Hepatitis C cure rates ‘jarringly low’ as many lack access to treatment
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Key takeaways:
- Among more than 1.7 million people with hepatitis C, only 34% were considered cured.
- Cure rates were lowest among people aged 20 to 39 years with client or self-pay insurance.
An analysis of data from 2013 to 2022 showed that only 34% of people diagnosed with hepatitis C in the United States were cured or cleared of the virus, with many still lacking access to highly effective treatments.
Among the approximately 2.4 million people in the U.S. who are estimated to have HCV, up to 1 million do not know they have it, said Jonathan Mermin, MD, MPH, director of the CDC’s National Center for HIV, Viral Hepatitis, STD, and TB Prevention.
“It's known as the silent killer because initial infection usually has few to no symptoms, but over time, the virus can slowly cause damage to the liver, causing liver cancer, liver failure and death,” Mermin said during a press briefing Thursday, ahead of the release of the new report in MMWR.
Carolyn Wester, MD, MPH, director of the CDC’s Division of Viral Hepatitis, and colleagues used data from Quest Diagnostics to assess the clearance cascade — testing to clearance to subsequent infection — among people with HCV from Jan. 1, 2013 to Dec. 31, 2022 — the decade after safe and highly effective direct-acting antivirals for HCV became available, Wester noted.
They analyzed data from patients living in all 50 states and the District of Columbia who received HCV testing and characterized them, via the clearance cascade, according to five steps:
- a positive HCV test result from Jan. 1, 2013 to Dec. 31, 2021;
- evidence of an HCV test from Jan. 1, 2013 to Dec. 31, 2022 (the follow-up period) for someone who was infected;
- evidence of a detectable HCV RNA during the follow-up period in any person with viral testing,
- cured or cleared; and
- persistent infection or reinfection.
The analysis identified 1,719,493 people as having been ever infected with HCV between Jan. 1, 2013, and Dec. 31, 2021. During the follow-up period from Jan. 1, 2013 to Dec. 31, 2022, 88% of them received viral testing.
Among those who received viral testing during the follow-up period, 69% had evidence of a detectable HCV RNA. Among these participants, 34% were classified as cured or cleared, whether that be through treatment or spontaneous resolution, which Wester called “jarringly low.”
Among patients who were cured or cleared, 7% had evidence of subsequent viremia, indicating persistent infection or reinfection.
Further analysis by age showed that among those ever infected, 29%, 43% and 27% were people aged 20 to 39 years, 40 to 59 years and 60 years or older, respectively. Initial infection was lowest among people aged 0 to 19 years (41%), whereas the prevalence of being cured or cleared was lowest among people aged 20 to 29 years (24%), and highest among those aged 60 years or older (42%). Persistent infection or reinfection was highest among patients aged 20 to 39 years (9%).
Additional analysis by insurance type showed that among the more than 1.7 million people ever infected, 50% were covered by commercial health insurance, 23% by another payer — including self-payers — 11% by Medicaid, 9% by an unspecified payer and 8% by Medicare.
The prevalence of viral testing ranged from 79% for unspecified payers to 91% for commercial and Medicare payers. By payer type, cured or cleared prevalence ranged from 23% for “other” to 45% for Medicare. The lowest proportion of cured or cleared, across all age groups was among those with another payer type (range = 16% to 29%), followed by unspecified (20% to 41%) and Medicaid (23% to 38%), and then by commercial (29% to 49%) and Medicare (33% to 46%) payers. The highest proportion of cured or cleared among all age groups and payers was 49% for commercially insured persons aged 60 years or older.
“Today's study shows that nearly a decade after highly effective cures became available, the vast majority of people with hepatitis C have not been cured,” Wester said. “Why?”
She explained that health coverage policies often make it difficult for people with HCV to access treatment, and because the high cost of treatment, some payers limit which patients are eligible for treatment, or require “burdensome preauthorization” before treatment can begin.
“All of these restrictions can delay or even prohibit access to these lifesaving medications,” she said.
Because so many people are not aware of their infection, Wester said there is an urgent need for increased screening and testing.
“Overcoming these barriers can mean the difference between life and death,” Wester said. “Everyone with hepatitis C deserves the chance to be cured.”
Data derived from Wester C, et al. MMWR Morb Mortal Wkly Rep. 2023;doi:10.15585/mmwr.mm7226a3.
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