Abstract # FRI-478 An alternative screening strategy for hepatitis C virus infection among Americans not belonging in the baby boomer birth cohort–P. Udompap et. al.
Study Aims and Results: Hepatitis C virus (HCV) screening is recommended for Americans at high risk
for infection (expected prevalence >1%) including adults born in 1945–1965 (baby boomer birth cohort,
BBBC). However, to date, a large proportion of individuals with HCV infection remains undiagnosed. In
this work, we consider a policy proposal of using the FIB-4 score, which may be automatically calculated
as a trigger for HCV screening.
We stratified participants in National Health and Nutrition Examination Survey (NHANES) 1999–2012 by
the FIB-4 score and ALT levels. Abnormal ALTwas defined as >30 U/L inwomen and >45 U/L in men. FIB-
4 was calculated using the standard formula – a score >1.45 was considered abnormal and >3.25 was
considered high. The prevalence of HCV infection was calculated in each stratum.
The study subject’s awareness of HCV infection was assessed by the response recorded in the follow-up
questionnaire administered among respondents with HCV infection.
Out of 36,071 adults (≥20 years) participants, 33,476 (92.8%) had complete laboratory data for FIB-4
score calculation, 42% of whom belonged in the BBBC. Overall, 11.4% had abnormal ALT, while
17.9% had abnormal FIB-4 and 1.2% high FIB-4. In the figure, the prevalence of HCV infection was clearly
higher among BBBC subjects than those outside BBBC (3.3% versus 0.7%, respectively). Among non-
BBBC subjects, women with abnormal ALT had HCV prevalence of 2.9% and men with abnormal ALT
3.7%. Non-BBBC subjects with high FIB-4 score had a prevalence of 4.3%, whereas those with abnormal
FIB-4 only 0.8%. Of participants unaware of their HCV infection, 59% would have been diagnosed if
abnormal ALT or high FIB-4 were used as a trigger. Of these, 34.7% did not belong in the BBBC.
Conclusions: Programming the electronic health record system for automatic calculation of FIB-4 and
flagging subjects with a score >3.25 would yield a high prevalence of HCV regardless of their BBBC
status. Among non-BBBC subjects, abnormal ALT should trigger HCV screening.Share This Page