Estimating hepatitis C prevalence in the United States, 2017-2020

Eric W Hall; Heather Bradley; Laurie K Barker; Karon Lewis; Jalissa Shealey; Eduardo Valverde; Patrick Sullivan; Neil Gupta; Megan G Hofmeister

doi:10.1097/HEP.0000000000000927

Estimating hepatitis C prevalence in the United States, 2017-2020

Hepatology. 2024 May 13. doi: 10.1097/HEP.0000000000000927. Online ahead of print.

Authors

Eric W Hall¹, Heather Bradley², Laurie K Barker³, Karon Lewis³, Jalissa Shealey², Eduardo Valverde⁴, Patrick Sullivan², Neil Gupta³, Megan G Hofmeister³

Affiliations

¹ School of Public Health, Oregon Health & Science University-Portland State University School of Public Health, Portland, OR, USA.
² Rollins School of Public Health, Emory University, Atlanta, GA, USA.
³ Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA.
⁴ National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.

PMID: 38739849
DOI: 10.1097/HEP.0000000000000927

Abstract

Background aims: The National Health and Nutrition Examination Survey (NHANES) underestimates the true prevalence of hepatitis C virus (HCV) infection. By accounting for populations inadequately represented in NHANES, we created two models to estimate the national hepatitis C prevalence among US adults during 2017-2020.

Approach results: The first approach (NHANES+) replicated previous methodology by supplementing hepatitis C prevalence estimates among the US noninstitutionalized civilian population with a literature review and meta-analysis of hepatitis C prevalence among populations not included in the NHANES sampling frame. In the second approach (persons who inject drugs [PWID] adjustment), we developed a model to account for underrepresentation of PWID in NHANES by incorporating the estimated number of adult PWID in the United States and applying PWID-specific hepatitis C prevalence estimates. Using the NHANES+ model, we estimated HCV RNA prevalence of 1.0% (95% confidence interval [CI]: 0.5%-1.4%) among US adults in 2017-2020, corresponding to 2,463,700 (95% CI: 1,321,700-3,629,400) current HCV infections. Using the PWID adjustment model, we estimated HCV RNA prevalence of 1.6% (95% CI: 0.9%-2.2%), corresponding to 4,043,200 (95% CI: 2,401,800-5,607,100) current HCV infections.

Conclusions: Despite years of an effective cure, estimated prevalence of hepatitis C in 2017-2020 remains unchanged from 2013-2016 when using comparable methodology. When accounting for increased injection drug use, estimated prevalence of hepatitis C is substantially higher than previously reported. National action is urgently needed to expand testing, increase access to treatment, and improve surveillance, especially among medically underserved populations, to support hepatitis C elimination goals.