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Reuters Health Information (2014-03-05): Chronic hepatitis C infects 1 in 100 Americans


Chronic hepatitis C infects 1 in 100 Americans

Last Updated: 2014-03-05 17:43:23 -0500 (Reuters Health)

NEW YORK (Reuters Health) - At least 1% of Americans are living with chronic hepatitis C (HCV) infection, according to data from the National Health and Nutrition Examination Survey (NHANES).

"Hepatitis C has a severe impact on the health and well-being of millions of Americans, especially baby boomers (those born from 1945 through 1965)," Dr. Scott D. Holmberg from the Centers for Disease Control and Prevention, Atlanta, Georgia told Reuters Health by email.

He added, "The new data from a nationally representative survey of the general United States population (the National Health and Nutrition Examination Survey, or NHANES) found about 2.7 million people have chronic hepatitis C infection."

"This number should be considered a minimum estimate for those infected in the U.S., because some populations known to be at high risk for hepatitis C, such as those who are homeless or incarcerated, are not included in the sample," Dr. Holmberg said.

Baby boomers represent about 81% of chronically infected people, he said.

The Institute of Medicine recently highlighted the importance to public health and policy planning of knowing the dimensions and directions of the HCV epidemic.

Dr. Holmberg and colleagues analyzed data from participants in NHANES between 2003 and 2010 to estimate the prevalence of HCV infection and to determine risk factors and exposures associated with chronic infection.

The estimated prevalence of HCV RNA (indicating ongoing infection) was 1.0% among individuals aged six or older, which corresponds to 2.7 million persons. Even more individuals (1.3%, or an estimated 3.6 million) had anti-HCV antibodies (indicating prior exposure to HCV).

People with chronic HCV were more likely than those who were never infected to be between the ages of 40 and 59, male, of non-Hispanic black race/ethnicity, and born in the U.S., the authors reported March 4th in Annals of Internal Medicine.

Chronically infected individuals were less likely to have education past high school or family income at least twice the poverty level.

Individuals aged 20 to 59 with chronic HCV infection were more likely to have received a blood transfusion before 1992, ever injected illicit drugs, or had 10 or more lifetime sexual partners than similarly aged individuals who had never had HCV infection.

In the 20- to 49-year-old age group, chronic HCV infection was also associated with a greater likelihood of being positive for antibody to herpes simplex virus type 2 (HSV2).

"Hepatitis C virus is a widely prevalent infection that causes more morbidity and mortality than most other infectious diseases," Dr. Holmberg said. "Because of the long incubation period between infection and overt disease-often 20, 30, or more years-infected patients and even clinicians may be inclined to dismiss hepatitis C as an indolent, even benign infection."

"Undiagnosed hepatitis C places millions at serious risk of liver disease, cancer, and death," Dr. Holmberg said. "Unfortunately, half or more of those with hepatitis C do not know they are infected."

"This study underscores the importance of CDC and U.S. Preventive Services Task Force recommendations that all persons born between 1945 and 1965, who face a prevalence of chronic hepatitis C infection six times greater than other adults, should get tested at least once for hepatitis C virus," Dr. Holmberg said.

"Getting tested, knowing your status, and, if infected, getting linked to proper care and treatment are all essential to reducing the burden of hepatitis C," Dr. Holmberg concluded.

Dr. Mark H. Kuniholm from Albert Einstein College of Medicine, Bronx, New York recently investigated the prevalence of HCV infection among US Hispanic/Latino adults. He told Reuters Health by email, "One finding of (this new) study was that only half of hepatitis C-positive participants aged 20 to 59 years reported a history of transfusion or illicit injection drug use. These data reinforce the notion that risk factor-based screening is unlikely to identify most US individuals with hepatitis C."

Dr. Kuniholm echoed the CDC recommendation: "All US adults, especially those adults born between 1945 and 1965, should be offered hepatitis C diagnostic testing."


Ann Intern Med 2014;160:293-300.

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