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ARTICLE

The Prevalence of Hepatitis C Virus Infection in the United States, 1999 through 2002

Gregory L. Armstrong, MD; Annemarie Wasley, ScD; Edgar P. Simard, MPH; Geraldine M. McQuillan, PhD; Wendi L. Kuhnert, PhD; and Miriam J. Alter, PhD

16 May 2006 | Volume 144 Issue 10 | Pages 705-714

Background: Defining the primary characteristics of persons infected with hepatitis C virus (HCV) enables physicians to more easily identify persons who are most likely to benefit from testing for the disease.

Objective: To describe the HCV-infected population in the United States.

Design: Nationally representative household survey.

Setting: U.S. civilian, noninstitutionalized population.

Participants: 15 079 participants in the National Health and Nutrition Examination Survey between 1999 and 2002.

Measurements: All participants provided medical histories, and those who were 20 to 59 years of age provided histories of drug use and sexual practices. Participants were tested for antibodies to HCV (anti-HCV) and HCV RNA, and their serum alanine aminotransferase (ALT) levels were measured.

Results: The prevalence of anti-HCV in the United States was 1.6% (95% CI, 1.3% to 1.9%), equating to an estimated 4.1 million (CI, 3.4 million to 4.9 million) anti-HCV–positive persons nationwide; 1.3% or 3.2 million (CI, 2.7 million to 3.9 million) persons had chronic HCV infection. Peak prevalence of anti-HCV (4.3%) was observed among persons 40 to 49 years of age. A total of 48.4% of anti-HCV–positive persons between 20 and 59 years of age reported a history of injection drug use, the strongest risk factor for HCV infection. Of all persons reporting such a history, 83.3% had not used injection drugs for at least 1 year before the survey. Other significant risk factors included 20 or more lifetime sex partners and blood transfusion before 1992. Abnormal serum ALT levels were found in 58.7% of HCV RNA–positive persons. Three characteristics (abnormal serum ALT level, any history of injection drug use, and history of blood transfusion before 1992) identified 85.1% of HCV RNA–positive participants between 20 and 59 years of age.

Limitations: Incarcerated and homeless persons were not included in the survey.

Conclusions: Many Americans are infected with HCV. Most were born between 1945 and 1964 and can be identified with current screening criteria. History of injection drug use is the strongest risk factor for infection.

Editors' Notes Context The Third National Health and Nutrition Examination Survey (NHANES III), conducted between 1988 and 1994, indicated that 1.8% of people in the United States had been infected with hepatitis C virus (HCV), 70% of whom had chronic infection. Most anti-HCV–positive individuals were between 30 and 49 years of age. Contribution Data from the recent NHANES (1999–2002) show little change in anti-HCV prevalence, but peak prevalence has shifted to individuals between 40 and 49 years of age. More than 85% of HCV RNA–positive individuals may be identified through targeted testing of 18% of adults between 20 and 59 years of age: persons with abnormal serum alanine aminotransferase levels, those who have used injection drugs, and those who received blood transfusions before 1992. Cautions Incarcerated and homeless people were not included in the survey. Implications Despite a decrease in new HCV infections, aging of chronically infected individuals may presage an imminent increase in complications. —The Editors

 

Author and Article Information

From National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, and National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland.

Grant Support: None.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Gregory L. Armstrong, MD, Division of Viral Hepatitis, Centers for Disease Control and Prevention, Mailstop G-37, 1600 Clifton Road NE, Atlanta, GA 30333; e-mail, GArmstrong{at}cdc.gov.

Current Author Addresses: Drs. Armstrong and Wasley and Mr. Simard: Division of Viral Hepatitis, Centers for Disease Control and Prevention, Mailstop G-37, 1600 Clifton Road NE, Atlanta, GA 30333.

Dr. McQuillan: Centers for Disease Control and Prevention, National Center for Health Statistics, Division of Health and Nutrition Examination Surveys, 3311 Toledo Road, Room 4204, Hyattsville, MD 20782.

Dr. Kuhnert: Division of Viral Hepatitis, Centers for Disease Control and Prevention, Mailstop A-33, 1600 Clifton Road NE, Atlanta, GA 30333.

Dr. Alter: Division of Viral Hepatitis, Centers for Disease Control and Prevention, Mailstop D-66, 1600 Clifton Road NE, Atlanta, GA 30333.

Author Contributions: Conception and design: G.L. Armstrong, G.M. McQuillan, M.J. Alter.

Analysis and interpretation of the data: G.L. Armstrong, A. Wasley, E.P. Simard, G.M. McQuillan, W.L. Kuhnert, M.J. Alter.

Drafting of the article: G.L. Armstrong, G.M. McQuillan.

Critical revision of the article for important intellectual content: G.L. Armstrong, A. Wasley, E.P. Simard, G.M. McQuillan, M.J. Alter.

Final approval of the article: G.L. Armstrong, A. Wasley, E.P. Simard, G.M. McQuillan, M.J. Alter.

Provision of study materials or patients: G.M. McQuillan.

Statistical expertise: G.L. Armstrong.

Obtaining of funding: M.J. Alter.

Administrative, technical, or logistic support: W.L. Kuhnert.

Collection and assembly of data: A. Wasley, E.P. Simard, G.M. McQuillan.

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