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Estimating hepatitis C prevalence in the United States, 2017-2020
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Download the PDF here
Download the PDF here
AASLD: Characteristics of persons treated for hepatitis C in the United States, 2014-2023 - (11/26/24) estimated 1.2 million treated for HCV.
feb 2025
We estimate that during 2017-2020 in the United States, between 2.2% and 2.9% of all adults, or ∼5.6-7.4 million persons, had prior infection with HCV (HCV antibody-reactive) and that between 1.0% and 1.6% of all adults, or ∼2.5-4.0 million persons, had current HCV infection (HCV RNA-detected). Our findings demonstrate that the hepatitis C burden in the United States is substantial and that the 2017-March 2020 estimate derived from NHANES alone underestimates the actual number of persons with prior HCV infection by ∼0.47-2.33 million persons and the number of persons with current HCV infection by ∼0.25-1.83 million persons.
Abstract
Background and Aims:
The National Health and Nutrition Examination Survey (NHANES) underestimates the true prevalence of HCV infection. By accounting for populations inadequately represented in NHANES, we created 2 models to estimate the national hepatitis C prevalence among US adults during 2017-2020.
Approach and Results:
The first approach (NHANES+) replicated previous methodology by supplementing hepatitis C prevalence estimates among the US noninstitutionalized civilian population with a literature review and meta-analysis of hepatitis C prevalence among populations not included in the NHANES sampling frame. In the second approach (persons who injected drugs [PWID] adjustment), we developed a model to account for the underrepresentation of PWID in NHANES by incorporating the estimated number of adult PWID in the United States and applying PWID-specific hepatitis C prevalence estimates. Using the NHANES+ model, we estimated HCV RNA prevalence of 1.0% (95% CI: 0.5%-1.4%) among US adults in 2017-2020, corresponding to 2,463,700 (95% CI: 1,321,700-3,629,400) current HCV infections. Using the PWID adjustment model, we estimated HCV RNA prevalence of 1.6% (95% CI: 0.9%-2.2%), corresponding to 4,043,200 (95% CI: 2,401,800-5,607,100) current HCV infections.
Conclusions:
Despite years of an effective cure, the estimated prevalence of hepatitis C in 2017-2020 remains unchanged from 2013 to 2016 when using a comparable methodology. When accounting for increased injection drug use, the estimated prevalence of hepatitis C is substantially higher than previously reported. National action is urgently needed to expand testing, increase access to treatment, and improve surveillance, especially among medically underserved populations, to support hepatitis C elimination goals.
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