Hepatitis C and Baby Boomers: Efficient Utilization of Resources

Abstract

Introduction: Hepatitis C Virus (HCV) infection is a silent epidemic currently affecting 3.5 to 5 million people in the US. With the advent of new direct acting antivirals (DAA) an aggressive screening and treatment approach is imperative. According to the guidelines all baby boomers should be screened. We hypothesized that universal screening of baby boomers without any risk factors may be an unnecessary burden and hence conducted this study. Methods: A retrospective chart review of all the baby boomers presented in between January 2010-October 2015 was performed. Information collected included the age, sex, race, HCV serology, genotype, alcohol consumption and HCV risk factors. The prevalence and risk factors stratification was performed and data was analyzed to particularly assess the prevalence of HCV with respect to their risk factors. The patients who were HCV positive but denied any risk factors were interviewed again about the presence of risk factors. Results: A total of 573 charts were reviewed. Prevalence of HCV was 26.8% (154/573 patients) with 59% males and 41% females. A total of 132 HCV infected patients were risk stratified as 22 patients were lost to follow up. Almost all (99.2 %) HCV infected population reported exposure to one of the risk factors, most common risk factors being intravenous drug abuse (37%), cocaine sniffing (26.5%) and blood transfusion before 1992 (19.6%). Only 1/132 HCV positive patients denied being exposed to identifiable risk factor. Majority of HCV negative patients, 85.2% (357/419) were negative for risk factors and 14.8 % patients were negative HCV but with positive risk factors. Conclusion: Complying with the CDC recommendation of universally screening baby boomers, we have faced resistance from some patients raising ethical issues. The fear and stigma of being tested for the disease that has been associated with high risk behaviors, adds to the psychological stress in the particular group of patient population. This study reinforces a striking association in between HCV infection and risk factors. Therefore, we suggest that aggressive screening of baby boomers with a risk factor questionnaire will be a more efficient practical approach rather than applying universal screening.Table 1: Risk Factor Stratification Of Baby Boomers