The changing epidemiology of hepatitis C virus infection in the United States: National Health and Nutrition Examination Survey 2001 through 2010

J Hepatol. 2014 Apr;60(4):691-8. doi: 10.1016/j.jhep.2013.11.014. Epub 2013 Nov 27.


Background & aims: In light of the dramatically changing hepatitis C therapeutic landscape, knowledge of the current burden of HCV infection in the general population of the United States is critical.

Methods: The National Health and Nutrition Examination survey collects nationally representative data on HCV infection in the civilian population of the United States. Data from 2001 to 2010 were combined for this study. HCV testing was completed in 38,025 participants.

Results: The prevalence of anti-HCV in the United Sates decreased from 1.9% (95% CI 1.5%-2.5%) in 2001-2002 to 1.3% (95% CI 0.9%-1.8%) in 2005-2006, and remained stable up to 2010. About 67% of all infected persons were positive for HCV RNA, indicating 2.3 million people with chronic HCV infection, of whom 68% have genotype 1. Seventy percent of infected persons were born between 1945 and 1965, with prevalence of 3.5% (95% CI 2.2%-4.8%). The stable rate since 2006 is mostly related to prevalent cases and foreign born persons migrating into US. Other important risk factors include less education and low economic status. Race, HIV status, number of sexual partners, and blood transfusions are no longer associated with HCV infection.

Conclusions: As of 2010, approximately 2.3 million persons were chronically infected with Hepatitis C in the US. Most of those infected are prevalent, rather than incident cases. The prevalence of HCV was on the decline, but has stabilized since 2006. Future studies should explore reasons for no decline in HCV prevalence since 2006.

Keywords: Hepatitis C infection; NHANES; Prevalence; Risk factors; Trends.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Child
  • Educational Status
  • Emigrants and Immigrants
  • Female
  • Hepatitis C / epidemiology*
  • Hepatitis C / transmission
  • Hepatitis C / virology
  • Hepatitis C, Chronic / epidemiology
  • Hepatitis C, Chronic / transmission
  • Hepatitis C, Chronic / virology
  • Humans
  • Male
  • Middle Aged
  • Nutrition Surveys
  • Prevalence
  • RNA, Viral / blood
  • Risk Factors
  • Social Class
  • Substance Abuse, Intravenous / complications
  • Time Factors
  • United States / epidemiology
  • Young Adult


  • RNA, Viral