Increasing prevalence of cirrhosis among U.S. adults aware or unaware of their chronic hepatitis C virus infection

Prowpanga Udompap, Ajitha Mannalithara, Nae Yun Heo, Donghee Kim, W. Ray Kim

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

Background & Aims Cirrhosis from hepatitis C virus (HCV) infection is a major cause of end-stage liver disease and hepatocellular carcinoma worldwide. We determine the prevalence of cirrhosis among HCV-infected American adults including those unaware of their infection. Methods Using the National Health and Nutrition Examination Survey (NHANES) data, we identified participants aged ≥20 years with detectable serum HCV RNA. The prevalence of advanced fibrosis and cirrhosis was determined for eras 1 (1988-94), 2 (1999-2006) and 3 (2007-2012) by using FIB-4 >3.25 and APRI >2.0, respectively. Results Out of 52,644 NHANES examinees, 49,429 were tested for HCV, of whom 725 met the inclusion criteria (positive HCV RNA with available data for FIB-4 and APRI). Based on APRI, 6.6% (95% confidence interval [CI]: 2.2-11.0) of HCV-infected adults in era 1, 7.6% (95% CI: 3.4-11.8) in era 2 and 17.0% (95% CI: 8.0-26.0) in era 3 had cirrhosis. In the multivariable regression analysis, this era effect was attributable to increasing age (odds ratio [OR]:1.04, 95% CI: 1.02-1.07), diabetes (OR: 2.33, 95% CI: 1.01-5.40) and obesity (OR: 2.96, 95% CI: 1.15-7.57). Cirrhosis was as common among respondents who were unaware of their infection as those who were aware (both 11%). Results were identical when FIB-4 was used. Conclusions Among HCV-infected American adults, the proportion with cirrhosis has increased rapidly. Cirrhosis prevalence remains high in individuals unaware of their HCV infection. These data highlight the urgency for HCV screening regardless of symptoms, systematic assessment for liver fibrosis in those with HCV infection and institution of antivirals to prevent advanced liver disease. Lay summary Chronic hepatitis C virus (HCV) infection is a major cause of cirrhosis, creating a large public health burden. Based on the U.S. National Health and Nutrition Examination Survey sample, we found the proportion of patients with cirrhosis among Americans with HCV infection increased from 6.6% to 17.0% over the past two decades. Patients who were unaware of their infection were just as likely to have cirrhosis as those who knew about their infection, which highlights the need for screening and treatment for HCV at the population level.

Original languageEnglish (US)
Pages (from-to)1027-1032
Number of pages6
JournalJournal of Hepatology
Volume64
Issue number5
DOIs
StatePublished - May 1 2016
Externally publishedYes

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Chronic Hepatitis C
Virus Diseases
Hepacivirus
Fibrosis
Confidence Intervals
Nutrition Surveys
Odds Ratio
Infection
RNA
End Stage Liver Disease
Symptom Assessment
Liver Cirrhosis
Antiviral Agents
Liver Diseases
Hepatocellular Carcinoma
Public Health
Obesity
Regression Analysis

Keywords

  • Cirrhosis.
  • Hepatitis C virus
  • Liver fibrosis

ASJC Scopus subject areas

  • Hepatology

Cite this

Increasing prevalence of cirrhosis among U.S. adults aware or unaware of their chronic hepatitis C virus infection. / Udompap, Prowpanga; Mannalithara, Ajitha; Heo, Nae Yun; Kim, Donghee; Kim, W. Ray.

In: Journal of Hepatology, Vol. 64, No. 5, 01.05.2016, p. 1027-1032.

