New Health Trends® Study by Quest Diagnostics in Collaboration with CDC Reveals Concerning Decreases in Hepatitis C Testing and Treatment During First Months of COVID-19 Pandemic

A new Quest Diagnostics Health Trends® report developed in collaboration with the Centers for Disease Control and Prevention (CDC) found that the COVID-19 pandemic reduced routine hepatitis C virus (HCV) testing and treatment. The study was published online today in American Journal of Preventative Medicine.

The study builds on an ongoing collaboration between Quest and CDC to study viral hepatitis infections and support the goal to eliminate hepatitis C in the United States. It is also the first large scale study by Quest Diagnostics to analyze patterns in hepatitis C virus antibody screening and RNA diagnostic testing along with prescription treatments, providing insights into the interplay of laboratory testing and therapy.

The study underscores that people living with undiagnosed hepatitis C could develop more advanced disease prior to eventually confirming their infection status, including cirrhosis and liver cancers, leading to higher rates of morbidity and death. Further, people living with undiagnosed HCV infections may continue to unknowingly transmit the virus to others. According to CDC, people with chronic hepatitis C can often have no symptoms and don't feel sick. When symptoms appear, they often are a sign of advanced liver disease.

According to the findings:

HCV antibody testing (used to screen for potential active HCV infection) volume decreased 59% during the early stage of the COVID-19 pandemic (April 2020) and rebounded to a 6% reduction in July, compared with the same months in 2018 and 2019

The number of HCV RNA (used to diagnose active HCV infection) positive results fell by 62% in March 2020 and remained 39% below the same months in 2018 and 2019

For hepatitis C treatment, prescriptions decreased 43% in May, 37% in June, and 38% in July of 2020, relative to the corresponding months in 2018 and 2019

Although HCV antibody screening rebounded close to the 2019 (pre-pandemic) volume, in June and July 2020, HCV RNA confirmed positives (diagnoses) and HCV treatments remained nearly 40% below the corresponding months of 2019

"This analysis adds to other studies that demonstrate that lack of access to testing and care in 2020 during the height of the pandemic means many individuals did not receive important diagnostic test and screenings, said Harvey W. Kaufman, M.D., Senior Medical Director, Head of the Health Trends Research Program for Quest Diagnostics, and the report's lead author. "It's important we communicate the need to bring Hepatitis C virus testing and treatment above pre-pandemic levels to identify people who have delayed or skipped healthcare services. Fortunately, HCV infection is now a curable condition and taking an HCV antibody screening test is the first step."

About HCV Prevalence; Gaps in Care and Testing Recommendations

HCV infection is the most commonly reported bloodborne infection in the U.S. and is a leading cause of liver-related morbidity and mortality.1,2 An estimated 2.4 million adults in the U.S. are living with HCV infection. Hepatitis C was reported as the underlying or contributing cause for 15,713 deaths in 2018.1 Approximately 70% of adults with acute HCV infection develop chronic HCV infection. If untreated, 1 in 4 of these individuals will die prematurely from HCV-associated complications such as liver failure and hepatocellular carcinoma.2 During 2015–2018, only 61% of people diagnosed with hepatitis C were aware they were living with hepatitis C infection, suggesting a gap in care.3

In response to increasing rates of acute HCV infection among young adults, including reproductive-aged people, the U.S. Preventive Services Task Force recommends laboratory screening for HCV in adults, aged 18–79 years as well as women during pregnancy.4 The CDC also recommends hepatitis C testing at least once per lifetime for all adults aged 18 years and over, and for all pregnant women during each pregnancy.5

Study Methodology
This study represents the largest analysis of its kind to date, assessing the impact of the COVID-19 pandemic on HCV testing and treatment. Investigators evaluated data from a large national reference clinical laboratory and national estimates of dispensed prescriptions for HCV treatment. The analysis included 12,309,475 HCV antibody test results and 326,603 HCV RNA test results during the time period from 2018 through 2020. In addition, the investigators analyzed 486,181 hepatitis C direct acting antiretroviral (DAA) medications dispensed January 2018 through July 2020 based on new and refilled pharmacy transactions in a national prescription database.

Investigators from Quest Diagnostics and the CDC evaluated the average number of HCV antibody tests, HCV antibody positive test results, and HCV RNA positive test results by month, January through July 2020, compared to the same months in 2018 and 2019. To assess the impact of HCV treatment, dispensed HCV direct acting antiretroviral medications were examined for the same time periods.

About Quest Diagnostics Health Trends™

Quest Diagnostics Health Trends™ is a series of scientific reports that provide insights into health topics, based on analysis of objective clinical laboratory data, to empower better patient care, population health management and public health policy. The reports are based on the Quest Diagnostics database of 48 billion de-identified laboratory test results, believed to be the largest of its kind in healthcare. Health Trends has yielded novel insights to aid the management of allergies and asthma, prescription drug monitoring, diabetes, Lyme disease, heart disease, influenza and workplace wellness. Quest Diagnostics also produces the Drug Testing Index (DTI)™, a series of reports on national workplace drug positivity trends based on the company's employer workplace drug testing data.

About Quest Diagnostics

Quest Diagnostics empowers people to take action to improve health outcomes. Derived from the world's largest database of clinical lab results, our diagnostic insights reveal new avenues to identify and treat disease, inspire healthy behaviors and improve healthcare management. Quest annually serves one in three adult Americans and half the physicians and hospitals in the United States, and our 50,000 employees understand that, in the right hands and with the right context, our diagnostic insights can inspire actions that transform lives. 

REFERENCES

1. Viral hepatitis surveillance—United States, 2018. Atlanta, GA: HHS, CDC; 2020. https://www.cdc.gov/hepatitis/statistics/2018surveillance/index.htm. Accessed March 30, 2021.

2. Seo S, Silverberg MJ, Hurley LB, et al. Prevalence of spontaneous clearance of hepatitis C virus infection doubled from 1998 to 2017. J Clin Gastroenterol Hepatol. 2020;18(2):511‒513. https://doi.org/10.1016/j.cgh.2019.04.035.

3. Ryerson AB, Schillie S, Barker LK, Kupronis BA, Wester C. Vital signs: newly reported acute and chronic hepatitis C cases — United States, 2009–2018. MMWR Morb Mortal Wkly Rep. 2020;69(14):399‒404. https://doi.org/10.15585/mmwr.mm6914a2.

4. U.S. Preventative Services Task Force. Hepatitis C virus infection in adolescents and adults: screening: United States Preventative Services Task Force statement. JAMA. 2020;323(10):970‒975. https://doi.org/10.1001/jama.2020.1123.

5. Schillie S, Wester C, Osborne M, Wesolowski L, Ryerson AB. CDC recommendations for hepatitis C screening among adults — United States, 2020. MMWR Recomm Rep. 2020;69(RR-2):1–17. https://doi.org/10.15585/mmwr.rr6902a1.