Acute Hepatitis C and Colorado’s Young Adults

New cases of acute hepatitis C are on the rise, both nationally and in Colorado, affecting people from all walks of life. But one age group stands out — young adults between the ages of 20 and 29.

Three of four (73 percent) new cases of this highly infectious bloodborne infection reported in 2015 were among that age group, according to the Colorado Department of Public Health and Environment (CDPHE). The second largest portion of cases was in the 30- to 39-year-old bracket. (See Figure 1.)

Colorado has seen a steady rise in acute cases recently, increasing from 23 reported new cases in 2013 to 40 in 2015, a 74 percent increase. That mirrors the national trend (See Figure 2.).

Injection drug use (IDU) is the main culprit for the increase in acute Hepatitis C cases, accounting for  65 percent of reported cases in 2015. The increase in hepatitis C infection parallels the rising opioid epidemic here and nationally.  

And the number of new cases is most likely underreported.  The Centers for Disease Control and Prevention (CDC) projects that for every reported case of acute hepatitis C, there are actually 14 cases. That means Colorado had more like 560 new acute cases in 2015 — roughly the size of my high school graduating class.

Of course, it’s important to understand the big picture of this disease in Colorado. CDPHE estimates there are around 70,000 Coloradoans currently infected with the hepatitis C virus, both acute and chronic. The “acute” form is a short-term infection affecting people within six months of contact, with symptoms such as vomiting and jaundice. When infection does not clear, or is not successfully treated, it develops into chronic hepatitis C, a more serious and even fatal form of infection.

In 2015, there were 4,144 new chronic cases reported, half of which were Baby Boomers. Even so, both acute and chronic cases are on the rise among the 20- to 29-year-old age group, meaning there is a growing population of young adults developing the more serious form of the infection (See Figure 3).

Why should we care? For starters, approximately 80 percent of people infected with acute hepatitis C develop the chronic form, which can lead to liver failure, cancer and death. Most cases (70 to 80 percent) show no symptoms, making it harder to identify and report the true burden of the disease in Colorado.

Underreporting means hundreds of people are unaware they are infected and can seek treatment. To cap it off, the virus is 10 times more infectious. Meaning it is more easily transmitted, than HIV.

The good news is hepatitis C is treatable and even curable, especially when treated early.

New, direct-acting antiviral drugs can cure up to 96 percent of people who take them. But they’re not cheap. For example, the course of a 12-week treatment can cost upwards of $84,000 - $94,500.

 At about $1,000 a pill, it is daunting for many to afford the treatment, especially young adults who already struggle to obtain health insurance. Half of Colorado’s uninsured are between 19 and 39, according to the Colorado Health Access Survey (CHAS).

Also, nearly half of the enrollees who have obtained Medicaid coverage under the Affordable Care Act’s expanded eligibility are between 19 and 35, according to the Colorado Department of Health Care Policy and Financing (HCPF).  Their coverage could be in peril if the Senate’s proposed Better Care Reconciliation Act (BCRA) passes. The Colorado Health Institute projects that 628,000 fewer Coloradans would be insured through Medicaid by 2030.

This means less access to the preventive screening and primary care that often detects the virus early. Currently, nearly 90 percent of Colorado residents infected with hepatitis C go untreated.

The Colorado Health Institute is working with CDPHE on a Hepatitis C virus epidemiologic report to better understand how many Coloradoans are impacted by the virus. Stay tuned for the new report with updated data.