Why is hepatitis C on the rise? A discussion with Director of CDCs Division of Viral Hepatitis, Dr. John Ward

Background:
Cases of acute hepatitis C virus (HCV) infection nearly tripled from 2010 through 2015, rising each year for five years, according to a new report from the Centers for Disease Control and Prevention (CDC).

To read more about hepatitis C virus, please click here.

Because the vast majority of new infections go undiagnosed, the number of HCV cases that were reported—from 850 cases in 2010 to 2,436 cases in 2015—doesn’t reflect the true scale of the epidemic, CDC said. After adjusting for under-diagnosis and under-reporting, CDC estimated that nearly 34,000 new HCV infections actually occurred in the United States in 2015.

The rising number of HCV infections has also meant an increase in HCV-related mortality. Hepatitis C is now associated with more deaths in the US than 60 other infectious diseases combined, according to CDC. About 20,000 Americans died from hepatitis C-related causes in 2015, according to the report, and the majority of deaths were among people age 55 and older.

But the older population isn’t the one the report is chiefly concerned about. The major risk factor for new HCV infections is injection drug use, primarily among younger adults.

In this interview, John W. Ward, MD, Director of the CDC’s Division of Viral Hepatitis, discusses what’s behind the increase in cases of hepatitis C, and what can be done about it.

MDLinx: The CDC report largely attributes the upsurge in acute HCV cases to new infections associated with greater use of injected drugs. In which populations are HCV cases and drug use rising?

Dr. Ward: Recent increases in acute hepatitis C infections related to injection drug use have occurred primarily among young people who are under 40 years old, non-Hispanic white, and living in rural or suburban (versus urban) settings. Increases were seen particularly in states within the Appalachian, Midwestern, and New England regions of the country.

The report adds: “HCV transmission primarily occurs through percutaneous exposure to blood; thus, injection drug use is an important risk factor.… Access to safe injection equipment for persons who inject drugs can prevent HCV infection, and HCV therapy can cure >90% of infected persons, thereby reducing the risk for HCV-associated mortality and transmission of HCV to others.”

MDLinx: What more can physicians do to help prevent and control rising HCV rates among their patients?

Dr. Ward: Health care providers are key in making sure that everyone at risk for hepatitis C is screened and tested. It’s important that anyone who has ever injected drugs—even just once—get screened for hepatitis C.

In addition, everyone born from 1945 to 1965 should be tested, as baby boomers are six times more likely to be living with hepatitis C than those in other age groups. Most people living with hepatitis C are unaware they have it, so testing is critical to enable people who are infected to take steps to protect their health and prevent transmission to others.

The report adds: “Evidence-based strategies as well as integrated-service provision are urgently needed in drug treatment programs to ensure patients are tested for HCV and persons found to be HCV-infected are linked to care and receive appropriate treatment. These efforts will require further collaboration among federal partners and state and local health departments to better address the syndemic of opioid abuse and HCV infection.”

About Dr. Ward: John W. Ward, MD, is Director of the Division of Viral Hepatitis at the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, in Atlanta, GA.