Hepatitis C Virus Infection Prevalence in the United States

Viremic hepatitis C has recently decreased among whites and blacks born in the United States, but not in other races or ethnicities, foreign-born individuals or those who were born after 1985, according to a study published in The Journal of Infectious Diseases. Furthermore, less than half of those with hepatitis C are aware of having the infection.

Although curative therapy is available for hepatitis C in the United States, not all people are diagnosed or linked to appropriate care. The cross-sectional study analyzed data from the National Health and Nutrition Examination Survey from 1999 to 2016 to examine hepatitis C prevalence among nonincarcerated or noninstitutionalized adults with hepatitis C RNA data available (N=46,486). Demographic and clinical data were collected along with disease awareness information.

Hepatitis C prevalence decreased from 1.32% (95% CI, 1.11-1.57; P =.001) from 1999 to 2004 to 0.80% (95% CI, 0.61-1.05; P =.19) in 2011 to 2016, although most of this decrease in prevalence was among US-born whites and blacks (from 1.23% in 1999-2004 to 0.66% in 2011-2016 for whites, P =.009; and from 2.88% to 1.66% for blacks, P =.023), but not foreign-born individuals or individuals born after 1985. Nevertheless, the highest prevalence of viremic hepatitis C infection in US-born participants was still seen among non-Hispanic blacks as compared with other ethnic or racial groups. In recent years, patients with viremic hepatitis C were more likely to be Mexican Americans or other Hispanics. In fact, the hepatitis C prevalence for Mexican Americans increased significantly from 1999 to 2004 and 2011 to 2016. There was a higher percentage of infected patients in the birth cohort after 1985 during 2011 to 2016 (5.5% vs 0.05%).

Approximately, 1,896,989 adults in the United States were estimated to be viremic with hepatitis C between 2011 and 2016 (95% CI, 1,441,021-2,495,716). Of these, 70.2% had health insurance and 29.8% were uninsured, and an estimated 49.8% of these were aware of their hepatitis C infection. Among those viremic with hepatitis C, 17.4% were at high risk for advanced fibrosis and 45.5% were at low risk. Awareness was higher among US-born individuals and individuals with health insurance coverage, and infection was less prevalent among individuals with health insurance.

Study limitations include the fact that the National Health and Nutrition Examination Survey excludes hospitalized, institutionalized, or otherwise marginalized individuals; potential recall bias; potential sampling error due to the smaller study size; and potential underreporting of stigmatized behaviors.

Study investigators concluded that, “while the prevalence of viremic HCV infection in the US has declined over the past two decades for most groups, there has been no significant change for the U.S. born Mexican Americans and foreign born persons and actually increased for those born after 1985, possibly reflecting some of the effects of the opioid epidemic. Therefore, we suggest that efforts must be made to capture not only the 1945-65 birth cohort or populations with known specific exposure risks but also the foreign born, the ethnic minority and the marginalized populations so that proper interventions to include increasing disease awareness and access to care can be developed and targeted to populations most at risk for HCV infection.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Zou B, Yeo YH, Le MH, et al. Prevalence of viremic HCV infection by age, race/ethnicity, birthplace and disease awareness among viremic persons in the U.S., 1999-2016 [published online September 27, 2019]. J Infect Dis. doi: 10.1093/infdis/jiz479