Evolving Epidemiology of Hepatitis C Virus in the United States

Abstract

The impact of hepatitis C virus (HCV) infection on health and medical care in the United States is a major problem for infectious disease physicians. Although the incidence of HCV infection has declined markedly in the past 2 decades, chronic infection in 3 million or more residents now accounts for more disease and death in the United States than does human immunodeficiency virus (HIV)/AIDS. Current trends in the epidemiology of HCV infection include an apparent increase in young, often suburban heroin injection drug users who initiate use with oral prescription opioid drugs; infections in nonhospital healthcare (clinic) settings; and sexual transmission among HIVinfected persons. Infectious disease physicians will increasingly have the responsibility of diagnosing and treating HCV patients. An understanding of how these patients were infected is important for determining whom to screen and treat.The first descriptions of the epidemiology of hepatitis C virus (HCV) infection date well before both the actual identification of the virus in 1989 [1] and the US Food and Drug Administration's approval of tests to detect antibody to hepatitis C virus in 1992. "Non-A, non-B hepatitis" was identified as a cause of chronic liver disease among transfusion recipients in studies during the 1970s in the United States [2] and abroad [3]. Since then, hepatitis C in this country has gone from an unknown and untreatable infection, mainly identified when transmitted through receipt of blood or hemodialysis, to an identifiable and curable-but underappreciated-infection today. In this article, we review trends in incidence, prevalence, mortality, and mode of transmission of HCV infection in the United States. INCIDENCE OF ACUTE, SYMPTOMATIC HCV INFECTIONThe lack of a simple test to determine the meaning of a positive HCV-antibody test remains one of the greatest obstacles to HCV infection epidemiology, diagnosis, and determination of which patients need treatment. A positive HCV-antibody test can imply either chronic HCV (about 80%) or resolved HCV (about 20%), or some small fraction of new, acute HCV

Development of Novel Combination Therapies

“…In the United States, about 3 million people have CHC (Armstrong, Wasley, et al 2006;Klevens, Dale, et al 2012). CHC causes cirrhosis and HCC and is the most common reason for liver transplantation in the United States.…”

Antibody Response to Hypervariable Region 1 Interferes with Broadly Neutralizing Antibodies to Hepatitis C Virus

“…The World Health Organization estimates an annual increase in the global burden by two million new infections (1), and in the United States HCV is increasing in young adults from injection drug use (2). Multiple lines of evidence suggest that CD4 ϩ and CD8 ϩ T cell responses are needed to control acute infection but insufficient to prevent long-term persistence (3).…”

Hepatitis C infection among hispanics in California

“…Drug use was a significant risk factor associated with HCV infection 14,[31][32][33][34] , particularly injected drugs 8,15,35 . Use of heroin and speedball were significantly associated with HCV infection, but the risk is much higher among Hispanics than their White-Non Hispanics counterparts.…”