Hepatitis C virus infection in USA: an estimate of true prevalence

Abstract

The recent National Health and Nutrition Examination Survey (NHANES) sampled only the civilian, non-institutionalized population of USA and may have underestimated the prevalence of hepatitis C virus (HCV) in this country. We searched the database MEDLINE, the Bureau of Justice Statistics, Center for Medicare and Medicaid and individual states Department of Corrections for all epidemiological studies regarding the prevalence of HCV in populations not sampled by the NHANES survey namely the incarcerated, homeless, nursing home residents, hospitalized and those on active military duty. Because of their relatively low frequency in the NHANES sample, we also expanded our search to include healthcare workers and long-term dialysis patients. Although included in the NHANES sample, we also performed searches on drug users (injection and non-injection) and veterans to confirm the findings of the NHANES study. Based on the prevalence of studies identified meeting our inclusion criteria, our most conservative estimates state that there at least 142 761 homeless persons, 372 754 incarcerated persons and 6805 persons on active military duty unaccounted for in the NHANES survey. While the NHANES estimates of drug users (both injection and noninjection) appear to be reasonable, the survey seems to have underestimated the number of HCV-positive veterans. Our most conservative estimates suggest that there are at least 5.2 million persons living with HCV in USA today, approximately 1.9 million of whom were unaccounted for in the NHANES survey.Hepatitis C virus (HCV) is the most common bloodborne infection in USA (1) and worldwide (2). Chronic HCV can lead to hepatic fibrosis, cirrhosis and hepatocellular carcinoma (HCC) and is the leading cause of liver transplantation nationwide (3).The National Health and Nutrition Examination Surveys (NHANES) is a series of surveys that have periodically collected data on HCV prevalence, allowing clinicians to target at-risk groups with educational services and therapeutic options. According to the most recent NHANES, 1.6% or 4.1 million persons in USA were anti-HCV positive, most of whom were born between 1945 and 1964 (4). With 15 079 total participants, its information is invaluable and easily the largest epidemiological survey of HCV data in existence regarding HCV prevalence in USA. The NHANES study highlights the burden of HCV infection in the aforementioned birth cohort and the need to diagnose these individuals before complications develop.The survey, however, sampled from a non-institutionalized, civilian population, did not include certain highrisk persons, namely the incarcerated, homeless, nursing homes residents, hospitalized patients, those on active military service and immigrants. Other groups with an expected high prevalence of HCV infection missed by the survey include healthcare workers (HCW) and persons on long-term haemodialysis because of low frequency and lack of availability in the NHANES dataset. As a result, the NHANES has likely underestimated the true preva...

A Budget Impact Analysis of Newly Available Hepatitis C Therapeutics and the Financial Burden on a State Correctional System

“…39,[47][48][49] The benefit of curing hepatitis C in this regard has been well established. 1,5,10 It is important to recognize that these cost savings are to the system as a whole. Departments of corrections will realize those savings only for those likely to develop complications while incarcerated, which includes those with advanced fibrosis and those with very long-term sentences.…”

“…[1][2][3][4] The Centers for Disease Control and Prevention (CDC) has recommended that individuals born between 1945 and 1965 be uniformly educated, screened, and properly linked to HCV care and treatment, given that this cohort accounts for 75 % of infections. [5][6][7][8][9] The economic burden from HCV-related morbidity and mortality in the near term will largely be attributed to this cohort as the HCV-positive population ages and develops cirrhosis.…”

“…6 Early detection and treatment of infection is necessary prior to development of cirrhosis to avoid these costs. 1,5,10,11 While recommendations for uniform screening based on the age cohort are becoming more widely embraced, targeted screening within key high-risk groups remains important. 1,4 Incarcerated individuals are at high risk for HCV due to higher rates of transmission risk behaviors among those incarcerated, such as injection drug use.…”

“…1,5,10,11 While recommendations for uniform screening based on the age cohort are becoming more widely embraced, targeted screening within key high-risk groups remains important. 1,4 Incarcerated individuals are at high risk for HCV due to higher rates of transmission risk behaviors among those incarcerated, such as injection drug use. [10][11][12][13][14][15][16][17][18][19][20] A 2013 meta-analysis estimated the HCV prevalence in general detainees to be 26 % worldwide and 29 % in North America.…”

Regional and global summary estimates of antibody to hepatitis C virus prevalence in detainee populations: Seeing the forest and the trees?

“…National, regional, and global estimates of anti-HCV prevalence in detainee populations are needed to produce better, "truer" estimates of the burden of HCV infection. 6 In this issue of HEPATOLOGY, Larney et al provide regional and global estimates of anti-HCV prevalence among detainees in "prisons and other closed settings". 7 Prisons and other closed settings was defined as prisons, jails, juvenile detention facilities, pretrial detention centers, and extrajudicial detention centers for people who use drugs and excluded psychiatric institutions and immigration detention facilities.…”