Too few young opioid drug users tested for hepatitis C infection

Only one-third of teens and young adults who regularly inject opioid drugs are tested for hepatitis C virus (HCV) infections, according to a new study, the first to look at opioid use and hepatitis C testing in at-risk youth.

The opioid crisis has been associated with an increase in HCV infections among those aged 15 to 30 years. Healthcare providers may not test young people they suspect of misusing opioids because the drugs are available in pill form, which does not increase the risk of HCV infection. But studies show many youths who misuse prescription oral opioids eventually begin injecting them.

“We’re missing an opportunity to identify and treat young people who are at risk for this deadly infection,” said lead author Rachel L. Epstein, MD, a post-graduate research fellow in the section of infectious diseases at Boston Medical Center. “Screening for opioid use disorder and other drug use, and then testing for hepatitis C in those at high risk, can help us do a better job of eliminating this serious infection, especially now that very effective hepatitis C medications are approved for teenagers.” 

In 2017, the Food and Drug Administration approved the first direct-acting antiviral HCV medications for teens. These medications can clear HCV infection in two to three months.

Epstein and colleagues analyzed EHR data for 269,124 teens and young adults, aged 13 to 21 years old, who visited one of 57 Federally Qualified Health Centers between 2012 and 2017. These health centers provided healthcare to diverse and underserved communities across 19 states. Mean age at first HCV screening was just over 18 years.

Only 35 percent of records with billing codes for opioid use disorder and 8.9 percent with any code for drug use were tested for HCV. Some 10.6 percent who were tested for HCV had also been tested for human immunodeficiency virus, a common co-infection with HCV.

Overall, 2.5 percent of those who visited the health centers were tested for HCV, and 1.8 percent tested positive for HCV. A multivariable analysis found those most likely to be tested for HCV were African American youth, those with any substance use disorder, and those age 19 to 21 years.

The results suggest that current guidelines, which only recommend testing those with known injected drug use or other specific risk factors, underestimate who is at risk for HCV infection, she said.

“The issue is complicated by the fact that not enough at-risk youth are screened for opioid or other drug use for a variety of reasons, including lack of time, comfort level between clinician and patient, and privacy and stigma concerns,” said Epstein. “And even when drug use is identified, there’s a belief that youth are less likely to test positive for hepatitis C, which isn’t necessarily the case as we show in our study. Clearly, this is an overlooked group that is at high risk.”

The researchers presented their results at Infectious Disease Week 2018 in San Francisco in October.