Conference Coverage

Opiate use tied to hepatitis C risk in youth



– A new study indicates young adults with opioid use disorder are seldom screened for hepatitis C virus infections; yet 11% of the subjects with opioid use disorder who were tested had been exposed to hepatitis C, and 6.8% had evidence of chronic hepatitis C infection.

Dr. Rachel Epstein, Boston Medical Center Jim Kling/MDedge News

Dr. Rachel Epstein

Lead study author Rachel Epstein, MD, of Boston Medical Center, presented a retrospective review of health records that included a total of 269,124 teenagers and young adults aged 13-21 who visited Federally Qualified Health Centers (FQHCs) in 19 states between 2012 and 2017.

Overall, 2.5% (6,812 subjects) of all subjects received hepatitis C testing and 122 (1.8%) tested positive. Based on health records, 23,345 had an ICD-9 code for any illicit drug use and 8.9% of those (2,090) were tested for HCV infection. Of the 933 subjects with an ICD-9 code for opioid use disorder, 35% were tested for HCV.

The results suggest that a group at significant risk of hepatitis C – those with opioid use disorder – is being overlooked in public health efforts to control the disease.

Clinicians may presume, “Oh, you just take opioids orally, you don’t inject drugs,” but oral opiate users can progress to intravenous drug use, Donna Futterman, MD, director of clinical pediatrics, Montefiore Medical Center, and professor of clinical pediatrics at Albert Einstein College of Medicine, both in New York, said during the press conference at the annual scientific meeting on infectious diseases.

Guidelines call for testing for hepatitis C only in individuals with known injected drug use, among other risk factors, but the research suggests that this significantly underestimates the population of teenagers and young adults who are at risk. Many who take opiates go on to use injectable drugs.

Another surprise finding in the study was that only 10.6% of those tested for hepatitis C had also been screened for human immunodeficiency virus (HIV).

Dr. Donna Futterman, Montefiore Medical Center and Albert Einstein College of Medicine, New York Jim Kling/MDedge News

Dr. Donna Futterman

“Providers think of one risk, but they don’t think of the other,” Dr. Futterman said. “Any drug that substantially changes your behavior can change your risk for HIV. So crack (cocaine), though it is not injected, is as strong a risk for HIV as is any other drug of abuse.”

The reasons for the low frequency of screening are likely complex, including lack of time, discomfort between the physician and patient, and concerns over privacy and stigma, according to Dr. Epstein, who emphasized the importance of communication to overcome such barriers.

“As a pediatrician, I try to be as open as possible with patients and let them know that anything they tell me is confidential. I start out discussing less private issues, things that are easier to talk about,” Dr. Epstein said.

But the results of the study also suggest that preconceived notions may be holding clinicians back from testing. “How can you test for hepatitis C and not think HIV?” Dr. Futterman said. “What is that differentiator in providers’ heads that makes them focus on one thing and not the other?”

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