More than one third of people living with hepatitis C virus (HCV) are not aware that they carry the virus, resulting in delayed treatment and ongoing transmission risk, according to study findings published in Clinical Infectious Diseases.

Over time, chronic HCV infection can lead to serious complications, including cirrhosis, liver cancer and the need for a liver transplant. Across the United States and worldwide, hepatitis C is a leading cause of liver cancer and liver-related death.

Karon Lewis, DrPH, MPH, of the Centers for Disease Control and Prevention (CDC), and colleagues conducted a study to assess the prevalence of HCV and awareness of disease status.

The research team used data collected between January 2017 and March 2020 through the National Health and Nutrition Examination Survey. NHANES includes a nationally representative sample of the noninstitutionalized civilian U.S. population, meaning it excludes groups such as incarcerated people, members of the active-duty military, people living in long-term care facilities and people experiencing homelessness.

Study participants completed questionnaires and had their blood tested for HCV antibodies. Those who tested antibody positive then received an HCV RNA test to confirm their current infection status.

During the study period, 0.9% of the study population—representing an estimated 2.2 million adults nationwide—had current active infection as indicated by a positive HCV RNA test. However, only 68% of those with an active infection were aware of their status, slightly up from 56% of people surveyed between 2013 and 2016.

People between ages 55 and 64 were 6.4 times more likely to have a current active infection compared with those ages 18 to 40. Men were about three times more likely to have a current infection than women. White and Black individuals were both about five times more likely to have an active infection compared with other races and ethnicities. Similarly, people living in poverty were 5.3 times more likely. People with public insurance were 4.7 times and those with no insurance were 5.8 times more likely to have a current infection compared to those with private insurance.

Lack of awareness is one factor contributing to low hepatitis C treatment rates. A recent CDC report found that only a third of people with HCV had been diagnosed, treated and cured. The CDC recommends that all adults should be screened for HCV at least once, regardless of risk factors, and recently called for a streamlined process that combines antibody and HCV RNA testing.

“In our analysis, persons experiencing poverty or lacking health insurance had substantially higher prevalence of current HCV infection compared with persons not experiencing poverty and persons with private insurance, highlighting the stark inequities associated with this disease,” wrote the researchers. “Recognizing these disparities and implementing programs to address these social determinants of health are critical to combating the hepatitis C epidemic in the United States.”

“Hepatitis C is a deadly disease that disproportionately affects persons who are medically underserved, are experiencing poverty or have substance use disorder,” they continued. “The Biden-Harris administration recently announced a bold initiative to eliminate hepatitis C in the United States. To make this historic opportunity a reality, increased efforts to reach, test and treat all people with hepatitis C with curative, life-saving medications are urgently needed to reduce disparities and achieve national hepatitis C elimination goals.”

Click here to read the study in Clinical Infectious Diseases.
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