Chronic Hepatitis Cohort Study Sheds Light on Burden of Hepatitis B and C in U.S.

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People born between 1945 and 1964 account for the highest proportion of hepatitis B and C cases, and these viruses are a significant cause of illness and death, according to an analysis described in the January 1, 2013, Clinical Infectious Diseases.

Over years or decades chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infection can lead to advanced liver disease including cirrhosis (scarring) and hepatocellular carcinoma. Hepatitis B can be prevented with an effective vaccine, but complete cures are uncommon. Hepatitis C, in contrast, currently has no vaccine but treatment is increasingly effective at curing infection.

Approximately 1.25 million people in the U.S. are thought to carry chronic hepatitis B, while estimates for chronic hepatitis C fall with in the 3-4 million range. But the disease progression and the clinical implications of these viruses in the "real world" are not fully known.

To shed light on this issue, Anne Moorman from the Centers for Disease Control and Prevention (CDC) Division of Viral Hepatitis and fellow researchers with the Chronic Hepatitis Cohort Study (CHeCS) conducted an observational study using electronic medical records for more 1.6 million adult patients seen between January 2006 and December 2010 at 4 integrated healthcare systems in Detroit (Henry Ford Health System), Danville, PA (Geisinger Health System), Honolulu (Kaiser Permanente Hawaii), and Portland, OR (Kaiser Permanente Northwest).

Results

Based on these findings, the study authors concluded, "Baseline demographics, hospitalization, and mortality data from CHeCS highlight the substantial U.S. health burden from chronic viral hepatitis, particularly among persons born during 1945-1964."

In their discussion the researchers noted that all-cause death rates among people with hepatitis C in CHeCS was 3-fold higher than the rate for the general population in the National Health and Nutrition Examination Survey or NHANES (33% vs 11%, respectively). Furthermore, CHeCS participants died at a comparatively young age.

The researchers said that their findings "strongly support" a policy of birth cohort screening for people born between 1945 and 1964. Last May the CDC recommendedthat everyone born during this period should get tested for HCV at least once, regardless of risk factors, but in December the U.S. Preventive Services Task Force advised only that people in this group should "consider" testing unless they were at known risk.

"Therapies for chronic viral hepatitis are likely to improve substantially over the coming years," but "[t]reatment results in clinical practice do not always mirror those in the clinical trial setting, particularly among minority and low-income patients with many barriers to care," the authors wrote.

The CHeCS study is ongoing with newly added participants, and the researchers will be looking at how factors such as smoking, substance use, and overall well-being can affect mortality, disease progression, treatment side effects, and drug resistance under "real-world" conditions.

2/1/13

Reference

AC Moorman, SC Gordon, LB Rupp. Baseline Characteristics and Mortality among People in Care for Chronic Viral Hepatitis: The Chronic Hepatitis Cohort Study. Clinical Infectious Diseases 56(1):40-50. January 1, 2013.