What is the prevalence of hepatitis C virus (HCV) infection in the US?

Updated: Oct 07, 2019
  • Author: Vinod K Dhawan, MD, FACP, FRCPC, FIDSA; Chief Editor: BS Anand, MD  more...
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The growing US opioid epidemic and its attendant rise in injection drug users (IDUs) has contributed to a more than a two-fold increase in the annual incidence rate of acute hepatitis C virus (HCV) infection over a decade (2004-2014), including a near four-fold increase in prescription opioid analgesic injection. [22]

HCV is the major cause of chronic hepatitis in the United States. HCV infections account for 20% of all cases of acute hepatitis and for more than 40% of all referrals to active liver clinics.

The overall prevalence of anti-HCV antibodies in the United States is 1.8% of the population. Approximately 74% of these individuals are positive for HCV RNA, meaning that active viral replication continues to occur. Thus, an estimated 3.9 million persons are infected with HCV and 2.7 million persons in the United States have chronic infection. [5] Genotype 1a occurs in 57% of patients; genotype 1b occurs in 17%.

In 2015, there were 2436 cases of acute hepatitis C reported to the Centers for Disease Control and Prevention (CDC), but this is likely an underrepresentation of the true number. [23] Alter et al reported that HCV infections account for approximately 30,000 new infections and 8,000-10,000 deaths each year in the United States. [5] Of the new infections, 60% occur in IDUs; less than 20% of new cases are acquired through sexual exposure; and 10% are due to other causes, including occupational or perinatal exposure and hemodialysis.

El-Serag et al reported that HCV was largely responsible for the increase in the incidence of hepatocellular carcinoma in the United States during the final decades of the 20th century. [24] In the United States, the number of deaths due to HCV-related complications increased from fewer than 10,000 in 1992 to just under 15,000 in 1999 [24] ; by 2010, there were more than 16,600 deaths attributable to HCV, [25] rising to over 19,600 such deaths in 2015. [23] According to Kim, this number is expected to increase in the future because of the current large pool of undiagnosed patients with chronic infection. [26]

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