Hepatitis: March essentials

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The top new studies selected from scanning more than 386 clinical articles on Hepatitis in the past month.


A practice of universal one-time testing may be more effective for high-risk, urban emergency
departments as more than 25% of HCV cases remain undiagnosed when Centers for Disease Control and Prevention screening recommendations were followed

Source: Clin Infect Dis                                                      

Key results

  • Of 4,713 patients, 652 (13.8%) were HCV antibody positive.
  • Of antibody positive patients, 204 (31.3%) had undocumented HCV infection.
  • Of patients with undocumented HCV infection, 99 (48.5%) would have been diagnosed based on birth-cohort testing, and an additional 54 (26.5%) would have been identified through risk-based testing as recommended by the CDC.
  • The remaining 51 patients (25.0%) with undocumented HCV would not have been tested.
  • Given an estimated 7,727 unique ED patients with HCV infection in a 1-year period, testing according to CDC guidelines would identify 1,815 undocumented infections; universal testing would identify an additional 526 HCV-infected patients.

Study design

  • This was an 8-week HCV seroprevalence study conducted in 2013 at an urban ED with an annual census of 66,000 patients, serving a diverse and socioeconomic disadvantaged population.
  • Antibody HCV screening was conducted for all patients with excess blood collected for clinical purposes.
  • Demographic and clinical information, including documented HCV infection, was obtained from electronic medical records.

Why this matters

  • CDC guidelines recommend one-time HCV testing for individuals born during 1945 to 1965 (baby boomer cohort), in addition to targeted risk-based testing.
  • EDs are considered a key setting for HCV testing because of their history of success in HIV screening, given the populations they serve.
  • This study showed a high seroprevalence of both known and undocumented HCV infection in an urban ED, confirming the suitability of this venue for screening purposes.
  • However, limiting HCV screening to CDC guidelines would have allowed 26.5% of undiagnosed patients to ‘slip through the cracks.’
  • The findings suggest that universal one-time testing may be a more effective screening method for HCV in high-risk urban EDs.

PubMed Abstract
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Hepatitis C virus (HCV) mortality, even when grossly undercounted on death certificates, far outstrips deaths from 60 other nationally notifiable infectious conditions (ONNICs) combined

Source: Clin Infect Dis                                                    

Key Results

  • HCV-related deaths increased from 11,051 in 2003 to 19,368 in 2013; the average annual increase was 6.2% (P<.05).
  • ONNIC-related deaths decreased from 24,745 in 2003 to 17,915 in 2013; the average annual decrease was 3.4% (P<.05).
  • The decline in deaths was related to a 41% drop in HIV deaths and, to a lesser extent, deaths associated with pneumococcal disease (decrease of 31%) and tuberculosis (decrease of 28.2%).
  • In 2012, the number of HCV deaths surpassed that of ONNICs.
  • The HCV mortality rate (per 100,000 population) increased from 3.72 in 2003 to 5.03 in 2013; the average annual increase was 3.4% (P<.05).
  • The ONNIC-related mortality rate decreased from 8.51 in 2003 to 5.25 in 2013; the average annual decrease was 4.9% (P<.05).
  • In 2013, 51.1% of HCV-related deaths occurred among individuals aged 55-64 y (mean, 59.7 y).

Study design

  • This was an analysis of multiple-cause-of-death data for 2003-2013, obtained from the US National Center for Health Statistics.
  • Trends in HCV-related mortality were compared with those for ONNICs.
  • Mortality rates were calculated by dividing the number of deaths by the total US census population for that year.

Why this matters

  • Despite the advent of effective therapies, HCV mortality rates increased steadily from 2003 to 2013, predominantly among middle-aged individuals.
  • In 2012, HCV mortality outstripped deaths associated with 60 ONNICs, including HIV, which continue to decline.
  • The HCV mortality burden may be underestimated because of under-reporting as a cause of death.
  • The findings underscore the urgency in finding, evaluating, and treating patients in the largest infectious disease epidemic in the United States.

PubMed Abstract


Women receive remarkably inadequate and discontinuous care for hepatitis B virus (HBV) after pregnancy

Source: J Viral Hepat

Key results             

  • More than one third (37%) of women were first diagnosed with HBV at a prenatal visit.
  • Nearly half (49%) never saw a liver specialist.
  • One third (32%) did not undergo timely ALT checks.
  • HBV DNA measurements were absent in 26% of women and untimely in 34%.
  • Of the 72 (42%) women considered high risk for HCC by AASLD criteria, only 33% and 38% had timely ultrasonography and α-fetoprotein (AFP) testing, respectively.
  • In multivariate analysis, women followed by a hepatologist were 3.74 times more likely to have a timely ALT (95% CI, 1.75-7.97; P=.001) and 8.1 times more likely to have timely HBV DNA quantification (95% CI, 3.45-18.96; P<.001).
  • Timely ultrasonography (OR, 37.43; 95% CI, 4.51-310.42; P=.0001) and AFP (OR, 16.66; 95% CI, 2.39-115.95; P=.004) for HCC were also more common in women seeing a hepatologist.

Study design

  • This was a retrospective study of 243 hepatitis B surface antigen-positive women who had sought prenatal care at Massachusetts General Hospital.
  • The primary outcome was adherence to the American Association for the Study of Liver Diseases (AASLD) and American College of Obstetricians and Gynecologists (ACOG) guidelines with respect to timely laboratory assessments, HCC surveillance, and referral to a hepatologist.
  • Mean follow-up duration was 5.8 y.

Why this matters

  • Clinicians focus on preventing perinatal HBV transmission, and the level of follow-up maternal care remains unknown.
  • This study was performed in a large, urban, academic tertiary care center.
  • Results showed that women receive inadequate postpartum ALT and HBV viral load monitoring, HCC screening, and follow-up with a hepatologist.

PubMed Abstract