Identification of Risk Factors for Testing of Hepatitis C in Non-Birth Cohort Patients: Is Universal Screening Necessary?

Abstract

Objectives: CDC reported that 45% of Hepatitis C (HCV) infected people denied known risk factors. Electronic health record RF-based, non-Birth Cohort (born outside of years 1945–1965) screening is challenging as risk factors are often input as nonsearchable data. Testing non-Birth Cohort patients solely based on risk factors has the potential to miss a substantial number of HCV infected patients. The aim was to determine the HCV antibody positive prevalence who would have been missed had providers only followed risk factor based screening recommendations. Methods: A 1:3 case-control retrospective nested chart review was conducted. HCV risk factors and opioid prescriptions were manually abstracted from the Electronic Health Record; other variables were collected using Explorys. In July 2015 HCV screening data was collected on non-Birth Cohort patients who were HCV tested across MedStar Health, as a presumptive marker for high risk. Univariate and multivariate logistic regression models were utilized to determine HCV antibody positive predictors. Results: Eighteen (23%) HCV antibody positive and 123 (49%) HCV antibody negative had no identified risk factors; 6 (33%) HCV antibody positive reported risk factors only after a positive test result. There was a significant interaction between age over 40 and opioid prescription use; these groups were 11× more likely to be HCV antibody positive (CI95 1.6–74.8). Conclusions: HCV testing solely based on presence of risk factors in non-Birth Cohort patients has the potential to miss a significant number of HCV antibody positive patients. Given patient- and provider-level barriers in elucidating risk factors, universal HCV antibody screening may be warranted.

Association Between Prescription Opioid Therapy for Noncancer Pain and Hepatitis C Virus Seroconversion

“…However, seroconversion risk was 3.2-fold higher with long-term vs no long-term prescription opioid therapy and there was evidence of higher risk with more intense long-term use (chronic vs episodic) and at higher daily doses (≥90 vs <90 MEQ). Our findings support 2 recent case-control analyses identifying an association between medically dispensed prescription opioids and HCV diagnosis . One of these analyses found that older individuals (age >40 years) with a history of prescription opioid use were 11 times more likely to test positive on an HCV antibody test, and the other analysis found prior prescription opioid dispensation to be the second most important variable for predicting HCV diagnosis in a machine learning prediction model .…”

“…42,43 In addition, owing to the inability to identify the exact date of seroconversion, some individuals who initiated prescription opioid therapy during follow-up may have done so after acquiring HCV; thus, prescription opioid therapy could be a proxy for HCV-related pain. 44 Our findings may support the offer of an HCV test to people with a history of long-term prescription opioid therapy 25,26,45 could increase the risk of harm and may facilitate illicit drug use in some individuals. 20,42 There is a need to support shared, patient-centered decision-making with regard to initiating, tapering, and discontinuing prescription opioid therapy.…”

“…Our findings support 2 recent case-control analyses identifying an association between medically dispensed prescription opioids and HCV diagnosis. 25 , 26 One of these analyses found that older individuals (age >40 years) with a history of prescription opioid use were 11 times more likely to test positive on an HCV antibody test, 26 and the other analysis found prior prescription opioid dispensation to be the second most important variable for predicting HCV diagnosis in a machine learning prediction model. 25 Our analysis builds on these studies by using a longitudinal approach with HCV seroconversion as the outcome and by distinguishing between prescription opioid dispensations for pain vs opioid agonist therapy.…”

“…An ecological study has implicated prescription opioid policies in increasing HCV diagnoses in the US 21 and 2 administrative case-control analyses have identified prior dispensation of prescription opioids as a risk factor for HCV diagnosis. 25 , 26 However, these studies assessed HCV diagnosis, and most analyses of HCV seroconversion have focused on the association between nonmedical prescription opioid injection and HCV acquisition among people who already inject drugs. 27 , 28 In this present analysis, we examined the association between medically dispensed prescription opioid therapy for noncancer pain and HCV seroconversion among individuals who were initially injection drug use–naive in a large population-based cohort of people who had more than 1 HCV test.…”

“…To date, few studies have directly assessed the association between medically dispensed prescription opioid therapy for pain and HCV seroconversion among individuals who initially have no history of injection drug use (injection drug use–naïve). An ecological study has implicated prescription opioid policies in increasing HCV diagnoses in the US and 2 administrative case-control analyses have identified prior dispensation of prescription opioids as a risk factor for HCV diagnosis . However, these studies assessed HCV diagnosis, and most analyses of HCV seroconversion have focused on the association between nonmedical prescription opioid injection and HCV acquisition among people who already inject drugs .…”