1748. A Comparison of Clinical Comorbidities, Substance Abuse, and Vital Status in Veterans Tested for Hepatitis C Infection Between 1992 and 1995
Session: Poster Abstract Session: Viral Infections; Pathogenesis and Epidemiology
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Background: An estimated 3.2 million Americans are chronically infected with hepatitis C virus (HCV).  To evaluate HCV infection before risk-based HCV testing was initiated at the Atlanta VA Medical Center (AVAMC), we analyzed a cohort tested between 1992 and 1995.  We compared the prevalence of clinical comorbidities, substance abuse, viral co-infections, and liver-related and all-cause mortality in veterans tested for hepatitis C antibody (HCV Ab) in this time period.

Methods: A laboratory generated list of all veterans who underwent HCV Ab testing at the AVAMC between 1992 and 1995 was obtained.  Using the computerized electronic medical record, demographics, active medical problems, HIV antibody and hepatitis B surface antigen results, and vital status was abstracted for each record.  Additional mortality information was obtained from the Social Security Death Index, and the National Death Index.

Results: Over the four year period, 1,049 veterans underwent HCV Ab testing; 313 (30%) were positive.  Eighty percent of the HCV Ab positive veterans were born between 1945 and 1965, compared with 47% of HCV Ab negative veterans (p<0.0001).  Prevalence of any drug use (42% vs 11%, p<0.0001), alcohol (48% vs 28%, p<0.0001), or tobacco abuse (55% vs 39%, <0.0001) was higher in the HCV Ab positive group.  HCV Ab positive veterans had more liver-related diagnoses (including cirrhosis, hepatic encephalopathy, variceal bleeding, and hepatocellular carcinoma) when compared with the HCV Ab negative group (24% vs. 11%, p<0.0001).  In this cohort, 64% have died in the years following HCV Ab testing; 17% of the deaths were liver-related in the HCV Ab positive group compared with 9% in the HCV Ab negative group (p=0.002).

Conclusion: The majority of veterans who were HCV Ab tested between 1992 and 1995 have subsequently died.  While most deaths were not liver-related, significantly more HCV Ab positive veterans had liver-related deaths.  HCV Ab positive veterans were more frequently born between 1945 and 1965, supporting the CDC recommendation to screen this birth cohort for HCV infection.  The high prevalence of drug, alcohol, and tobacco abuse in the HCV Ab positive group highlights the need for aggressive substance abuse interventions in chronic HCV infection.

Emily J. Cartwright, MD1, Christopher Rentsch, MPH2 and David Rimland, MD1,2, (1)Emory University School of Medicine, Atlanta, GA, (2)VA Medical Center, Decatur, GA


E. J. Cartwright, None

C. Rentsch, None

D. Rimland, None

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