About one-third of Americans with HCV had evidence of viral clearance in past decade

About one-third of Americans with a history of hepatitis C virus (HCV) infection had laboratory evidence of viral cure or clearance in the years since highly effective HCV treatments became available, a recent study found.

Following CDC guidance, researchers used longitudinal data from a large national commercial laboratory throughout the past decade to develop a simplified national HCV clearance cascade. It characterized people according to five steps: 1) ever infected, defined as any receipt of a positive HCV test result from 2013 through 2021 (the index period); 2) viral testing, defined as evidence of one or more HCV RNA tests performed from 2013 through 2022 (the follow-up period) for those who had ever been infected; 3) initial infection, defined as evidence of a detectable HCV RNA during the follow-up period in any person with viral testing; 4) cured or cleared, defined as evidence of subsequent undetectable HCV RNA during the follow-up period among those with an initial infection; and 5) persistent infection or re-infection, defined as evidence of subsequent detectable HCV RNA during the follow-up period in anyone categorized as cured or cleared.

The researchers analyzed data from patients living in all 50 states and the District of Columbia who received hepatitis C testing by Quest Diagnostics (three coauthors of the study were affiliated with the company). Results were published June 30 by MMWR.

During the index period, about 1.72 million patients were categorized as ever having been infected with HCV. During the follow-up period, 88% of those ever infected had viral testing; 69% who received viral testing had initial infection; 34% with initial infection were cured or cleared (through treatment or spontaneously); and 7% of those cured or cleared had persistent infection or re-infection.

Of those ever infected, 29% were ages 20 to 39 years, 43% were ages 40 to 59 years, and 27% were ages 60 years and older; 60% were male. About half were covered by commercial health insurance, 11% by Medicaid, and 8% by Medicare, with the rest unspecified or other payers. The prevalence of cure or clearance was lowest among those ages 20 to 29 years (24%), was highest among those ages 60 years and older (42%), and, by payer type, ranged from 23% for those covered by other payers to 45% for those covered by Medicare. The highest proportion of cure or clearance among all age groups and payers was 49% among commercially insured patients ages 60 years and older.

The study population does not represent all patients with HCV infection, and data from a single laboratory are not necessarily nationally representative, the authors noted. They added that the cascade likely underestimates the number and percentage of those who did not receive a subsequent HCV RNA test after initial infection, those being cured or cleared, and those having persistent infection or re-infection, among other limitations.

The Viral Hepatitis National Strategic Plan for the U.S. aims to increase the proportion of people who have cleared HCV infection to 58% by 2025 and 80% by 2030. The HCV clearance cascade found “substantial gaps in cure … and will facilitate the process of monitoring progress toward national elimination goals,” the study authors wrote. “It is essential that increased access to diagnosis, treatment, and prevention services for persons with hepatitis C be addressed to prevent progression of disease and ongoing transmission and achieve national hepatitis C elimination goals.”