Hepatitis C treatment rates low among some at-risk US populations
Children, recently pregnant women less likely to get crucial antiviral therapy
Access to hepatitis C treatment and care remains low among children and recently pregnant women in the U.S., according to data from two recently published studies.
“We are still having difficulties in getting the treatments to the populations that need them the most,” said Megan Curtis, MD, an assistant professor at Washington University School of Medicine (WashU Medicine) who was involved in both studies, in a university news story. “These kinds of studies can help us identify where those barriers are.”
The researchers believe the data can be used by public health authorities to identify better ways to reach these populations and move toward the goal of hepatitis C elimination.
“We need to come up with better strategies for addressing hepatitis C,” Curtis said. “We have all the tools to eliminate it. We have medications that can treat it. We know the people who need to get it. We just need to step up the availability and the awareness.”
Hepatitis C prevalence on rise in US
The prevalence of hepatitis C, where an infection with the hepatitis C virus (HCV) causes liver inflammation (hepatitis), is on the rise in the U.S.
This increase has been linked to the ongoing opioid epidemic, as the bloodborne infection is commonly spread through sharing needles or other drug equipment. It can also be passed from infected mothers to babies during pregnancy or childbirth.
When hepatitis C is not controlled long-term, it may lead to serious or life-threatening liver problems.
There are safe and effective antiviral therapies for hepatitis C, with a few months of pills leading to a cure for more than 95% of people.
However, antivirals are most effective when started early and taken consistently, and access to such care can vary. The goal of the two recent studies was to identify populations of people who may face hurdles in accessing treatment.
The first study, “Disparities in Linkage to Care Among Children With Hepatitis C Virus in the United States,” was published in Pediatrics.
Researchers retrospectively examined U.S. electronic health records to explore access to hepatitis C care among children born between 2000 and 2018 who were diagnosed with an HCV infection.
Among 928 children, about one-third were linked to hepatitis C care, and 12% were prescribed an antiviral medication.
Statistical analyses adjusted for potential influencing factors including sex, birth date, and region showed that white children were more than three times more likely to receive care than Black children, and Hispanic/Latinx children were more than two times more likely.
Moreover, children living in the South were less likely to receive treatment compared with those living in other parts of the country.
Children born from 2014-2018 were more likely to be treated than those who were born earlier, which may reflect “changes in Medicaid and insurance coverage during that period, as well as increased availability of treatment for younger children in later years,” the university story stated.
Disparities may be due to socioeconomic, age-related factors
Nevertheless, children born more recently received treatment at a much lower rate than that reported for adults with hepatitis C. There are various reasons why these disparities may exist, including socioeconomic and age-related ones.
Curtis noted parents may delay treatment “because of the difficulty of administering a medicine to a young child.” Clinicians might delay “because some children who have hepatitis C will spontaneously clear it on their own,” but “this isn’t always the case,” the researcher pointed out.
The second study, “Association Between Sex and Recent Pregnancy and Hepatitis C Virus Treatment in People With Opioid Use Disorder,” was published in O&G Open.
The researchers took a similar approach to examine access to hepatitis C treatment among HCV-infected people entering treatment for opioid use disorder, with a particular interest in sex- and pregnancy-related disparities.
The results showed that among nearly 20,000 individuals, 37.3% were prescribed antiviral therapies within a year of treatment for opioid use disorder. Men were most likely to receive an antiviral prescription (40.6%), followed by women who had not been pregnant recently (35.7%), and women who had been recently pregnant (31.8%).
In statistical analyses adjusted for a number of influencing factors, including age, year of enrollment, and race and ethnicity, men were 18% more likely, and women who were not recently pregnant 9% more likely, to be prescribed hepatitis C treatment than recently pregnant women.
As with children, the reasons for these disparities are likely multifactorial.
“People with hepatitis C are often asymptomatic for years after being exposed, so if you are young, otherwise healthy and have a new baby, getting prompt treatment may not be a top priority, especially if it is challenging to access,” said Caroline Cary, a medical student at WashU Medicine and the study’s first author. “It’s imperative to make hepatitis C care more readily accessible to new moms considering the long-term consequences of the condition.”
Now, there’s a need to use data like these to advance hepatitis C elimination efforts, according to the researchers. With the right approach, “we could be done with hepatitis C in a generation,” Curtis said.
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