Substance Abuse Fuels Rise in HCV in Four Eastern States

Laurie Barclay, MD

May 07, 2015

Acute hepatitis C virus (HCV) infections increased 364% between 2006 and 2012 among persons 30 years of age or younger in Kentucky, Tennessee, Virginia, and West Virginia, according to a study published in the May 8 issue of the Morbidity and Mortality Weekly Report.

The increased infection rates were strongly correlated with opioid abuse and injection drug use. In addition, adults younger than 30 years accounted for 44.8% of all HCV cases in these states during the surveillance period; the median age was 25 years.

"[HCV] infection is the most common blood-borne infection in the United States, with approximately three million persons living with current infection," write Jon E. Zibbell, PhD, from the Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, and colleagues. "Percutaneous exposure to contaminated blood is the most efficient mode of transmission, and in the United States, injection drug use...is the primary risk factor for infection."

Previous state surveillance reports from 2006 to 2012 have shown a nationwide increase in reported cases of acute HCV infection, especially among states in central Appalachia and other states east of the Mississippi River. Most of these cases occur in adolescents and young adults 30 years of age or younger from nonurban areas. Nearly three quarters (73%) of these cases are associated with injection drug use as the main risk factor.

To better understand those data, Dr Zibbell and colleagues analyzed surveillance data from acute HCV case reports and drug treatment admissions in the four hardest-hit states, focusing on those younger than 30 years.

In addition to finding the overall steep rise in HCV infection in this age group, the researchers found that, nonurban residents had more than twice the increase in annual incidence compared with urban residents, although both urban and nonurban areas showed significant increases. Males and females were equally affected, and most of the cases were in non-Hispanic whites.

Moreover, between 2006 and 2012, these four states had a 21.1% increase in treatment admissions for abuse of any opioid, a 16.8% increase in treatment admissions for abuse of prescription opioids, and a 12.6% increase in treatment admissions for injection of any opioid.

"These increases indicate a strong correlation among opioid abuse, drug injecting, and HCV infection in these four states," the authors write.

Although prevalence of HIV in this population is presently low in these four states, the investigators warn of the potential for an increase in HIV infections, as injection drug use is a risk factor for both HIV and HCV.

"Evidence-based strategies as well as integrated-service provision are urgently needed in drug treatment programs to ensure patients are tested for HCV and persons found to be HCV-infected are linked to care and receive appropriate treatment," the report authors conclude. "These efforts will require further collaboration among federal partners and state and local health departments to better address the syndemic of opioid abuse and HCV infection."

The authors have disclosed no relevant financial relationships.

Morb Mortal Wkly Rep. 2015;64:453-458. Full text

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