Only 60% of people with hepatitis C know that they have the disease, according to findings published in PLOS ONE. Increased awareness, leading to expanded treatment, is a key strategy for the elimination of hepatitis C virus (HCV) as a public health threat.

In 2016, the World Health Organization called for the elimination of hepatitis C as a public health threat by 2030. But for this target to be achieved, 90% of people with HCV would need to be diagnosed and 80% of them would need to be treated. In the United States, estimates indicate that 2 to 3 million people have hepatitis C, but only a third have been successfully treated.

To learn more about barriers to HCV elimination, Karthik Gnanapandithan, MD, of the Mayo Clinic in Florida, and Maged Ghali, MD, of University of Florida Health, used National Health and Nutrition Examination Survey data from 2013 to 2020 to assess awareness of hepatitis C status. Participants answer questions about their health, undergo physical exams and give blood samples for testing. Those who test positive for HCV antibodies are then tested for HCV RNA, a direct indicator of active viral replication.

For their weighted analysis, the study authors included 206 people who tested positive for HCV RNA, meaning they currently have an active infection. Of this group, only 60% said they had previously been diagnosed with hepatitis C. This implies that over 800,000 people are unaware of their status.

Latino and Black people had similarly lower awareness levels compared with white people. Fewer people from Mexican American (40%) and Asian (13%) communities were aware of their HCV status. Moreover, people born outside the United States and those who were not U.S. citizens were more likely to have undiagnosed hepatitis C.

People with hepatitis C had much higher liver enzyme levels than those who tested negative, and those who were aware of their HCV status had significantly higher levels than those who had been diagnosed, suggesting they are at higher risk for liver fibrosis and cirrhosis.

Awareness of HCV status has been rising over the past decade but not fast enough to eliminate the virus. “Despite the improvement in the percentage of people aware of their infection status, the absolute number of patients unaware of their illness has not changed much,” wrote the researchers. “This is due to a concomitant increase in the number of people living with HCV.”

“We believe policy measures focused on further intense screening and educational campaigns, particularly in high-risk groups, are vital in realizing the World Health Organization’s goal of eliminating HCV as a global health threat,” they added.

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