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. 2016 May;64(5):1027-1032.
doi: 10.1016/j.jhep.2016.01.009. Epub 2016 Jan 22.

Increasing prevalence of cirrhosis among U.S. adults aware or unaware of their chronic hepatitis C virus infection

Prowpanga Udompap  1 , Ajitha Mannalithara  1 , Nae-Yun Heo  2 , Donghee Kim  1 , W Ray Kim  3
Affiliations

Increasing prevalence of cirrhosis among U.S. adults aware or unaware of their chronic hepatitis C virus infection

Prowpanga Udompap et al. J Hepatol. 2016 May.

Abstract

Background & aims: Cirrhosis from hepatitis C virus (HCV) infection is a major cause of end-stage liver disease and hepatocellular carcinoma worldwide. We determine the prevalence of cirrhosis among HCV-infected American adults including those unaware of their infection.

Methods: Using the National Health and Nutrition Examination Survey (NHANES) data, we identified participants aged ⩾20 years with detectable serum HCV RNA. The prevalence of advanced fibrosis and cirrhosis was determined for eras 1 (1988-94), 2 (1999-2006) and 3 (2007-2012) by using FIB-4 >3.25 and APRI >2.0, respectively.

Results: Out of 52,644 NHANES examinees, 49,429 were tested for HCV, of whom 725 met the inclusion criteria (positive HCV RNA with available data for FIB-4 and APRI). Based on APRI, 6.6% (95% confidence interval [CI]: 2.2-11.0) of HCV-infected adults in era 1, 7.6% (95% CI: 3.4-11.8) in era 2 and 17.0% (95% CI: 8.0-26.0) in era 3 had cirrhosis. In the multivariable regression analysis, this era effect was attributable to increasing age (odds ratio [OR]:1.04, 95% CI: 1.02-1.07), diabetes (OR: 2.33, 95% CI: 1.01-5.40) and obesity (OR: 2.96, 95% CI: 1.15-7.57). Cirrhosis was as common among respondents who were unaware of their infection as those who were aware (both 11%). Results were identical when FIB-4 was used.

Conclusions: Among HCV-infected American adults, the proportion with cirrhosis has increased rapidly. Cirrhosis prevalence remains high in individuals unaware of their HCV infection. These data highlight the urgency for HCV screening regardless of symptoms, systematic assessment for liver fibrosis in those with HCV infection and institution of antivirals to prevent advanced liver disease.

Lay summary: Chronic hepatitis C virus (HCV) infection is a major cause of cirrhosis, creating a large public health burden. Based on the U.S. National Health and Nutrition Examination Survey sample, we found the proportion of patients with cirrhosis among Americans with HCV infection increased from 6.6% to 17.0% over the past two decades. Patients who were unaware of their infection were just as likely to have cirrhosis as those who knew about their infection, which highlights the need for screening and treatment for HCV at the population level.

Keywords: Cirrhosis; Hepatitis C virus; Liver fibrosis.

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Figures

Figure 1
Figure 1
Flow diagram of subject selection
Figure 2
Figure 2
Percentages of the individual with abnormal AST, platelet counts and APRI score > 2.0 in each era
Figure 3
Figure 3
Proportion of the respondents with high, indeterminate and low probability of cirrhosis based on APRI score
See this image and copyright information in PMC

References

    1. Denniston MM, Jiles RB, Drobeniuc J, Klevens RM, Ward JW, McQuillan GM, et al. Chronic hepatitis C virus infection in the United States, National Health and Nutrition Examination Survey 2003 to 2010. Annals of internal medicine. 2014;160:293–300. - PMC - PubMed
    1. Ly KN, Xing J, Klevens RM, Jiles RB, Ward JW, Holmberg SD. The increasing burden of mortality from viral hepatitis in the United States between 1999 and 2007. Annals of internal medicine. 2012;156:271–278. - PubMed
    1. Denniston MM, Klevens RM, McQuillan GM, Jiles RB. Awareness of infection, knowledge of hepatitis C, and medical follow-up among individuals testing positive for hepatitis C: National Health and Nutrition Examination Survey 2001-2008. Hepatology. 2012;55:1652–1661. - PMC - PubMed
    1. van der Meer AJ, Veldt BJ, Feld JJ, Wedemeyer H, Dufour JF, Lammert F, et al. Association between sustained virological response and all-cause mortality among patients with chronic hepatitis C and advanced hepatic fibrosis. JAMA. 2012;308:2584–2593. - PubMed
    1. Davis GL, Alter MJ, El-Serag H, Poynard T, Jennings LW. Aging of hepatitis C virus (HCV)-infected persons in the United States: a multiple cohort model of HCV prevalence and disease progression. Gastroenterology. 2010;138:513–521. 521, e511–516. - PubMed

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