Curent Issues in the Epidemiology of Hepatitis C Virus (HCV0 Infection in the United States

Incident HCV has declined much in recent years, but an estimated 3.2 million Americans have chronic HCV infection that now rivals HIV as a cause of mortality. National surveillance for HCV is highly variable and unreliable except for determining the broadest trends; but, with the impetus of a recent IOM report, efforts are underway to overhaul and focus HCV surveillance. Available data indicate that injection drug use ( IDU) remains the main cause of HCV infection in the United States, but many acutely infected persons do not admit or know of any clear risk factor (such as IDU) for their HCV infection. Transmission sexually and mother-to-child is still uncommon, though much more so for persons who are also HIV-infected. A more troublesome realization in recent years has been the large number of infections acquired in healthcare settings because of inadequate infection control. Chronic HCV has still not received adequate public health –“secondary prevention”--activity, especially as HCV is putatively the only viral infection that can be “cured” with new antiviral therapies. Despite this, recent data from various CDC studies indicate that only a minority (40%) of HCV-infected patients have been tested and know their status; of these, only a minority (30-40%) are being medically seen for their infection and only a few (15%) are receiving drug therapy for HCV. Efforts should be focused on better defining sources of infection, but a large public health effort should also be devoted to getting people tested, identified, into care, and receiving antiviral therapy.