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. 2025 Feb 1;81(2):625-636.
doi: 10.1097/HEP.0000000000000927. Epub 2024 May 13.

Estimating hepatitis C prevalence in the United States, 2017-2020

Eric W Hall  1 , Heather Bradley  2 , Laurie K Barker  3 , Karon C Lewis  3 , Jalissa Shealey  2 , Eduardo Valverde  4 , Patrick Sullivan  2 , Neil Gupta  3 , Megan G Hofmeister  3
Affiliations

Estimating hepatitis C prevalence in the United States, 2017-2020

Eric W Hall et al. Hepatology. .

Abstract

Background and aims: The National Health and Nutrition Examination Survey (NHANES) underestimates the true prevalence of HCV infection. By accounting for populations inadequately represented in NHANES, we created 2 models to estimate the national hepatitis C prevalence among US adults during 2017-2020.

Approach and results: The first approach (NHANES+) replicated previous methodology by supplementing hepatitis C prevalence estimates among the US noninstitutionalized civilian population with a literature review and meta-analysis of hepatitis C prevalence among populations not included in the NHANES sampling frame. In the second approach (persons who injected drugs [PWID] adjustment), we developed a model to account for the underrepresentation of PWID in NHANES by incorporating the estimated number of adult PWID in the United States and applying PWID-specific hepatitis C prevalence estimates. Using the NHANES+ model, we estimated HCV RNA prevalence of 1.0% (95% CI: 0.5%-1.4%) among US adults in 2017-2020, corresponding to 2,463,700 (95% CI: 1,321,700-3,629,400) current HCV infections. Using the PWID adjustment model, we estimated HCV RNA prevalence of 1.6% (95% CI: 0.9%-2.2%), corresponding to 4,043,200 (95% CI: 2,401,800-5,607,100) current HCV infections.

Conclusions: Despite years of an effective cure, the estimated prevalence of hepatitis C in 2017-2020 remains unchanged from 2013 to 2016 when using a comparable methodology. When accounting for increased injection drug use, the estimated prevalence of hepatitis C is substantially higher than previously reported. National action is urgently needed to expand testing, increase access to treatment, and improve surveillance, especially among medically underserved populations, to support hepatitis C elimination goals.

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Conflict of interest statement

Heather Bradley and Eric W.Hall consults for Merck. Patrick Sullivan consults and received grants from Merck. He is on the speakers’ bureau and received grants from Gilead and received grants from Viiv. The remaining authors have no conflicts to report.

Figures

FIGURE 1
FIGURE 1
Formulas for estimating hepatitis C prevalence, United States. Abbreviations: NHANES, National Health and Nutrition Examination Survey; PWID, persons who injected drugs.
See this image and copyright information in PMC

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