepatitis C ◽

Treatment Initiation ◽

Cox Regression ◽

Hcv Infection ◽

Inpatient Setting ◽

Hepatitis C Infection ◽

Chronic Hcv

Abstract Background Chronic hepatitis C (HCV) infection affects over 2.4 million Americans and accounts for 18 000 deaths per year. Treatment initiation in this population continues to be low even after introduction of highly effective and shorter duration direct-acting antivirals. This study assesses factors that influence key milestones in the HCV care continuum. Methods Retrospective time-to-event analyses were performed to assess factors influencing liver fibrosis staging and treatment initiation among individuals confirmed with chronic HCV infection at University of Illinois Hospital and Health Sciences System between 1 August 2015 and 24 October 2016 and followed through 28 January 2018. Cox regression models were utilized for multivariable analyses. Results Individuals tested at the liver clinic (hazard ratio [HR] = 2.03; 95% confidence interval [CI]: 1.19–3.46) and at the federally qualified health center (HR = 3.51; 95% CI: 2.19–5.64) had higher instantaneous probability of being staged compared with individuals tested at the emergency department (ED) or inpatient setting. And probability of treatment initiation increased with advancing liver fibrosis especially for Medicaid beneficiaries (HR = 1.64; 95% CI: 1.35–1.99). Conclusions The study demonstrates a need for improving access for patients with early stages of the disease in order to reduce HCV-related morbidity and mortality, especially those tested at nontraditional care locations such as the ED or the inpatient setting.

Download Full-text

Treatment of acute hepatitis C infection with interferon-alfa 2b monotherapy prevents development of chronic HCV infection

Gastroenterology ◽

10.1016/s0016-5085(08)82820-x ◽

2001 ◽

Vol 120 (5) ◽

pp. A567 ◽

Cited By ~ 1

Author(s):

Elmar Jaeckel ◽

Markus Cornberg ◽

Teresa Santantonio ◽

Julika Mayer ◽

Heiner Wedemeyer ◽

...

Keyword(s):

Hepatitis C ◽

Acute Hepatitis ◽

Interferon Alfa ◽

Hcv Infection ◽

Acute Hepatitis C ◽

Hepatitis C Infection ◽

Chronic Hcv Infection ◽

Chronic Hcv

Download Full-text

Interferon treatment for chronic hepatitis C infection in hemophiliacs-- influence of virus load, genotype, and liver pathology on response

Blood ◽

10.1182/blood.v87.5.1704.1704 ◽

1996 ◽

Vol 87 (5) ◽

pp. 1704-1709 ◽

Cited By ~ 28

Author(s):

JP Hanley ◽

LM Jarvis ◽

J Andrew ◽

R Dennis ◽

PC Hayes ◽

...

Keyword(s):

Chronic Hepatitis ◽

Hepatitis C ◽

Chronic Hepatitis C ◽

Early Stage ◽

Hcv Infection ◽

Hcv Rna ◽

Interferon Treatment ◽

Hepatitis C Infection ◽

Virus Load ◽

Chronic Hcv

Abstract In this study, we assessed the effectiveness of interferon treatment in 31 hemophiliacs with chronic hepatitis C virus (HCV) infection. Interferon alfa-2a (3 MU three times weekly) was administered for 6 months. Response was assessed by both serial alanine transaminase (ALT) and HCV RNA levels measured by a sensitive semiquantitative polymerase chain reaction (PCR) method. HCV genotype was determined by restriction fragment length polymorphism (RFLP), and evidence of changing genotypes during interferon therapy was sought. Severity of liver disease was assessed by both noninvasive and invasive methods, including laparoscopic liver inspection and biopsy. Sustained normalization of ALT levels occurred in eight patients (28%), and seven (24%) became nonviremic as assessed by PCR (<80 HCV/mL). Responders universally cleared HCV RNA within 2 months of starting interferon. Genotype 3a was associated with a favorable response to interferon. No evidence was found for a change in circulating genotype in patients who failed to respond to interferon or who relapsed. This study confirms that response rates to interferon are low in hemophiliacs as compared with other groups with chronic HCV infection. We have also demonstrated that virus load measurement over the first 8 to 12 weeks of treatment is an extremely useful method to identify responders at an early stage.

Download Full-text

Current and Emerging Therapeutic Regimens for Patients with Chronic Hepatitis C Infection

Open Medicine Journal ◽

10.2174/1874220301603010058 ◽

2016 ◽

Vol 3 (1) ◽

pp. 58-69

Author(s):

Pejman Solaimani ◽

Christopher Hogan ◽

Matthew Chin ◽

Juan L Miranda ◽

Douglas L Nguyen

Keyword(s):

Chronic Hepatitis ◽

Hepatitis C ◽

Chronic Hepatitis C ◽

Pegylated Interferon ◽

The United States ◽

Hepatitis C Infection ◽

Pegylated Interferon Alpha ◽

Emerging Therapies ◽

Chronic Hcv Infection ◽

Chronic Hcv

With 5.2 million people living with Hepatitis C, it is the most common blood-borne infection in the United States. Untreated chronic HCV infection may result in adverse consequences such as cirrhosis, portal hypertension, hepatic failure and hepatocellular carcinoma. Previously approved treatments include Pegylated-interferon alpha-2a/2b plus ribavirin, Boceprevir and Telaprevir. Recently approved medications include Sofosbuvir (SOF), Simeprevir (SMV), Ledispavir-Sofosbuvir (Harvoni®) and Ombitasvir-paritaprevir-ritonavir with dasabuvir tablets (Viekira Pak). Here we review the literature describing the current and emerging therapies for chronic hepatitis C.

