title: The Burden of Hepatitis C Infection-Related Liver Fibrosis in the United States.
abstract: Knowledge of the estimated proportion of hepatitis C virus (HCV)-infected persons with advanced fibrosis or cirrhosis is critical to estimating healthcare needs.
  
  
  
  We analyzed HCV-related testing conducted by Quest Diagnostics from January 2010 through December 2013. Tests included hepatitis C antibody, HCV RNA, HCV genotype (nucleic acid tests [NAT]), liver function tests, and platelet counts; patient age was also determined. Aspartate aminotransferase (AST)-to-platelet ratio (APRI) was calculated as = 100*(aspartate aminotransferase [AST]/upper limit of AST)/platelet. Fibrosis-4 (FIB-4) was calculated as (age × AST)/(platelet ×√ alanine aminotransferase [ALT]). Persons were "currently infected" if they had ≥1 positive HCV NAT; "in care" if a positive RNA test was followed <6 months by ≥1 additional NAT(s), or ALT, AST, and platelets <90 days, or any test ordered by an infectious diseases or gastroenterology specialist; and "evaluated for treatment" if they had a genotype test.
  
  
  
  Approximately 10 million HCV test results were analyzed, representing 5.6 million unique patients. Of the 2.6 million patients with data to estimate liver disease, 5% were currently infected. Among those currently infected, APRI and FIB-4 scores indicated that 23% overall-and 27% among the cohort born during 1945-1965-had advanced fibrosis or cirrhosis at first diagnosis. A total of 54% of infected were in care and 51% of infected with advanced fibrosis or cirrhosis were evaluated for treatment.
  
  
  
  Testing from a large US commercial laboratory indicates that about 1 in 4 HCV-infected persons have levels of liver disease put them at highest risk for complications and could benefit from immediate antiviral therapy.
authors: Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors: R Monina
authors: RM
authors: Klevens
authors: Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors: Lauren
authors: L
authors: Canary
authors: Quest Diagnostics, Madison, New Jersey.
authors: Xiaohua
authors: X
authors: Huang
authors: Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors: Maxine M
authors: MM
authors: Denniston
authors: Quest Diagnostics, Madison, New Jersey.
authors: Anthony E
authors: AE
authors: Yeo
authors: Quest Diagnostics, Madison, New Jersey.
authors: Rick L
authors: RL
authors: Pesano
authors: Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors: John W
authors: JW
authors: Ward
authors: Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors: Scott
authors: S
authors: Holmberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017281:Cost of Illness; D005260:Female; D016174:Hepacivirus / Q000235:genetics; D006526:Hepatitis C / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D012720:Severity of Illness Index; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: epidemiology; fibrosis; hepatitis C virus