Hepatitis C Reaching Crisis Levels; Requires Coverage for Routine Screenings
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Summit on HIV and Viral Hepatitis Charts Priorities to Accelerate Testing, Reduce Disparities in Care
Responding to the decision by the
This action is necessary now that chronic HCV infection is reaching crisis levels in the U.S. Today, an estimated 3.2 million Americans are infected, three times the number of people who have HIV. Disproportionately affected are ethnic minorities and especially, Native Americans, African Americans and Latinos, who are infected at significantly higher rates than the general population. However, because most cases of HCV go undiagnosed and untreated with effective therapies, CDC projects that illnesses and deaths due to chronic liver disease, cirrhosis or hepatocellular carcinoma (HCC), the most common type of liver cancer, will increase substantially over the next two decades. Although the healthcare costs associated with chronic HCV infection are difficult to determine, estimates for treating advanced liver disease in the affected population run as high as
"As the federal government and the states work to implement the remaining provisions of the Affordable Care Act, no workable agenda can ignore the pressing need to expand access to a simple test, used just one time, that will identify more people with HCV and get them treated with effective therapies that can cure their infection," said
Action Needed to Accelerate HCV Testing, Increase Resources to Fight HCV
In light of new estimates that 75 percent of people living in the U.S. with HCV do not know they are infected, the Forum for
Towards this end, the summit leaders focused on reimbursement policies that are linked to coverage recommendations from the
In contrast, summit attendees applauded draft USPSTF guidelines issued on
"USPSTF's new coverage recommendations have the potential to rapidly expand routine HIV testing and therefore, get immediate attention for the nearly one in five people who don't know they are infected," said
Another important priority for the summit leaders is to achieve parity in federal resources for HCV research, public health interventions and public and physician programs with what the
Targeting Those at Greatest Risk
Mobilizing the public health community around early detection of is especially warranted now that HCV is on the rise and occurs disproportionately among ethnic minorities and the medically underserved, which is why summit leaders advocate concentrating resources on reaching those Americans who face significant barriers in access to care.
Based on what is now known about the epidemiology of hepatitis C, those most impacted by the epidemic are Native Americans, blacks and Latinos, who often go undiagnosed and don't get treated with newly available therapies that can cure the majority of HCV infections. According to the latest findings:
- American Indian/Alaska Natives are 2.8 times more likely to develop Hepatitis C, based on 2010 estimates, and AI/AN women are 2.6 times as likely to die from viral hepatitis, as compared to whites. Approximately 22 percent of those infected with HCV are African Americans. In addition, blacks are also more likely to be infected with genotype 1, the most difficult type of HCV to treat, and therefore, have high rates of cirrhosis, liver cancer and HVC mortality.
- HCV affects 2.1 percent of the Latino population compared to between 1 percent and 1.5 percent of the general population. Latinos also face substantial barriers to access to medical care, including language and cultural differences and along with blacks, have less desirable treatment outcomes from standard therapy.
Underscoring these findings,
Confronting the HIV/AIDS Epidemic
While elevating viral hepatitis as a public health priority, the 2012 summit also focuses on the realities of today's HIV/AIDS epidemic, which disproportionately affects men who have sex with men (MSM), minority populations, the poor and the disenfranchised living in discreet geographic regions, especially in urban areas of the Northeast and
Describing the evolving face of HIV/AIDS in the U.S.,
Besides African Americans, Hispanics and Native Americans are disproportionately affected by HIV/AIDS. In 2010, Latinos accounted for 20 percent of all new HIV infections, or 9,653 cases, yet due to such barriers as poverty, lack of insurance, low education, limited access to health care, and language difficulties, nearly four in 10 (38 percent) are tested for HIV late in their illness and diagnosed with AIDS within a year. Recent data also indicate that HIV/AIDS has reached epidemic levels among American Indians and Alaska Natives. Despite their small number within the overall U.S. population, American Indians/Alaska Natives have a 30 percent higher rate of AIDS and HIV infection as compared to the white population when their infection rates are weighted based on their population size.
Complementing the new demographics of HIV/AIDS, Dr. Mayer said the U.S. epidemic is concentrated in specific neighborhoods around the country – the urban areas of the Northeast and
In the HPTN061 study, 12 percent of 1,553 black MSM from
"What we are finding is that the HIV epidemic today is concentrated among the disenfranchised and socially marginalized living in underserved communities," said Dr. Mayer. "If we are to reverse the tide of this epidemic, we must focus on the root causes of HIV disparities in at-risk communities, including stigma, poverty, STI prevalence, incarceration, and limited social mobility."
Closing the Gaps in Testing and Treatment
High rates of undiagnosed and untreated viral hepatitis and HIV exist side-by-side with unprecedented drug discovery, which has produced a robust arsenal of new therapies and scientifically-proven interventions that achieve a virologic cure of hepatitis C and suppress viral load in the case of HIV. Thus, closing this divide is the "end game" for both the viral hepatitis and HIV/AIDS communities.
Summarizing the state of the science on HIV/AIDS, Dr. Bartlett said that new treatment guidelines could be a "game changer" if fully implemented, by accelerating the use of ART in everyone diagnosed with HIV.
"After years of debate on when to initiate antiretroviral therapy, there is now scientific consensus that ART is an important strategy for reducing HIV transmission and should be made available to everyone, regardless of their CD4 count.," said Dr. Bartlett. "Based on what we know today, it can be argued that all patients diagnosed with HIV infection are candidates for ART."
Because testing is considered the single most important strategy for curbing the HIV and HCV epidemics, summit leaders welcomed the meaningful changes now taking place under the Affordable Care Act to expand preventive care but agreed much can be learned from new approaches and experiments that are expanding screening and detection efforts in local communities. One successful community-based approach is social networking, which enlists HIV-positive and high-risk HIV negative persons in communities of color to identify and recruit high risk individuals from their social, sexual, or drug-using networks. Other successful strategies include telemedicine support to clinical providers in managing viral hepatitis, the use of health system navigators in community and HIV clinics, mobile street vans that deliver medical and supportive services to patients in inner city neighborhoods, and transitional care management to retain ex-offenders in care.
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