HCV in the Latino Community -Epidemiology, Natural History, Risk Factors, Screening and Diagnosis

Transcription

1 HCV in the Latino Community -Epidemiology, Natural History, Risk Factors, Screening and Diagnosis Wari Allison MD, PhD Assistant Professor/Research Dept. of Medicine/Infectious Disease Medical Director San Antonio AIDS Foundation

2 Nothing to Disclose Disclosures

3 Objectives Provide information about the epidemiology of hepatitis C virus infection in the US Provide information about the association of HCV with hepatocellular carcinoma in Latino communities. Give an overview of risk factors for HCV Give an overview of HCV screening and diagnosis

4 The Virus Genus: Hepacivirus, Family: Flaviviridae ss RNA virus Incubation average 2-3mths, range 0.5-6mths Symptoms: vary, usually asymptomatic Complications: acute rarely fulminant hepatitis chronic cirrhosis, hepatocellular carcinoma HCC

5 How is HCV spread?

6 Sex, Drugs and.. SEX Semen exposure Bloody practices Internet hook up sites Anonymous sex Commercial sex workers Other STDs HIV HCV DRUGS Crystal methamphetamines IVDU Lack of harm reduction programs: needle exchange Transactional sex for drugs

7 Natural History of HCV infection HCV EXPOSURE 15-40% clear virus spontaneously 60-85% persistent (chronic) infection % develop cirrhosis over years 20 Puoti et al. Hepatology 1992, MMWR , Poynard et al. Lancet 1997 Independently associated with increased rates of cirrhosis are: -Age at infection > 40 years -Male gender -Daily alcohol consumption > 50g/day

8 Age adjusted Hepatitis C, B and HIV mortality rates USA Age adjusted Hepatitis C, B and HIV mortality rates USA

9 Racial/Ethnic disparities in HCV prevalence HCV prevalence in those who self-identify as non-hispanic black is higher than in other racial/ethnic groups Among those who self-identify as Hispanic, population based surveys show prevalence of HCV seropositivity to differ markedly by country of origin or ancestry, with a higher prevalence in those of Puerto Rican vs. Mexican descent Deniston MM et al. Ann Intern Med 2014;160: ; Liu G et al. Dig Dis Sci 2014;59:1950-7; Kuniholm MH et al. J Infect Dis 2014;209:

10 Racial/Ethnic disparities in HCV prevalence Mortality rates from HCV in Hispanic and non- Hispanic black people are twice those observed for non-hispanic white people. Among people with HCC, Hispanic people have substantially poorer survival rates than non- Hispanic white people. HCV infection is also associated with lower income and education levels >> poor minority communities are therefore at high risk for morbidity and mortality from HCV. Deniston MM et al. Ann Intern Med 2014;160: ; Wise M et al. Hepatology 2008;47: ; Davila JA et al. Clin Gastroenterol Hepatol 2006;4:

11 Risk for HCC in Latinos in Texas Data from the SEER (Surveillance, Epidemiology and End Results) registry of the NIH National Cancer Institute and the Texas Cancer Registry Calculated annual and 3-year moving average age-specific & age-adjusted HCC incidence rates and annual percent changes (APCs) for Latinos and non-hispanic whites (NHW) Ramirez AG et al. Plos One 2014; 9(6): e99365

12 Risk for HCC in Latinos in Texas South Texas Latinos have the highest HCC rates in the country 3-4 times higher than NHW in SEER regions WHY??? We re not sure Latinos in Texas have higher rates of obesity and DM, proportionally higher Mexican immigrant population and non immigrant population of Mexican descent Ramirez AG et al. Plos One 2014; 9(6): e99365

13 USPSTF: screening recommendation for HCV 2013 Screen persons at high risk for infection in whom prevalence >50% Offer one-time screening in all persons born between , prevalence 3-4% Revised from 2004 recommendation that had been against screening in adults not at increased risk of infection and stated insufficient evidence to recommend for or against screening in adults at high risk Revision based on increased benefits of screening through improved responses after triple-regimen antiviral treatment and reduction in all-cause and liver-related mortality and HCC following treatment

14 Established risk factors for HCV infection Past or current injection drug use Blood transfusion, blood product or organ receipt prior to 1992 Long-term hemodialysis Unregulated tattooing or piercing Healthcare worker percutaneous exposure Surgery before implementation of universal precautions Being born to mother with HCV Incarceration Intranasal drug use Contaminated injected medicines? High risk sexual behavior

15 HCV in baby boomers 27% of population born HCV prevalence 3.3% 77% of adult HCV infections 60% do not know status Testing could identify > 800,000 new HCV cases and avoid 120,000 deaths Smith et al. Ann Intern Med 2012; Rein et al. Ann Intern Med 2012; Amstrong et al. Ann Intern Med 2006

16 HCV Screening Antibody testing (anti-hcv) Detected in new, chronic and resolved infections TELLS IF EVER INFECTED, NEED CONFIRMATORY TEST May be negative in acute HCV EIA (enzyme immunoassay) Confirmatory method HCV PCR Rapid HCV antibody Testing Fingerstick or venipuncture whole blood

17 HCV and HIV Of people with HIV in the United States: About 25% are coinfected with HCV About 10% are coinfected with HBV About 80% of people with HIV who inject drugs also have HCV HIV co-infection more than triples the risk for liver disease, liver failure, and liver-related death from HCV No modifications to HCV treatment for patients with HIV: just have to watch drug interactions CDC, 2015