Download Full-text

Bacterial Translocation and Host Immune Activation in Chronic Hepatitis C Infection

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz255 ◽

2019 ◽

Vol 6 (7) ◽

Cited By ~ 2

Author(s):

Mi Sun Moon ◽

Gabriella Quinn ◽

Elizabeth C Townsend ◽

Rabab O Ali ◽

Grace Y Zhang ◽

...

Keyword(s):

Hepatitis C ◽

Bacterial Translocation ◽

Immune Activation ◽

Hcv Infection ◽

Hepatitis C Infection ◽

Chronic Hcv Infection ◽

Chronic Hcv ◽

Circulating Levels ◽

Hepatic Macrophage ◽

Macrophage Uptake

Abstract Hepatitis C virus (HCV) infects 71 million individuals, and barriers to treatment remain. Bacterial translocation is a complication of chronic HCV infection, and this study evaluated circulating microbial components including lipopolysaccharide, peptidoglycan, and β-D-glucan in addition to their pattern recognition receptors and degree of hepatic macrophage uptake. The findings suggest that regulation of serum peptidoglycan and β-D-glucan differs from that of lipopolysaccharide. Additionally, macrophage activation in the liver may be better reflected by the degree of macrophage uptake than by circulating levels of microbial markers. These findings allow for a greater understanding of bacterial translocation and host immune activation during HCV infection.

Download Full-text

THE COURSE OF HEPATITIS C INFECTION AND RESPONSE TO ANTI-VIRAL THERAPY IN PATIENTS WITH THALASSEMIA MAJOR AND HEPATITIS C INFECTION: A LONGITUDINAL, PROSPECTIVE STUDY.

Mediterranean Journal of Hematology and Infectious Diseases ◽

10.4084/mjhid.2019.060 ◽

2019 ◽

Vol 11 (1) ◽

pp. e2019060 ◽

Cited By ~ 2

Author(s):

Sanaa Kamal ◽

Sara Abdelhakam ◽

Dahlia Ghoraba ◽

Mohamad Amer Mohsen ◽

Ahmed Abdelsalam ◽

...

Keyword(s):

Hepatitis C ◽

Liver Fibrosis ◽

Thalassemia Major ◽

Hcv Infection ◽

Progression Rate ◽

Hepatitis C Infection ◽

Fibrosis Progression ◽

Acute Hcv ◽

Chronic Hcv ◽

Prospective Longitudinal

Background/Aims: The course of hepatitis C infection (HCV) in patients with thalassemia has not been adequately studied and management has not been optimized. The current prospective longitudinal study assessed the clinical course, outcome, progression and management of recently acquired HCV in patients with transfusion dependent thalassemia major versus acute HCV without thalassemia. Methods: A well-characterized cohort of patients with thalassemia and recent HCV infection or recent HCV without thalassemia were enrolled and prospectively followed. The blood transfusion needs and chelating agents were determined. Liver functions tests, HCV-RNA, iron and ferritin levels were measured. Patients with chronic HCV evolution received treatment for HCV. The fibrosis progression rate was determined in chronic HCV patients with or without thalassemia by paired liver biopsies or serial transient elastography (TE), or serum markers of liver fibrosis. Liver iron content (LIC) was assessed by R2 MRI. Results: Self-limited acute HCV was observed in 17% of patients with acute HCV and thalassemia versus 35% of patients without thalassemia (P=0.031). The fibrosis progression rates were significantly higher in patients with chronic HCV and thalassemia compared to those with chronic HCV alone (1.14±0.48) and (0.35±0.14) (P < 0.0001) respectively. A direct linear correlation was observed between the fibrosis progression rate and each of LIC (R=+0.67; P=0.01) and ferritin (R=0.77; P<0.01). In patients with chronic HCV and thalassemia, the sustained virologic response (SVR) to pegylated interferon based therapy and direct antiviral agents (DAAS) were 33% and 82% respectively (P=), while in chronic HCV patients without thalassemia, the SVR rates to PEG-IFN/RBV and DAAs were 51% and 92% respectively. Five patients with concomitant HCV and thalassemia died during the study due to cardiac causes (n=3) and liver cancer (n=2). Conclusions: Patients with acute HCV and thalassemia have low rates of spontaneous resolution of HCV infection and the majority develop chronic HCV. Direct acting antiviral combinations are associated with high SVR rates and low adverse event in treatment naïve and experienced patients with chronic HCV and thalassemia. Liver fibrosis is accelerated in thalassemia patients with chronic HCV, therefore, early diagnosis, treatment with DAAs, adequate iron chelation and non-invasive monitoring liver status are recommended to prevent cirrhosis and hepatocellular carcinoma.

Download Full-text