More Hepatitis C Testing is Needed in Teens with OUD
A nationwide study presented this month demonstrated that teens and young adults who have injected drugs are at risk for contracting Hepatitis C, but most aren’t tested and therefore don’t receive life-saving treatment. The study of more than 250,000 at-risk youth found only one-third of those with diagnosed opioid use disorder (OUD) were tested for Hepatitis C.
This study is the first to look at opioid use and Hepatitis C testing in at-risk youth. “We’re missing an opportunity to identify and treat young people who are at risk for this deadly infection,” said Rachel L. Epstein, MD, MA, lead author of the study. “Screening for OUD and other drug use, and then testing for Hepatitis C in those at high risk, can help us do a better job of eliminating this serious infection, especially now that very effective Hepatitis C medications are approved for teenagers.”
Hepatitis C is an infection of the liver. During the initial stages of the infection people often have mild or no symptoms. They may periodically develop a fever, and could notice they have dark urine, abdominal pain, and yellow-tinged skin. Over many years, the infection leads to liver disease and cirrhosis. Sometimes, complications such as liver failure, liver cancer, or dilated blood vessels in the esophagus and stomach are reported. Hepatitis C killed more than 18,000 Americans in 2016, making it the most common cause of death from a reportable infectious disease, according to the Centers for Disease Control and Prevention (CDC).
The infection can be spread by sharing needles used to inject drugs, and studies have shown that youths who misuse prescription oral opioids eventually begin injecting them. In 2017, the Food and Drug Administration (FDA) approved the first direct-acting Hepatitis C medications for teens. These medications can cure a person with Hepatitis C infection in two to three months.
Researchers analyzed electronic medical records for 269,124 teens and young adults who visited one of 57 Federally Qualified Health Centers between 2012 and 2017. Of the 875 who had diagnosed opioid use disorder (OUD), 36 percent were tested for Hepatitis C, and of those, 11 percent had been exposed to Hepatitis C and 6.8 percent had evidence of chronic infection. Overall, 6,812 (2.5 percent) who visited the health centers were tested for Hepatitis C and of those, 122 (1.8 percent) tested positive for Hepatitis C.
“The issue is complicated by the fact that not enough at-risk youth are screened for opioid or other drug use for a variety of reasons, including lack of time, comfort level between clinician and patient, and privacy and stigma concerns,” said Dr. Epstein. “And even when drug use is identified, there’s a belief that youth are less likely to test positive for Hepatitis C, which isn’t necessarily the case as we show in our study. Clearly, this is an overlooked group that is at high risk.”
Factors leading to the greatest likelihood of being tested for Hepatitis C, researchers found, included being African American, having any substance use disorder and being 19 to 21 years old (rather than in the younger range). Other groups could be overlooked, and diagnoses missed.