In the JournalsPerspective

CDC: More people die of HCV than any other infectious disease

The CDC reports that the number of hepatitis C virus infection-related deaths reached an all-time high of 19,659 in 2014, making hepatitis C the number one infectious disease that kills people.

“Because hepatitis C often has few noticeable symptoms, the number of new cases is likely much higher than what is reported. Due to limited screening and underreporting, we estimate the number of new infections is closer to 30,000 per year,” John W. Ward, MD, director of CDC’s division of viral hepatitis, said in a press release. “We must act now to diagnose and treat hidden infections before they become deadly and to prevent new infections.”

In a new study, Kathleen N. Ly, MPH, epidemiologist in the CDC’s division of viral hepatitis, and colleagues evaluated death certificates from the National Center for Health Statistics database from 2003 to 2013. They sought to measure trends in HCV-related mortality in the U.S. and compare them with 60 other infectious conditions that are routinely reported to the CDC.

Kathleen Ly, MPH

Kathleen N. Ly

Results showed that the number of deaths associated with HCV increased from 11,051 in 2003 to 19,368 in 2013. Comparatively, deaths associated with the other 60 infectious conditions decreased from 24,745 in 2003 to 17,915 in 2013.

The number of deaths from HCV represented an average annual increase of 865 deaths. The annual percentage increase was 6.2% (P < .05), according to the report. The number of deaths from the other 60 infectious conditions represented an average annual decrease of 718 deaths and annual percentage decrease of 3.4% (P < .05).

The decrease in the other infectious conditions is attributed to a decline in HIV-related deaths, as well as pneumococcal disease- and tuberculosis-related deaths. When these three diseases were combined, they were associated with a 39.9% decline in deaths from 2003 (n = 17,764) to 2013 (n = 10,683).

“Why are so many Americans dying of this preventable, curable disease? …Once hepatitis C testing and treatment are as routine as they are for high cholesterol and colon cancer, we will see people living the long, healthy lives they deserve,” Jonathan Mermin, MD, director of CDC’s national center for HIV/AIDS, viral hepatitis, STD and TB prevention, said in the release.

According to the study, the HCV-associated mortality rate increased from 3.72 per 100,000 population in 2003 (95% CI, 3.65-3.79) to 5.03 deaths in 2013 (95% CI, 4.96-5.11); these represent an average annual increase of 0.14 deaths per 100,000 population per year and an average annual percentage increase of 3.4% (P < .05).

The researchers also believe that the data they collected in the study may still underestimate the burden of HCV mortality due to the fact 59% of people who died of a liver-related cause and were known to be infected with HCV did not have HCV listed as a cause of death on their death certificate, according to the report.

“There are many putative reasons why there remains underappreciation of the seriousness of HCV infection, an infection among an estimated 3.2 million U.S. residents, and continuing deficiencies in the decades-long asymptomatic incubation period that they may make clinicians and patients discount the importance of the infection; the lack of cohesive and vocal advocacy groups as many patients were former injection drug users; “compassion fatigue” from HIV/AIDS and other large acute public health problems; and currently, a new therapeutic nihilism not about the efficacy of antivirals but about their perceived cost, despite evident cost-effectiveness, ” the researchers wrote.

According to the CDC, the greatest HCV burden falls on baby boomers — those born from 1945 to 1965 — many of whom have been living with HCV for many years and don’t even know it.

A separate study in March, conducted by researchers at the British Columbia Centre for Excellence in HIV/AIDS and coauthored by CDC, showed the U.S. to be in an HCV genotype 1a epidemic that expanded between 1940 and 1960, subsequently declined in the early 1990s then increased slightly in the late 1990s and early 2000s.

“Many baby boomers were infected during medical procedures in the years after World War II, when injection and blood transfusion technologies were not as safe as they are today,” according to the press release from the CDC, adding that without diagnosis and treatment, they were more likely to develop liver cancer and may unknowingly transmitted the disease to others.

“Healthcare providers should screen all people born between 1945 and 1965 for hepatitis C, and help those living with the virus to access treatment that, in most cases, leads to a cure," Ly told Healio.com/Hepatology. "In addition, more must be done to stop new infections resulting from injecting drug use, including the implementation of comprehensive prevention programs that comprise, among other things, rapid links to medical care, substance abuse treatment and access to sterile injection equipment.” – by Melinda Stevens

Disclosure: The researchers report no relevant financial disclosures.

The CDC reports that the number of hepatitis C virus infection-related deaths reached an all-time high of 19,659 in 2014, making hepatitis C the number one infectious disease that kills people.

“Because hepatitis C often has few noticeable symptoms, the number of new cases is likely much higher than what is reported. Due to limited screening and underreporting, we estimate the number of new infections is closer to 30,000 per year,” John W. Ward, MD, director of CDC’s division of viral hepatitis, said in a press release. “We must act now to diagnose and treat hidden infections before they become deadly and to prevent new infections.”

