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HCV prevalence remains highest in US West, Appalachian regions

Results from a national survey showed that hepatitis C prevalence was higher in the West and Appalachian states between 2013 and 2016 compared with other areas, as reported in JAMA Network Open.

“With the increasing availability of direct-acting antivirals, national and state-level public health strategies have raised elimination of HCV as a possible goal,” Eli S. Rosenberg, PhD, from the University at Albany School of Public Health in New York, colleagues wrote. “Accurate estimates of the current burden of HCV infection in each U.S. jurisdiction are critical to the policy, programmatic, and resource planning of elimination strategies.”

To estimate the current state-wide prevalence of HCV among U.S. adults, Rosenberg and colleagues evaluated the recent NHANES and vital statistics data for 2013 to 2016. They included both HCV-related and narcotic overdose mortality to yield updated estimates that reflect patterns of HCV infection attributable to previous and recent transmission.

HCV prevalence ranged by state from 0.45% to 2.34% with a median of 0.88%.

13 states in the U.S. West region had an HCV prevalence higher than the median rate. While the region constitutes 23.4% of the U.S. population, it contained 27.1% of patients with HCV. Three of the 10 states with the highest rates — Kentucky, Tennessee and West Virginia — constituted 4% of the U.S. population but 5.8% of patients with HCV.

California, Florida, Michigan and Texas, and five states in the Appalachian region — New York, North Carolina, Ohio, Pennsylvania and Tennessee — together constituted 51.9% of all U.S. patients with HCV.

“Even with effective tools for addressing the HCV epidemic, substantial challenges remain in their application to rural [people who inject drugs],” Rosenberg and colleagues wrote. “The evidence base for understanding the unique HCV risk, prevention, and care context of these areas remains limited. Others have prioritized areas for further research and recent federal commitments are promising.”

According to Rosenberg and colleagues, direct medical services such as HCV testing and curative treatments are the cornerstones for “extending life and averting transmission,” with clear cost-effective outcomes from earlier treatment.

Additionally, indirect HCV prevention is possible through addressing opioid use disorders through approaches such as medication-assisted treatmen and policies at both the state and system level. – by Talitha Bennett

Disclosure: Rosenberg reports no relevant financial disclosures. Please see the full study for the other authors’ relevant financial disclosures.