Dr. Jonathan Mermin is Director of the CDC National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP).
New data featured on HepVu.org estimate about 3.9 million non-institutionalized people have had past or current Hepatitis C virus (HCV), and in 2010 an estimated 2.7 million had chronic HCV infections. Without any treatment, approximately 15-25% of people infected with Hepatitis C virus will naturally clear the virus and resolve the infection. However, the remaining 75-85% of people will develop a long-term, chronic infection, which can lead to life-threatening liver problems, including cirrhosis and liver cancer1. Hepatitis C is the leading cause of end stage liver disease in the United States. However, there are now highly-effective medications that cure people of chronic HCV infection.
Many infected people do not display symptoms and are unaware of their infection2. To test for Hepatitis C, one is often first administered a screening test to determine if the individual has developed antibodies to the Hepatitis C virus (anti-HCV). A positive antibody test indicates the person has previously been exposed to HCV. After a positive antibody test, a second test is used to measure the presence of HCV RNA to determine if the person has a current infection. For public health surveillance, it is important to know both the number individuals who have ever been infected (those with anti-HCV, as reported on HepVu.org) and the number people who are currently infected. However, from a clinical and public health perspective, it may be most important to identify the number of persons who currently have a chronic infection and may need treatment.
In the same publication that yielded the prevalence of anti-HCV estimates featured on HepVu.org, data were presented for the prevalence of chronic HCV infection in each state. These results used the same data sources and a simpler version of the estimation method used for the primary results. These new findings are a valuable resource for understanding the geographic distribution of an estimated 2.7 million chronic HCV infections, and we are excited to provide a map of these results here. They generally reveal patterns that echo those for the prevalence of past or present infection (anti-HCV) featured on HepVu.org. The West Census region has the highest prevalence of chronic HCV infection (1.45%), followed by the South (1.22%), Northeast (0.99%) and Midwest (0.76%). Jurisdictions with the highest prevalence rate of chronic HCV include Washington D.C., New Mexico, Oklahoma, Oregon and Tennessee. It’s important to keep in mind that because these results primarily represent non-institutionalized persons, certain groups at high risk for Hepatitis C such as the incarcerated and homeless are not counted. The true numbers of chronic HCV infections in states would likely be higher if these groups were included.
Knowing the burden of current chronic hepatitis C in each jurisdiction is essential for the planning of testing campaigns, prevention programs and treatment availability. Without complete and comprehensive surveillance data, these estimates provide insight into the size of the HCV epidemic in each state. These results will help us allocate resources to the appropriate areas in our effort to improve the health of individuals currently infected with HCV.
- Alter MJ, Margolis HS, Krawczynski K, Judson FN, Mares A, Alexander WJ, Hu PY, Miller JK, Gerber MA, Sampliner RE, et al. The natural history of community-acquired hepatitis C in the United States. The Sentinel Counties Chronic non-A, non-B Hepatitis Study Team. The New England journal of medicine. 1992;327(27):1899-905. Epub 1992/12/31. doi: 10.1056/nejm199212313272702. PubMed PMID: 1280771.
- Holmberg SD, Spradling PR, Moorman AC, Denniston MM. Hepatitis C in the United States. The New England journal of medicine. 2013;368(20):1859-61. Epub 2013/05/17. doi: 10.1056/NEJMp1302973. PubMed PMID: 23675657.