HCV RNA Testing in HCV Seropositive Patients

Posted on April 1, 2015

Only 48% of HCV Seropositive Patients Undergo HCV RNA Testing and Only 5% Initiate Therapy

The Centers for Disease Control and Prevention recommends one-time hepatitis C virus (HCV) testing of individuals born between 1945 and 1965, with follow-up RNA testing for those with reactive serology. A study published last year in the journal Open Forum Infectious Diseases put perspective on the clinical practice challenges being faced in light of this recommendation. While the majority of 4466 patients showing reactive HCV serology at the Boston Medical Center between 2005 and 2010 were shown to be in the 40–69 age group, only 2135 (48%) underwent HCV RNA testing and 245 (5%) initiated treatment. The following factors were independently associated with HCV RNA testing:

  • Diagnosis in the outpatient clinic (OR, 1.64; 95% CI, 1.42–1.90)
  • Age at HCV diagnosis in decades (OR, 0.98; 95% CI, 0.98–0.99)
  • Private insurance (OR, 1.17; 95% CI, 1.01–1.34)
  • ≥10 visits after HCV diagnosis (OR, 2.15; 95% CI, 1.89–2.44)

While this study indicates that the majority (76%) of HCV testing is occurring in the outpatient clinic and individuals diagnosed there are more likely to link to HCV care, the lack of HCV RNA testing and the even more alarming low numbers of patients initiating treatment are major issues that need addressing. In light of these issues, and with the hope of reducing barriers to screening and care, and encouraging treatment within primary care and community sites for many HCV-infected patients, Elsevier Multimedia Publishing and the American Journal of Medicine (AJM) has developed a comprehensive, online Resource Center (http://hepcresource.amjmed.com) dedicated to providing both primary care providers and specialists with the latest information on the screening, diagnosis, treatment, and management of HCV.

Additional interesting facts about the 4466 seropositive patients in the Boston study included the following:

  • 885 (20%) were foreign born
  • 2885 (65%) were covered by public insurance
  • 431 (10%) of patients were infected with HIV
  • 3400 (76%) were tested in the outpatient clinic
  • 967 (22%) were tested in the inpatient wards
  • 99 (2%) were tested in the emergency department
  • Hepatitis C seropositivity rates (approximately 16%) were similar across the 3 settings evaluated

As little HCV testing is occurring in inpatient wards and the emergency department, there may be an opportunity to expand testing in those two locations. However, once again, approximately 60% of patients who were shown to be seropositive in these settings did not link to HCV care. HCV testing, especially with the advent of State testing mandates, needs to be combined with interventions to ensure that those diagnosed with HCV are evaluated for and receive subsequent HCV-related care.

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