What’s Really Behind the Recent Decline in U.S. Hepatitis C Prevalence?

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What’s Really Behind the Recent Decline in U.S. Hepatitis C Prevalence?

Hepatitis C infections are declining.

This week, the Centers for Disease Control and Prevention (CDC) revealed a new estimate of the number of Americans living with hepatitis C. That number — 2.4 million — is a dramatic drop from the CDC’s prior estimate of 3.5 million, which was released in 2015.

On the surface, a 1.1 million drop in the prevalence of hepatitis C in the U.S. would seem to signal a major victory for the advances made in hepatitis C treatment this decade. But in reality, 85% of people diagnosed and living with hepatitis C are not getting treated and cured with these expensive new drugs each year, according to the nonprofit Initiative for Medicines, Access and Knowledge, Inc. (I-MAK). Meanwhile, acute cases of hepatitis C tripled from 2010 to 2016, driven mostly by the opioid epidemic.

Ultimately, the CDC’s new estimate “is not directly comparable” to its prior estimate, due to “methodological differences” in the way the two numbers were derived, said CDC spokesperson Paul Fulton, Jr.

Both the 2015 and 2018 estimates began with an analysis of the National Health and Nutrition Examination Survey (NHANES), a nationwide survey that uses interviews and physical examinations to create a snapshot of the nation’s health.

But there are notable differences between the two estimates. They used different methods to try to account for hepatitis C infections that are not included in the NHANES data, including those in populations with high rates of hepatitis C, such as people who are incarcerated or homeless.

The first estimate was derived from NHANES data collected from 2003 to 2010, before the new generation of direct-acting antivirals was approved. That estimate also included children, adolescents, and adults, while the 2018 estimate only included those over 18 years old, meaning fewer individuals were ultimately counted.

The 2015 research was a collaborative effort by the CDC, Treatment Action Group, National Development and Research Institutes, Beth Israel Medical Center, and Weill Cornell Medical College. In addition to NHANES data, researchers estimated prevalence for groups who were not included in that dataset. Specifically, they estimated prevalence among people who were incarcerated or homeless, Native Americans living on reservations, and people in hospitals — ultimately determining that there were about 800,000 infections in these groups.

Read on: What's Really Behind the Recent Decline in U.S. Hepatitis C Prevalence?

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