Update on HCV and other infections related to injection drug use. Ann Thomas, MD, MPH Acute and Communicable Disease Prevention

Transcription

1 Update on HCV and other infections related to injection drug use Ann Thomas, MD, MPH Acute and Communicable Disease Prevention Dec 14, 2018

2 Overview Update on NHANES prevalence data Trends in HCV, HIV and syphilis in OR Other health indicators in PWIDs HCV screening and treatment 2

3 Prevalence of HCV in the US NHANES, vs * Millions of Americans HCV Ab+ RNA + * estimates include: incarcerated individuals nursing home residents unsheltered homeless active-duty military Denniston, et al. Ann Int Med 2014;160: Hofmeister, et al. Hepatology 3

4 Numbers and age-adjusted rates of HCV-related deaths, Oregon Numbers of deaths Age-adjusted rates/100, Number Rate

5 Rates of Chronic HCV cases in persons < 30, Oregon, HCV < PDX Rest of OR 53% increase in cases under 30 years of age

6 Rates of new HIV diagnoses in Oregon Rest of OR PDX Area 18% drop in cases statewide between 2012 and 2016

7 Rates of HIV deaths, Oregon PDX Rest of OR 17% drop in deaths statewide between 2012 and 2016

8 Rates of early syphilis Oregon, Year Congenital Syphilis Cases PDX Rest of OR % increase statewide, from 310 cases to 591cases

9 Proportion of cases reporting injection drug use, Portland area vs rest of Oregon, HIV cases HIV deaths Acute HCV Syphilis PDX Rest of OR 9

10 Hospitalizations due to IDU-related bacterial infections, by infection type, Oregon IDU-Related SBI Hospitalizations (n) 3,000 2,500 2,000 1,500 1, Endocarditis Bacteremia Sepsis Osteomyelitis Skin\Soft Tissue Infection 10

11 Total annual costs* of IDU-related SBI Hospitalizations, Oregon $250,000,000 $218,987,964 Cost in 2015 dollars $200,000,000 $150,000,000 $100,000,000 $50,000,000 $69,385, $ *Adjusted for charge-to-cost and inflation (2015 USD)

12 Increases in numbers of cases of GAS, Portland Tricounty area, Invasive Group A Streptococcus by High Risk Group PWID Homeless PWID & Homeless In 2017, 57% of cases if invasive GAS were either PWID, PEH or both

13 Numbers of cases of candidemia, Portland Tricounty area, Number of cases * non-pwid PWID *2018 data collection incomplete

14 Percent of candidemia cases in PWID by surveillance site, 2017, n=1221 Proportion of Cases who Inject Drugs (%) 30% 25% 20% 15% 10% 5% 0% 7.8% 4.8% 3.9% 16.7% 1.4% 29.4% 8.6% 25.8% 16.3% CA CO GA MD MN NM NY OR TN Overall proportion in PWID = 10.5% 14 14

15 Rates of Neonatal Abstinence Syndrome (NAS) per 1,000 live births, Oregon, Rates per 1,000 live births N=278 N= Portland Metro Area Rest of Oregon 37% increase in rates between 2012 and

16 Rate of women with HCV reported on birth certificate (per 1,000 live births) Oregon Snodgrass, MMWR 2018;67:

17 Baby Boomer Screening In 2012, CDC implemented recommendation for onetime screening of individuals born between 1945 and 1965 National Health Interview Survey estimated that only 13.8% had been screened in 2015 in the US, 3 years after the CDC and the US Preventive Services Taskforce made the recommendation 17 Jemal. Am J Prev Med 2017;53:e31-e33

18 Proportion of persons ever tested for HCV by age group and gender, Oregon 2017 Percent Born before 1945 Born Born after 1965 Male Female 18

19 Severe Outcomes of HCV, Oregon Medicaid Patients, Identified cohort of Oregon residents with HCV enrolled in Medicaid at least 12 mos Cross-matched data set with hospital discharge, OSCaR, and death certificate databases 19 Estimate incidence of advanced liver disease (hospitalization with cirrhosis, varices, hepatic encephalopathy, etc), liver cancer, and deaths (underlying cause of death=hcv or advanced liver disease)

20 Severe Outcomes of HCV, Oregon Medicaid Patients, Of 11,790 Medicaid beneficiaries with HCV: 156 (1.3%) with hepatocellular carcinoma 596 (5.1%) initial hospitalizations for advanced liver disease 474 (4.0%) HCV-related deaths Only 262 (2.2%) ever initiated treatment with antivirals Jindai. Public Health Reports: 20

21 HCV Care Continuum, Oregon ,000 90,000 Diagnosed\Undiagnosed estimate 90,500 80,000 70,000 Reported and living, ,985 60,000 50,000 40,000 In care, , 39,210 30,000 20,000 10, % 8% Initiated antiviral HCV treatment, , 3, Sources: CDC, Hepvu.org, Orpheus, (May 26, 2017), and Oregon APAC,

22 Oregon HIV Care Continuum, ,000 8,000 Number of Oregon residents 7,000 6,000 5,000 4,000 3,000 2,000 Diagnosed, 7,157 88% In care, 6,269 On treatment, 6,081 97% Suppressed, 5,463 95% 1,000 0 Diagnosed In care On treatment Suppressed Source: Oregon HIV Program, ORPHEUS and CAREAssist enrollment,

23 Age-adjusted Death Rates for HCV and HIV, Oregon, Age-adjusted rate per 100, Advent of HAART HCV HIV HIVHCV 0.00 How antiretroviral treatment changed the curve for HIV

24 Summary Increasing burden of infectious diseases among PWIDs But, Oregon has new opportunity to make a difference in trajectory of HCV epidemic Still, need to work to improve availability of harm reduction services, SEP, MAT, naloxone, wound care services 24

25 Questions 25