Kim Nicole J, Holguin Daniel, Bush Dylan, Khalili Mandana
Division of Gastroenterology and Hepatology University of Washington Seattle WA.
Division of Gastroenterology and Hepatology Zuckerberg San Francisco General Hospital San Francisco CA.
Hepatol Commun. 2019 Jul 11;3(9):1183-1190. doi: 10.1002/hep4.1401. eCollection 2019 Sep.
The opioid epidemic has recently increased the rates of hepatitis C virus (HCV) infection among young women. We therefore aimed to characterize the cascade of HCV care in a cohort of underserved women of reproductive age. Medical records of 19,121 women between the ages of 15 and 44 years, receiving primary care in the San Francisco safety-net health care system, were reviewed. Cohort characteristics were as follows: median age 33 years (interquartile range 26-38), 18% white (12% black, 46% Latina, 22% Asian, 2% other race), 1.3% hepatitis B surface antigen (HBsAg)-positive, and 0.9% human immunodeficiency virus (HIV) co-infection. HCV antibody (HCVAb) testing occurred in 38.7% (n = 7,406), of whom 2.8% (n = 206) were HCVAb-positive and 2.4% (n = 177) had a detectable HCV viral load. Of the 5% (n = 1,017) with a history of pregnancy, 61% (n = 615) had HCVAb testing (2.6% were positive). On multivariable analysis, HBsAg testing (odds ratio [OR] 8.25 [95% confidence interval (CI)] 6.80-10.01]; < 0.001), HIV infection (OR 5.98 [95% CI 1.86-19.20]; = 0.003), and log alanine aminotransferase (ALT) (OR 1.30 [95% CI 1.16-1.45]; < 0.001) were associated with HCV screening. Compared with whites, women of Latina (OR 0.45 [95% CI 0.37-0.55]; < 0.001) and Asian (OR 0.74 [95% CI 0.58-0.94]; = 0.01) race were less likely to receive HCV screening. Age (OR 1.80 per decade [95% CI 1.26-2.57]; = 0.001), white race (versus non-white; OR 10.48 [95% CI 7.22-15.21]; < 0.001), HIV infection (OR 3.25 [95% CI 1.40-7.55]; = 0.006), and log ALT (OR 1.93 [95% CI 1.49-2.49]; < 0.001) were associated with HCVAb positivity. Most (>60%) underserved women of reproductive age were not tested for HCV. Moreover, women of Latina and Asian race were less likely to receive HCV screening. Given the known high HCV risk in the underserved population, targeted interventions, especially for racial minority women of reproductive age, are needed to enhance HCV screening in those at risk.
阿片类药物流行最近增加了年轻女性中丙型肝炎病毒（HCV）感染率。因此，我们旨在描述一组未得到充分服务的育龄妇女的HCV治疗流程。我们回顾了在旧金山安全网医疗系统接受初级护理的19121名年龄在15至44岁之间女性的病历。队列特征如下：中位年龄33岁（四分位间距26 - 38岁），18%为白人（12%为黑人，46%为拉丁裔，22%为亚洲人，2%为其他种族），1.3%乙肝表面抗原（HBsAg）阳性，0.9%合并人类免疫缺陷病毒（HIV）感染。38.7%（n = 7406）的女性进行了HCV抗体（HCVAb）检测，其中2.8%（n = 206）HCVAb呈阳性，2.4%（n = 177）可检测到HCV病毒载量。在有妊娠史的5%（n = 1017）女性中，61%（n = 615）进行了HCVAb检测（2.6%呈阳性）。多变量分析显示，HBsAg检测（比值比[OR] 8.25 [95%置信区间（CI）] 6.80 - 10.01]；P < 0.001）、HIV感染（OR 5.98 [95% CI 1.86 - 19.20]；P = 0.003）以及对数丙氨酸转氨酶（ALT）（OR 1.30 [95% CI 1.16 - 1.45]；P < 0.001）与HCV筛查相关。与白人相比，拉丁裔（OR 0.45 [95% CI 0.37 - 0.55]；P < 0.001）和亚洲（OR 0.74 [95% CI 0.58 - 0.94]；P = 0.01）种族的女性接受HCV筛查的可能性较小。年龄（每十年OR 1.80 [95% CI 1.26 - 2.57]；P = 0.001）、白人种族（与非白人相比；OR 10.48 [95% CI 7.22 - 15.21]；P < 0.001）、HIV感染（OR 3.25 [95% CI 1.40 - 7.55]；P = 0.006）以及对数ALT（OR 1.93 [95% CI 1.49 - 2.49]；P < 0.001）与HCVAb阳性相关。大多数（>60%）未得到充分服务的育龄妇女未进行HCV检测。此外，拉丁裔和亚洲种族的女性接受HCV筛查的可能性较小。鉴于在未得到充分服务人群中已知的高HCV风险，需要有针对性的干预措施，特别是针对育龄种族少数族裔女性，以加强对高危人群的HCV筛查。
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