CDC: Hepatitis C clearance rates well below national elimination goals

Key takeaways:

• The proportion of people cleared or cured of HCV by state ranged from 10% to 51%.
• The findings could help “stimulate” implementation of best practices for preventing and treating HCV, experts said.

Hepatitis C virus clearance rates in all states fell well short of national elimination goals, a study published in MMWR showed.

As Healio previously reported last year, HCV cured or cleared rates were substantially low from 2013 to 2022, with only 34% of the more than 1.7 million people diagnosed with HCV considered to be cured.

According to Clarisse A. Tsang, MPH, from the CDC’s National Center for HIV, Viral Hepatitis, STD and TB Prevention, and colleagues, the HHS’ national HCV elimination goals for 2025 and 2030 call for at least 58% and 80% of people with HCV to achieve viral clearance, respectively.

Monitoring clearance cascades — which the researchers defined as “the sequence of steps that follow the progression from testing to sustained viral clearance” — is key for tracking progress toward HCV elimination goals, Tsang and colleagues wrote.

The researchers examined data from Quest Diagnostics on patients living in all 50 states and Washington D.C. who had received HCV testing from Jan. 1, 2013, to Dec. 31, 2022.

In accordance with CDC guidance, the clearance cascade characterized people based on five criteria:

• ever infected (a positive HCV test result);
• received viral testing (having had an HCV RNA test among those categorized as ever infected);
• initial infection diagnosis (a detectable HCV RNA test result among those with viral testing);
• cured or cleared (an undetectable HCV RNA test result during the follow-up period among those with an initial infection); and
• persistent infection or reinfection (a detectable HCV RNA test result among those categorized as cured or cleared).

Overall, 1,631,609 people were identified as having ever been infected with HCV during the study period.

The median state-level proportion of viral testing was 91%, which ranged from 51% in Hawaii to 99% in South Dakota.

The median proportion of those diagnosed with an initial infection after undergoing viral testing was 83% and ranged from 59% in New York to 96% in South Dakota.

The median proportion of people cured or cleared was 29%, well below the HCV viral clearance goals for 2025 and 2030, Tsang and colleagues wrote. This percentage varied significantly by state, ranging from 10% in West Virginia to 51% in Connecticut.

Five of the states with the lowest rates of HCV cure or clearance were in southern Appalachia or the northern or central U.S., “highlighting the importance of improving linkage to care and treatment coverage in these regions, which are experiencing high rates of acute hepatitis C cases in association with injection drug use,” the researchers wrote.

The median state-level proportion of people with persistent infection or reinfection was 5%, which among states ranged from 2% in Maine and Oklahoma to 11% in California.

There were some limitations in the study. Tsang and colleagues noted that the results do not reflect all people infected with HCV because people who received HCV testing from laboratories other than Quest Diagnostics were not included in the estimates.

Still, they concluded that the findings “could serve to stimulate state-level public health action to implement best practices for diagnosing, treating, and preventing HCV infection.”

“These practices include focusing efforts on increasing hepatitis C testing in all settings in which persons with hepatitis C receive care, ensuring unrestricted access to treatment irrespective of insurance coverage, and providing comprehensive harm reduction services for persons who use and inject drugs,” they wrote.