Falls in hepatitis C tests, concern for treatment


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The COVID-19 pandemic has coincided with sharp falls in routine testing and treatment of hepatitis C virus. (HCV), according to the results of a collaborative study between the Centers for Disease Control and Prevention (CDC) and Quest Diagnostics. The authors say there could be an associated increase in the rates of transmission, morbidity, and mortality of this curable disease.

Dr. Harvey Kaufman

Lead author Harvey W. Kaufman, MD, senior medical director and head of the health trends research program for research diagnosis, said Medscape Medical News, “There are a lot of patients who have skipped care.”

He noted that without treatment, this disease can progress cirrhosis, hepatocellular carcinoma, and death.

Transmission is also a concern because most people with HCV are unaware of their disease and have no symptoms, which increases the risk of spreading it to other people.

The conclusions of the study were published online May 10 al American Journal of Preventive Medicine. The researchers compared the 12,309,475 results of HCV antibody testing and the 326,603 results of HCV (confirmatory) RNA testing from January to July 2018, 2019 and 2020.

The decrease in HCV antibody testing during the pandemic period was statistically significant (b = −0.440; 95% CI, −0.580 to −0.310; Pg<.001). In addition, the number of positive HCV RNA tests decreased by approximately 62.3% in March 2020 and remained low until July compared to the same months in 2018 and 2019, according to the study.

The findings raise concerns that people living with undiagnosed HCV, the most common blood-borne infection in the United States, may develop more advanced diseases before confirming their condition.

In addition, the volume of direct-acting antivirals dispensed decreased by 22.7% in April 2020 compared to the averages of April 2018 and 2019 and continued to decrease by 39.6% between May and July 2020 compared to the average for the same months of 2018 and 2019.

Kaufman says the research team has continued to analyze the results beyond the study period. They found that by the end of 2020 there had been a sharp rise in evidence, although evidence has not yet recovered to pre-pandemic levels.

These delays in care have been a setback for the World Health Organization’s goal of eliminating HCV by 2030, Kaufman said.

“We were moving forward to the pandemic,” he added.

These findings reflect those of another study this showed that in the 3.5 months following March 16, 2020, hospital-wide tests fell by 49.6% and the identification of new patients fell by 42.1%. Outpatient-only tests and identification of new patients fell 71.9% and 63.3%, respectively.

Dr. jaideep behari

Jaideep Behari, MD, PhD, of the Liver Disease Center at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, said Medscape Medical News that in recent months, he and his colleagues have seen an increase in the number of patients returning to HCV testing and treatment after delaying this care during the pandemic. There has also been an increase in colonoscopies and endoscopies.

Behari said that since HCV generally progresses slowly, delays in care should not have a substantial effect on outcomes, as long as patients are present at some point this year.

He said the biggest concern is with patients who have been lost to follow-up. These patients may never see their doctors again and may miss trial opportunities.

“Concern is always found in high-risk populations, for example, injecting drug users and other vulnerable populations,” he said. “If there is a break in the relationship with care and referral at the right time, it is likely that the patient will never try again and potentially treatment.”

The CDC recommended routine routine HCV testing for people of all ages who have risk factors. Occasional testing is recommended for adults 18 years of age and older and for all pregnant women during each pregnancy, except in regions where HCV infection rates are less than 0.1%.

Behari said that thanks to the combination of telemedicine, the use of nurses and medical assistants, and flexible scheduling, appointment hours for HCV-related care at his center have been reduced by 2 months by 2020. to 1 week or less now.

An estimated 2.4 million adults live with HCV in the United States. The CDC reported that HCV was the underlying cause or contributed to 15,713 deaths in 2018.

Kaufman and two co-authors are employed by Quest Diagnostics and have shares in the company. Behari has not revealed any relevant financial relationship.

I am J Prev Med. Published online May 10, 2021. Full text

Marcia Frellick is a Chicago-based freelance journalist. She has previously written for the Chicago Tribune and Nurse.com and was editor of the Chicago Sun-Times, the Cincinnati Enquirer and the St. Cloud (Minnesota) Times. Follow her on Twitter at @mfrellick.

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