Hepatitis E seropositivity is higher in older adults and may represent an increased exposure risk over time; in contrast, the opioid crisis has caused a demographic shift in hepatitis C infection, which is now a predominately millennial disease, according to research presented in 2 sessions at IDWeek 2019, held October 2 to 6 in Washington, DC.1,2

Because the epidemiologic and demographic characteristics of patients with hepatitis E in the United States are not well described, the first of the 2 studies presented was designed to identify traits and comorbidities of seropositive patients to develop better screening and prevention practices.1 Data were found through a retrospective review of patients who had undergone hepatitis E virus immunoglobulin (Ig) M or IgG serologic testing using the Advanced Cohort Explorer tool. Baseline characteristics and underlying comorbidities were extracted, and participants were grouped by antibody type according to serologic testing results. One-year survival from the testing date was assessed.1

Of the 979 unique participants (79.8% white) tested for hepatitis E with serology, 12.6% (n=123) had positive serology. Of all participants, 46.8% (n=458) were both IgG and IgM negative (the largest proportion of participants), and 432 participants only received IgM or IgG testing. In patients with positive vs negative testing, liver disease was more prevalent (5.8% vs 2.1%), as was higher age (average 55.1 vs 52.2 years). Across all groups, percentages of 1-year survival were similar (82.8%-100%).1

Study investigators concluded that the increased incidence of positive hepatitis E serology among older adults could represent increased exposure risk over time, and a “higher percentage of positive testing was also observed in subjects with liver disease, which may indicate a possible etiologic association. Further population-based studies are needed to estimate prevalence of [hepatitis E] infection and associated liver disease, outcomes in infected patients, and indications for testing in at-risk populations.”1

The second presentation reported that prior research has shown that millennials (born 1980-1995) are a primary driver in the opioid crisis and have the fastest-growing population of individuals with the hepatitis C virus.2

To assess hepatitis C infection trends since 2016 within Norton Healthcare, a large healthcare system, investigators screened 86,243 individuals from 2016 through 2018 for hepatitis C infection per standard risk-based criteria as recommended by the US Centers for Disease Control and Prevention. Longitudinal and time series analyses techniques were used to test for demographic shifts over time.2

Of the total individuals screened, 3.0% (n=2615) were positive for chronic hepatitis C, and the average age of infected individuals significantly decreased each year by an average of 3.7 years (from 47.3 years in 2016 to 39.9 years in 2018; P <.001). Furthermore, the percentage of millennials infected increased over time (33.6% in 2016, 42.4% in 2017 and 51.4% in 2018; P <.001) while the percentage of baby boomers infected decreased significantly over time (44.0% in 2016, 38.8% in 2017, and 29.3% in 2018; P <.001). Individuals with chronic hepatitis C were more likely to be men (increasing from 49.6% to 54.4%; P =.008) and Hispanic (increasing from 1.6% to 17.7%; P <.001). Investigators forecasted that the age will plateau at around 28 years in just over 7 years’ time.2

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Study investigators concluded, “[R]esults suggest that HCV infection has become a predominately millennial disease, skipping a generation. These results correlate with trends seen with the opioid epidemic, which is driven by millennials. We conclude that the opioid crisis has led to a drastic demographic shift, and currently the typical HCV infected individual is a younger male. Without interventions, this trend will continue for over 7 years, plateauing near the demarcation of millennials and generation Z.”2

Disclosure: Several study authors for the first study declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


1. Stone EC, Garrigos ZE, Sohail MR, Razonable RR, O’Horo Sr. JC. Hepatitis E virus serostatus: A retrospective assessment of demographics and comorbidities to assess high risk populations. Poster presented at: IDWeek 2019; October 2-6, 2019; Washington, DC. Poster 290.

2. Rose M, Myers JA, Ryan N, Prince A, Talbot M, Espinosa CM. Hepatitis C is now a millennial disease in response to the opioid crisis: A demographic shift in hepatitis C infection. Poster presented at: IDWeek 2019; October 2-6, 2019; Washington, DC. Poster 293.