The hidden epidemic of hepatitis C virus infection in the United States: occult transmission and burden of disease

Abstract

Society faces an immense burden of hepatitis C virus (HCV) infection-related morbidity and mortality. Transmission of HCV is ongoing, and the incidence of HCV infection has been increasing in recent years. New therapies for treating HCV infection hold considerable promise for increasing cure rates and thus reducing HCV transmission. However, many persons with HCV infection in the United States are unaware of their infection status. The Centers for Disease Control and Prevention (CDC) recently expanded its HCV testing recommendations to include 1-time HCV testing for individuals born between 1945 and 1965, a population with a 3% prevalence of infection. Linkage to care and treatment for those identified with infection through testing would have a profound impact in reducing HCV disease burden. Coordinated efforts by public health agencies, clinical care providers, laboratories, and payers are necessary to improve primary and secondary prevention of HCV disease. This article summarizes a presentation by John W. Ward, MD, at the IAS-USA live continuing medical education program held in Atlanta, Georgia, in October 2012.

Figure 1.

Future burden of hepatitis C virus (HCV)-related morbidity and mortality in the United States. DCC indicates decompensated cirrhosis; HCC, hepatocellular carcinoma. Adapted from Rein DB et al.

Figure 2.

Age distribution of confirmed hepatitis C virus (HCV) cases in Massachusetts in 2002 (top) and 2009 (bottom). Adapted from Centers for Disease Control and Prevention.

Figure 3.

Estimated 10-year relative reduction in hepatitis C virus (HCV) prevalence among injection drug users (IDUs) according to number of HCV-infected IDUs treated annually with assumed sustained virologic response rate of 62.5%. Adapted from Martin et al.

Figure 4.

Comparison of cost-effectiveness of hepatitis C virus (HCV) strategy compared with other routine preventive services. QALY indicates quality-adjusted life-year. Adapted from http://www.prevent.org/National-Commission-on-Prevention-Priorities/Rankings-of-Preventive-Services-for-the-US-Population.aspx. Accessed December 4, 2012.