November 6, 2018
On November 6, CDC published the article, Estimating Prevalence of Hepatitis C Virus Infection in the United States, 2013–2016, which includes updated estimates of hepatitis C prevalence among adults aged 18 years or older. During 2013-2016, approximately 4.1 million adults had evidence of past or current hepatitis C virus (HCV) infection (HCV antibody positive) and nearly 2.4 million adults had evidence of current infection (HCV RNA positive). This new estimate of current infection suggests a decline from the 3.5 million estimated to be infected between 2003 and 2010 (Edlin et al. Toward a more accurate estimate of the prevalence of hepatitis C in the United States. Hepatology 2015; 62: 1353-1363). However, the estimates cannot be directly compared due to a number of factors including methodological differences.
With millions of Americans living with hepatitis C, the burden of this disease is substantial and poses a serious threat not only to baby boomers (born between 1945-1965) who have the highest death rate associated with HCV, but also to adults younger than 40 (including women of childbearing age), who have the highest rates of new infection. The emerging acute HCV epidemic among persons who inject drugs is also a serious threat today. Most acute HCV cases reported to CDC recently have been attributed to injection drug use and likely associated with the nation’s opioid crisis. CDC estimates that more than 41,000 Americans were newly infected with hepatitis C in 2016 alone.
The lower hepatitis C prevalence could be the result of the refinement in methodology, changes in the National Health and Nutrition Examination Survey (NHANES) laboratory testing protocols used to confirm HCV antibody positive specimens, and different data sources and methods used to estimate HCV prevalence in additional at-risk populations that were not covered in NHANES. Though we cannot say with certainty what is driving the change in prevalence, we do know that testing and treatment played a role in reducing burden. Available data suggests HCV treatment cured hundreds of thousands of Americans.
Despite challenges, we can stop this disease. We know how to prevent, treat, and cure hepatitis C, but as emphasized in the study, we must also intensify public health programs to better prevent, track, and respond to new infections. Together we can take these steps and continue to make strides, prioritize efforts, and work to reach the ultimate goal of hepatitis C elimination.
Paul J. Weidle, PharmD, MPH
Division of Viral Hepatitis
National Center for HIV, Viral Hepatitis, STD, and TB Prevention
Jonathan H. Mermin, M.D., MPH
RADM and Assistant Surgeon General, USPHS
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Centers for Disease Control and Prevention