By: Marcus J. Hopkins, Blogger
The Centers for Disease Control and Prevention (CDC) has released new data that estimate that approximately 2.4 million adults are living with Hepatitis C (HCV) in the United States (Hofmeister, et al., 2018). This estimate was reached by analyzing 2013-2016 data from the National Health and Nutrition Examination Survey to estimate the prevalence of HCV in the non-institutionalized population in combination with literature reviews and population size estimation approaches to estimate the HCV prevalence and population sizes for incarcerated people, unsheltered homeless people, active-duty military personnel, and nursing home residents (Hofmeister).
These data represent the latest effort by the CDC to more accurately reflect the severity of the HCV epidemic in the United States. The accuracy of this estimate has been significantly hampered by the failure of the CDC to classify HCV as a mandatorily reportable condition (like HIV). Instead, the CDC has left up to individual states whether or not they consider HCV a reportable condition, which has led to a range of wildly varying approaches from no reporting whatsoever, to incredibly detailed reporting that goes down to the county and/or jurisdictional level. These variations have led to certain states providing no functional data about the incidence or prevalence of this deadly virus in their states.
One of the primary drivers of new HCV infections has been the prescription opioid and heroin epidemic that extends into virtually every corner of the U.S.:
Earlier CDC research found that new hepatitis C cases tripled between 2010 and 2016. Most were traced to injection-drug use among younger adults addicted to heroin and other opioids. Adults under 40 have the highest rate of new infections (Norton, 2018).
In states where Injection Drug Use (IDU) is highly prevalent (suburban and rural areas of New England, the Midwest, and Appalachia), IDU accounts for a significant percentage of new HCV infections – in West Virginia and Massachusetts – the states with the second- and first-highest rates of HCV infection respectively – evidence suggests that it is the leading risk factor identified in HCV incidence reporting.
The recent news that Medicaid was expanded by voter ballot initiatives in Idaho, Nebraska, and Utah brings some hope that people living with HCV in those states will gain access to curative treatment. That said, even with Medicaid programs paying for treatment, it is both far cheaper, and more effective to prevent infection, rather than to play “Recovery Medic.” This can be effectively accomplished by establishing (and adequately funding) Syringe Services Programs (SSPs) which have been shown to reduce the number of new infectious disease infections and increase access to and utilization of drug abuse recovery services. Unfortunately, according to a 2017 CDC study, only three U.S. states have laws that “support full access” to both SSPs and HCV treatment (Norton).
For those of us in the HCV data game, these data are of little surprise. While this latest CDC estimate is down from the previous one, there are factors to consider when looking at this decrease: the introduction of HCV Direct-Acting Antivirals has decreased the number of people living with HCV as access to these medications has increase and people who wereliving with HCV have died in greater number as their disease ravaged their livers and other bodily organs. Essentially, people either got cured, or they died (Norton).
- Hofmeister, M.G., Rosenthal, E.M., Barker, L.K., Rosenberg, E.S., Barranco, M.A., Hall, E.W., Edlin, B.R., Mermin, J., Ward, J.W., Ryerson, A.B. (2018, November 06). Estimating Prevalence of Hepatitis C Virus Infection in the United States, 2013‐2016. Hepatology. DOI: https://doi.org/10.1002/hep.30297
- Norton, A. (2018, November 06). Opioids Drive Hep C to More than 2 Million in U.S. Atlanta, GA: WebMD, LLC: Hepatitis: News. Retrieved from: https://www.webmd.com/hepatitis/news/20181106/opioids-drive-hep-c-to-more-than-2-million-in-us#1
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