April 25, 2015, Vienna, Austria: Study results presented today at The International Liver Congress™ 2015 show that the occurrence of advanced liver fibrosis is similar for patients infected with the hepatitis C virus (HCV), whether or not they have been diagnosed.
Most individuals with HCV remain asymptomatic, which makes the diagnosis difficult. The study authors used the hypothesis that individuals whose HCV is not diagnosed are less likely to have advanced fibrosis than those who have been diagnosed. They then compared liver fibrosis between respondents of the National Health and Nutrition Examination Survey (NHANES) in the USA, in patients with diagnosed and undiagnosed HCV infection.
Of the respondents with known HCV infection, the proportion with a high, intermediate and low probability of advanced fibrosis was 14.5%, 40.3%, 45.2%, respectively; in those with undiagnosed HCV the results were 19.1%, 30.9%, 50.0%, respectively.
The study highlights that even if people are unaware they are infected with HCV, the virus affects their liver in the same way, resulting in advanced fibrosis. These results validate the current recommendation that screening for HCV, particularly among high-risk groups, is vital.
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EU and Public Health: Hall C (Plenary) Presentation time: 11:30 - 11:45 Presenter: Prowpanga Udompap (United States) Abstract O120: ADVANCED FIBROSIS IS COMMON IN INDIVIDUALS WHOSE HEPATITIS C HAS NOT BEEN DIAGNOSED: RESULTS FROM THE NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY 2001-2012
ADVANCED FIBROSIS IS COMMON IN INDIVIDUALS WHOSE HEPATITIS C HAS NOT BEEN DIAGNOSED: RESULTS FROM THE NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY 2001-2012
Prowpanga Udompap* 1, Ajitha Mannalithara1, Nae-Yun Heo1, W. Ray Kim1 1Division of Gastroenterology and Hepatology, Stanford University, Stanford, United States
Background and Aims: Hepatitis C virus (HCV) infection is a global public health problem - while it is common, its consequences may be severe, including end stage liver disease and hepatocellular carcinoma. Moreover, most individuals with HCV remain asymptomatic, which makes the diagnosis difficult. With the hypothesis that individuals whose HCV is not diagnosed are less likely to have advanced fibrosis than those who have been diagnosed, we compare liver fibrosis between respondents to the National Health and Nutrition Examination Survey (NHANES) with diagnosed and undiagnosed HCV infection.
Methods: Testing for HCV was incorporated in NHANES 2001-2012. In a subgroup of the respondents with HCV infection, follow-up questionnaires were administered. Awareness of HCV infection was assessed by the question whether they had known they had HCV before receiving a letter from NHANES. Liver fibrosis was estimated by the FIB-4 and APRI scores. Based on the published cut-off values for advanced fibrosis, the proportion of respondents with a high probability of advanced fibrosis was compared between respondents with known and undiagnosed HCV.
Results: Out of 30,140 respondents of the NHANES survey, 360 tested positive for HCV RNA. There were 355 participants with complete laboratory data needed for the FIB-4 and APRI scores, of whom 130 had completed the full hepatitis C follow-up questionnaires. Slightly less than half (47.7%, n=62) knew that they had hepatitis C infection before the survey, whereas in the remainder (52.3%), HCV was only discovered from the survey. In the figure, the two groups were comparable with respect to age, sex, aminotransferase and platelet counts. BMI was higher in those with known diagnosed, the significance of which is uncertain. The raw FIB-4 and APRI scores were similar between the two groups. Among the respondents with known HCV infection, the proportion with a high, intermediate, and low probability of advanced fibrosis was 14.5%, 40.3%, 45.2%, respectively. The corresponding data in those with undiagnosed HCV were 19.1%, 30.9%, 50.0%, respectively. A similar pattern was seen with the APRI score.
Conclusions: While more than half of survey respondents did not know of their HCV infection, their liver fibrosis was no less advanced than those whose HCV had been diagnosed prior to participation in the survey. These data further justifies the current recommendation for HCV screening in asymptomatic individuals.
Disclosure of Interest: P. Udompap: : None Declared, A. Mannalithara: : None Declared, N.-Y. Heo: : None Declared, W. R. Kim: Consultant: Gilead, BMS