HCV Testing Needs Expansion Beyond Baby Boomers
By now, many of us have seen the advertisements on television promoting baby boomers getting tested for hepatitis C. In 2012, the CDC officially recommended routine HCV testing for anyone born between the years of 1945 and 1965, owing to the much higher prevalence of infection among folks born in the baby boom era.
At the time this recommendation was made, this all made sense. However, data over the last couple of years indicate HCV is not restricted to this sub-population and, in fact, they suggest we should be testing more widely.
Multiple emergency room surveillance programs, including one from ID Week 2016 that Ravi Jhaveri, MD, discusses in-depth in our Take Home, have shown a spike in HCV infection among adolescents and young adults. These rates begin to approach the rates of infection in the baby boomer populations evaluated in the same emergency departments.
The higher prevalence in the younger population is postulated to be due to intravenous drug use among younger adults. What’s different between the baby boomers who test positive in the ED and the younger group is the racial makeup: baby boomers are disproportionally minority populations whereas the young adult population testing positive in the ED is mostly white persons. This higher prevalence among whites underscores the likelihood of this being related to drug use and, in particular, linked to the opioid epidemic spreading throughout the country over the past 5 years.
Taken together, this suggests we need to modernize our recommendations. It also highlights the anachronistic message of the well-produced, relatively expensive advertising that is on TV targeting only baby boomers. While the advertisement accomplishes its mission of alerting baby boomers to the need for HCV testing, it unfortunately creates a message for the public that says, in essence, “If I’m not in this group, I don’t have anything to worry about.”
This is counterproductive both to the population who will be missed because they won’t be tested, but also messaging to providers who will operationalize this message. If providers implement universal testing of baby boomers, but ignore younger populations, they will miss an entire subset of the population who are infected. The younger patients will not learn of their infection because the providers aren’t testing them for HCV.
We need to modernize our recommendations as soon as possible and broaden the messaging to the general population and the provider population that HCV is fairly ubiquitous among the adult populations in the United States. Failure to do so will delay the ultimate goal of eradicating hepatitis C from the U.S.
– Michael S. Saag, MD
Co-Chief Medical Editor