In a new study, Kathleen N. Ly, MPH, epidemiologist in the CDC’s division of viral hepatitis, and colleagues evaluated death certificates from the National Center for Health Statistics database from 2003 to 2013. They sought to measure trends in HCV-related mortality in the U.S. and compare them with 60 other infectious conditions that are routinely reported to the CDC.

Kathleen Ly, MPH

Kathleen N. Ly

Results showed that the number of deaths associated with HCV increased from 11,051 in 2003 to 19,368 in 2013. Comparatively, deaths associated with the other 60 infectious conditions decreased from 24,745 in 2003 to 17,915 in 2013.

The number of deaths from HCV represented an average annual increase of 865 deaths. The annual percentage increase was 6.2% (P < .05), according to the report. The number of deaths from the other 60 infectious conditions represented an average annual decrease of 718 deaths and annual percentage decrease of 3.4% (P < .05).

The decrease in the other infectious conditions is attributed to a decline in HIV-related deaths, as well as pneumococcal disease- and tuberculosis-related deaths. When these three diseases were combined, they were associated with a 39.9% decline in deaths from 2003 (n = 17,764) to 2013 (n = 10,683).

“Why are so many Americans dying of this preventable, curable disease? …Once hepatitis C testing and treatment are as routine as they are for high cholesterol and colon cancer, we will see people living the long, healthy lives they deserve,” Jonathan Mermin, MD, director of CDC’s national center for HIV/AIDS, viral hepatitis, STD and TB prevention, said in the release.

According to the study, the HCV-associated mortality rate increased from 3.72 per 100,000 population in 2003 (95% CI, 3.65-3.79) to 5.03 deaths in 2013 (95% CI, 4.96-5.11); these represent an average annual increase of 0.14 deaths per 100,000 population per year and an average annual percentage increase of 3.4% (P < .05).

The researchers also believe that the data they collected in the study may still underestimate the burden of HCV mortality due to the fact 59% of people who died of a liver-related cause and were known to be infected with HCV did not have HCV listed as a cause of death on their death certificate, according to the report.

“There are many putative reasons why there remains underappreciation of the seriousness of HCV infection, an infection among an estimated 3.2 million U.S. residents, and continuing deficiencies in the decades-long asymptomatic incubation period that they may make clinicians and patients discount the importance of the infection; the lack of cohesive and vocal advocacy groups as many patients were former injection drug users; “compassion fatigue” from HIV/AIDS and other large acute public health problems; and currently, a new therapeutic nihilism not about the efficacy of antivirals but about their perceived cost, despite evident cost-effectiveness, ” the researchers wrote.

According to the CDC, the greatest HCV burden falls on baby boomers — those born from 1945 to 1965 — many of whom have been living with HCV for many years and don’t even know it.

A separate study in March, conducted by researchers at the British Columbia Centre for Excellence in HIV/AIDS and coauthored by CDC, showed the U.S. to be in an HCV genotype 1a epidemic that expanded between 1940 and 1960, subsequently declined in the early 1990s then increased slightly in the late 1990s and early 2000s.

“Many baby boomers were infected during medical procedures in the years after World War II, when injection and blood transfusion technologies were not as safe as they are today,” according to the press release from the CDC, adding that without diagnosis and treatment, they were more likely to develop liver cancer and may unknowingly transmitted the disease to others.

“Healthcare providers should screen all people born between 1945 and 1965 for hepatitis C, and help those living with the virus to access treatment that, in most cases, leads to a cure," Ly told Healio.com/Hepatology. "In addition, more must be done to stop new infections resulting from injecting drug use, including the implementation of comprehensive prevention programs that comprise, among other things, rapid links to medical care, substance abuse treatment and access to sterile injection equipment.” – by Melinda Stevens

Disclosure: The researchers report no relevant financial disclosures.

    Perspective
    Michael S. Saag

    Michael S. Saag

    We’ve known for a long time that HCV infection was a major cause of death in the United States.  We now have evidence, among infectious diseases, it is the lead killer. The data emerge from a convergence of factors: HIV is now managed to the point where folks successfully engaged in care are living near normal life-spans and not dying like they did in the 1980s and 90s, along with the ‘maturation’ of HCV infection, acquired during that same time, where many HCV infected folks are experiencing fatal complications of chronic HCV infection, such as advanced cirrhosis, decompensated liver disease and hepatocellular carcinoma. Additionally, it is clear that chronic inflammation elicited from ongoing HCV viral replication over years accelerates disease progression in other organ systems such as the kidney, heart, and brain, further increasing death rates among those with HCV.

    • Michael S. Saag, MD
    • Professor of medicine, Jim Straley Chair in AIDS Research Director of the Center for AIDS Research University of Alabama at Birmingham

    Disclosures: Saag reports no relevant financial disclosures.