Research output: Contribution to journalArticle

Udompap, Prowpanga ; Mannalithara, Ajitha ; Heo, Nae Yun ; Kim, Donghee ; Kim, W. Ray. / Increasing prevalence of cirrhosis among U.S. adults aware or unaware of their chronic hepatitis C virus infection. In: Journal of Hepatology. 2016 ; Vol. 64, No. 5. pp. 1027-1032.
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abstract = "Background & Aims Cirrhosis from hepatitis C virus (HCV) infection is a major cause of end-stage liver disease and hepatocellular carcinoma worldwide. We determine the prevalence of cirrhosis among HCV-infected American adults including those unaware of their infection. Methods Using the National Health and Nutrition Examination Survey (NHANES) data, we identified participants aged ≥20 years with detectable serum HCV RNA. The prevalence of advanced fibrosis and cirrhosis was determined for eras 1 (1988-94), 2 (1999-2006) and 3 (2007-2012) by using FIB-4 >3.25 and APRI >2.0, respectively. Results Out of 52,644 NHANES examinees, 49,429 were tested for HCV, of whom 725 met the inclusion criteria (positive HCV RNA with available data for FIB-4 and APRI). Based on APRI, 6.6{\%} (95{\%} confidence interval [CI]: 2.2-11.0) of HCV-infected adults in era 1, 7.6{\%} (95{\%} CI: 3.4-11.8) in era 2 and 17.0{\%} (95{\%} CI: 8.0-26.0) in era 3 had cirrhosis. In the multivariable regression analysis, this era effect was attributable to increasing age (odds ratio [OR]:1.04, 95{\%} CI: 1.02-1.07), diabetes (OR: 2.33, 95{\%} CI: 1.01-5.40) and obesity (OR: 2.96, 95{\%} CI: 1.15-7.57). Cirrhosis was as common among respondents who were unaware of their infection as those who were aware (both 11{\%}). Results were identical when FIB-4 was used. Conclusions Among HCV-infected American adults, the proportion with cirrhosis has increased rapidly. Cirrhosis prevalence remains high in individuals unaware of their HCV infection. These data highlight the urgency for HCV screening regardless of symptoms, systematic assessment for liver fibrosis in those with HCV infection and institution of antivirals to prevent advanced liver disease. Lay summary Chronic hepatitis C virus (HCV) infection is a major cause of cirrhosis, creating a large public health burden. Based on the U.S. National Health and Nutrition Examination Survey sample, we found the proportion of patients with cirrhosis among Americans with HCV infection increased from 6.6{\%} to 17.0{\%} over the past two decades. Patients who were unaware of their infection were just as likely to have cirrhosis as those who knew about their infection, which highlights the need for screening and treatment for HCV at the population level.",
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AU - Kim, Donghee

AU - Kim, W. Ray

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N2 - Background & Aims Cirrhosis from hepatitis C virus (HCV) infection is a major cause of end-stage liver disease and hepatocellular carcinoma worldwide. We determine the prevalence of cirrhosis among HCV-infected American adults including those unaware of their infection. Methods Using the National Health and Nutrition Examination Survey (NHANES) data, we identified participants aged ≥20 years with detectable serum HCV RNA. The prevalence of advanced fibrosis and cirrhosis was determined for eras 1 (1988-94), 2 (1999-2006) and 3 (2007-2012) by using FIB-4 >3.25 and APRI >2.0, respectively. Results Out of 52,644 NHANES examinees, 49,429 were tested for HCV, of whom 725 met the inclusion criteria (positive HCV RNA with available data for FIB-4 and APRI). Based on APRI, 6.6% (95% confidence interval [CI]: 2.2-11.0) of HCV-infected adults in era 1, 7.6% (95% CI: 3.4-11.8) in era 2 and 17.0% (95% CI: 8.0-26.0) in era 3 had cirrhosis. In the multivariable regression analysis, this era effect was attributable to increasing age (odds ratio [OR]:1.04, 95% CI: 1.02-1.07), diabetes (OR: 2.33, 95% CI: 1.01-5.40) and obesity (OR: 2.96, 95% CI: 1.15-7.57). Cirrhosis was as common among respondents who were unaware of their infection as those who were aware (both 11%). Results were identical when FIB-4 was used. Conclusions Among HCV-infected American adults, the proportion with cirrhosis has increased rapidly. Cirrhosis prevalence remains high in individuals unaware of their HCV infection. These data highlight the urgency for HCV screening regardless of symptoms, systematic assessment for liver fibrosis in those with HCV infection and institution of antivirals to prevent advanced liver disease. Lay summary Chronic hepatitis C virus (HCV) infection is a major cause of cirrhosis, creating a large public health burden. Based on the U.S. National Health and Nutrition Examination Survey sample, we found the proportion of patients with cirrhosis among Americans with HCV infection increased from 6.6% to 17.0% over the past two decades. Patients who were unaware of their infection were just as likely to have cirrhosis as those who knew about their infection, which highlights the need for screening and treatment for HCV at the population level.

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