An 18-month disruption in hepatitis C virus (HCV) testing, linkage, and treatment due to the COVID-19 pandemic resulted in fewer identified HCV cases and sustained virologic response (SVR), and an increase in cirrhosis and liver-related deaths, according to results of a study published in Clinical Infectious Diseases.
In this modeling study, researchers used data from the Boston Medical Center, a safety net hospital, which serves a patient population at increased risk for or infected with HCV, to estimate the relative change in HCV care delivery due to the COVID-19 pandemic. In addition, they used date from the AIDS Linked to the Intravenous Experience (ALIVE) cohort study to estimate injection drug use transitions.
In their base case scenario analysis, researchers used decreased rates of HCV testing, linkage, and treatment over an 18-month period (from March 2020 to August 2021) of pandemic-related disruptions in care. The researchers increased the testing, diagnosis, and treatment parameters from pandemic levels toward pre-pandemic levels with increased cascade rates between 0% and 100%, and they ran the model for each scenario until March 2030. They also performed an alternate scenario analysis using a 12- and 24-month period of pandemic-related disruptions in care.
In the “no pandemic” scenario, the researchers estimated that by March 2030 there would be 5000 incident HCV infections, 230 cases of cirrhosis, and 71 liver-related deaths per 100,000 people, with 58% of infections identified, 18% initiating treatment, and 14% achieving SVR. Compared with the “no pandemic” scenario, HCV care delivery in a scenario with no return to pre-pandemic levels was estimated to have 1060 fewer identified cases of HCV infection, 21 additional cases of cirrhosis, and 16 additional liver-related deaths per 100,000 people, with only 3% of identified cases initiating treatment and less than 1% achieving SVR.
In the best-case hypothetical scenario, where there was a return to pre-pandemic HCV rates after a 18-month disruption in care, there was an estimated 4380 incident HCV infections, with 58% of all infections identified, 17% initiating treatment, and 13% achieving SVR. Compared with the “no pandemic” scenario, the best-case hypothetical scenario had an estimated 1 additional case of cirrhosis and 1 additional liver-related death per 100,000 people.
Of note, all outcomes were worse if HCV testing, linkage, and treatment rates did not return to pre-pandemic levels. Compared with the 18-month disruption in care scenario, outcomes were less pronounced in the 12-month scenario and worse in the 24-month scenario.
This study was limited by its inclusion of patient data from only 1 hospital. In addition, the analysis did not evaluate HCV outcomes with adjustments for race or ethnicity.
“Recommitting resources and efforts to screen, link, and treat people with HCV – a major public health threat – should be considered,” the researchers concluded.
Disclosure: Some author(s) declared affiliations with a biotechnology company. Please see the original reference for a full list of disclosures.
Barocas JA, Savinkina A, Lodi S, et al. Projected long-term impact of the COVID-19 pandemic on hepatitis C outcomes in the United States: a modelling study. Clin Infect Dis. Published online September 9, 2021. doi:10.1093/cid/ciab779