Hepatitis C virus infection in USA: an estimate of true prevalence

Liver International
Early View (Articles online in advance of print)

Eric Chak 1, Andrew H. Talal 2, Kenneth E. Sherman 3, Eugene R. Schiff 4, Sammy Saab 5

Article first published online: 15 MAR 2011
DOI: 10.1111/j.1478-3231.2011.02494.x
© 2011 John Wiley & Sons A/S

Author Information

1 Department of Medicine, UCLA-Olive View Medical Center, University of California at Los Angeles, Sylmar, CA, USA
2 Division of Gastroenterology and Hepatology and Center for the Study of Hepatitis C, Department of Medicine, Weill Cornell Medical College, Cornell University, New York, NY, USA
3 Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
4 Department of Medicine, University of Miami School of Medicine, Miami, FL, USA
5 Department of Medicine and Surgery, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA

* Correspondence: Correspondence Sammy Saab, MD, MPH, AGAF, UCLA Pfleger Liver Institute, 200 Medical Plaza, Suite 214, Los Angeles, CA 90095, USA Tel: +1 310-206-6705 Fax: +1 310-206-4197 e-mail: ssaab@mednet.ucla.edu

Abstract

Keywords :hepatitis C virus;prevalence

The recent National Health and Nutrition Examination Survey (NHANES) sampled only the civilian, non-institutionalized population of USA and may have underestimated the prevalence of hepatitis C virus (HCV) in this country. We searched the database MEDLINE, the Bureau of Justice Statistics, Center for Medicare and Medicaid and individual states Department of Corrections for all epidemiological studies regarding the prevalence of HCV in populations not sampled by the NHANES survey namely the incarcerated, homeless, nursing home residents, hospitalized and those on active military duty. Because of their relatively low frequency in the NHANES sample, we also expanded our search to include healthcare workers and long-term dialysis patients. Although included in the NHANES sample, we also performed searches on drug users (injection and non-injection) and veterans to confirm the findings of the NHANES study. Based on the prevalence of studies identified meeting our inclusion criteria, our most conservative estimates state that there at least 142 761 homeless persons, 372 754 incarcerated persons and 6805 persons on active military duty unaccounted for in the NHANES survey. While the NHANES estimates of drug users (both injection and non-injection) appear to be reasonable, the survey seems to have underestimated the number of HCV-positive veterans. Our most conservative estimates suggest that there are at least 5.2 million persons living with HCV in USA today, approximately 1.9 million of whom were unaccounted for in the NHANES survey.

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