Prevalence of HCV infection varies widely across U.S.

Last Updated: 2018-12-26

By Will Boggs MD

NEW YORK (Reuters Health) - The prevalence of hepatitis C virus (HCV) infection varies five-fold across the U.S., with more than 2 million people currently infected, researchers report.

"We found that there are multiple regions of the U.S. that face high burdens of persons with current HCV infection," Dr. Eli S. Rosenberg from University at Albany School of Public Health, State University of New York, Rensselaer, New York, told Reuters Health by email. "These regions likely require different public health approaches to addressing their HCV epidemics."

With the increasing availability of direct-acting antivirals, elimination of HCV has become an attainable goal. Regional prevalence estimates are needed to guide local HCV elimination efforts.

Dr. Rosenberg's team used newly released National Health and Nutrition Examination Survey (NHANES) data to estimate the prevalence of current HCV infection among adults in each state and the District of Columbia.

Based on an estimated 2.3 million adults infected in 2016, the prevalence of HCV infection is 0.93% of the U.S. adult population, according to the December 21 JAMA Network Open online report.

There were large variations in HCV prevalence by state. The West census region (including 13 states) contained 27.1% of infected persons, despite having only 23.4% of the U.S. population. Three of the 10 states with the highest rates (Kentucky, Tennessee, and West Virginia) are in the Appalachian region.

The median state HCV prevalence was 0.88%, with a range of 0.45% (North Dakota) to 2.34% (District of Columbia).

The highest rates were frequently in states deeply affected by the opioid crisis or with a history of increased levels of injection drug use and chronic HCV infection, the researchers note.

"In the paper, we discuss a number of effective public health approaches towards hepatitis C treatment and prevention, such as expanding access to direct acting antivirals, syringe services, and medication assisted therapy for persons with opioid use disorder," Dr. Rosenberg said. "As states further develop their plans for combating hepatitis C in their jurisdictions, these estimates of total burden of infection can inform investments in such approaches."

He added, "Physicians should be sure to offer testing per the Centers for Disease Control and Prevention (CDC) guidelines, which recommend testing for groups, such as adults born 1945-1965, and at-risk groups, such as those with a history of injection drug use, and be aware that there are highly efficacious options available for cure, prevention of ongoing transmission, and prevention of acquisition."

Dr. Simon Pickard from University of Illinois at Chicago's College of Pharmacy, who recently evaluated the societal cost of heroin use in the U.S., told Reuters Health by email, "Predictably, but gravely concerning, (the) areas of the country hardest hit by the opioid epidemic are among the states with the highest prevalence of HCV."

"It heightens the need to invest in awareness and prevention of HCV transmission that largely derives from needle sharing," he said. "Greater funds need to be directed to areas and subgroups disproportionately at risk, such as the Appalachian region and the prison population. Although tremendous advances have been made in treatments for HCV, they are still much more costly than investing in programs preventing transmission in the first place."

Dr. Pickard added, "This study suggests we need to expand public health efforts to combat the opioid epidemic and its broader effects on population health."

CDC's recommendations for HCV testing can be found at http://bit.ly/2LyzI5e.

SOURCE: http://bit.ly/2LA1deH

JAMA Network Open 2018.