The Epidemiology of Chronic Hepatitis C and One-Time Hepatitis C Virus Testing of Persons Born During 1945 to 1965 in the United States

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Key points

  • Despite overall declines in hepatitis C incidence, hepatitis C virus (HCV) continues to be transmitted; new infections are increasing in some populations, including young persons who inject drugs.

  • As indicated by a national health survey, an estimated 3.2 million persons are living with HCV in the United States.

  • Chronic hepatitis C is a major cause of liver disease, including hepatocellular carcinoma, the fastest growing cancer-related cause of death.

  • Many if not most persons living with viral

HCV transmission

Approximately 60% to 70% of HCV-infected persons are asymptomatic during the acute phase of infection. The average time from viral exposure to a positive antibody to HCV (anti-HCV) seroconversion is 8 to 9 weeks, and anti-HCV can be detected in more than 97% of persons by 6 months after exposure.13, 14, 15 The most efficient route of HCV transmission is parenteral exposure to blood, including transfusions and injections. Among PWID, HCV infection is acquired rapidly after initiation of

Hepatitis C incidence

Hepatitis C incidence in the United States peaked at approximately 240,000 new infections per year in the early to mid-1980s, before the discovery of HCV in 1988 (Fig. 2).40, 41 In the following years, incidence of hepatitis C declined steadily until 2004, when incidence leveled at an estimated 15,000 to 20,000 new infections (0.3 cases per 100,000 population). In 2010, an estimated 17,000 new HCV infections occurred, with injection drug use being the most commonly reported risk factor.42

Hepatitis C prevalence

Based on a national health survey, an estimated 3.2 (2.7–3.9) million persons are living with HCV in the United States.1 However, because this survey excludes or underestimates populations at greatest risk for hepatitis C (eg, incarcerated persons), an additional 500,000 to 1,000,000 persons are likely infected with HCV.45 Chronic hepatitis C is a major cause of liver disease; approximately 36% of all persons awaiting liver transplant and at least 50% of all persons with hepatocellular

HCV infection prevalence among persons born during 1945 to 1965

Of persons living with hepatitis C, an estimated 76% are adults born during 1945 to 1965 (a population known as baby boomers in the United States).52 As this population likely has been infected for several decades, HCV-associated morbidity and mortality are on the increase. Hepatitis C-associated mortality increased 50% during 1999 to 2007 (annual mortality change: +0.18 deaths per 100,000 population per year). In 2007, HCV caused 15,106 deaths, 73.4% of which occurred among persons aged 45 to

Economic implications of HCV infection

HCV infection poses an economic burden in the United States, resulting in lost productivity and additional health care costs for infected persons. Compared with other employees, those with HCV infection require more sick leave per year and short-term and long-term disability, resulting in more absences from work and lost productivity.54 HCV infection also results in substantial direct costs for medical care. A study of medical reimbursement claims from 2002 to 2006 revealed that hospitalization

New treatments for HCV

Therapy can clear HCV infection from the body, resulting in sustained virologic response (SVR), which indicates virologic cure. Until 2011, approximately 40% of patients who completed a 48-week course of a standard therapeutic regimen of pegylated interferon and ribavirin achieved SVR.2 In 2011, 2 new agents, boceprevir and telaprevir, were licensed for treatment of HCV, representing the first direct-acting agents (DAAs) with specific activity against HCV infection. Compared with pegylated

Testing and linkage to care

Only through HCV testing with linkage to care can HCV-infected persons receive needed clinical management and treatment. However, at a time of increasing HCV-related morbidity and mortality, hepatitis C is an underrecognized and undertreated disease. In 2007, fewer than 85,000 persons were treated for HCV infection (a fraction of the estimated 3.2 million persons infected with the virus).11 Some patients do not meet the recommended criteria to receive therapy, and others have conditions (eg,

Summary

Despite overall declines in hepatitis C incidence, HCV continues to be transmitted; new infections are increasing in some populations, including young PWID. Chronic HCV infections acquired in decades past are now manifesting, damaging the liver and leading to increases in HCV-related morbidity and mortality; hepatitis C represents a major health disparity for persons born during 1945 to 1965. Many if not most persons living with viral hepatitis remain undiagnosed. To realize the health benefits

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