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Most US Adults With Hepatitis C Unaware of Infection, Study Finds


Patients being unaware of their hepatitis C virus (HCV) infection is preventing the World Health Organization (WHO) from accomplishing its goal of eliminating HCV and hepatitis B virus as public threats by 2030.

Although in recent years more patients have become aware of their hepatitis C virus (HCV) infection, over 800,000 are still unaware of it and their subsequent liver disease risk, according to a study published by PLoS One.

The researchers explained that HCV is one of the leading causes of liver-related mortality and morbidity. Consequently, in 2016, the World Health Organization (WHO) announced they would attempt to eliminate HCV and hepatitis B virus as public health threats by 2030; this requires 90% of individuals with active HCV infection to be diagnosed, 80% to be treated with the intent to cure, and measures to be implemented to reduce HCV in high-risk populations.

While direct-acting antivirals (DAAs), the current HCV therapy, have improved the cure rate of HCV infection to more than 90%, eliminating HCV as a threat has proven difficult due to almost 45% of those living with the infection being unaware of their status. Because of this, the researchers studied public awareness of HCV in the United States using National Health Nutrition and Examination Survey (NHANES) data from 2013 to 2020. Their survey goals included measuring patients’ awareness of HCV infection and identifying possible diagnosis barriers.

Through their analysis of NHANES data, the researchers found 206 adult participants with HCV infection between January 2013 and March 2020. Overall, the weighted awareness of infection during the study period was 60.1%, correlating to approximately 0.84 million US adults who are unaware of their HCV infection.

hepatitis c virus

Hepatitis C virus

Image credit: Dr_Microbe - stock.adobe.com

Results showed Mexican-American and Asian populations have much lower awareness at 39.8% and 13.4%, respectively. The researchers added that, compared with non-Hispanic White patients, the odds ratio (OR) of infection awareness was 0.33 (95% CI, 0.15-0.72) in Mexican-American patients and 0.07 (95% CI, 0.0007-0.79) in Asian patients. Additionally, disease awareness was considerably lower in non-US citizens (P < .001) and non-US-born participants (OR, 0.19; 95% CI, 0.06-0.55).

Liver enzyme levels were higher in those unaware of their infection status. The mean (standard error [SE]) alanine transaminase levels of those unaware were 70.5 (7.2) U/L compared with 53.9 (5.2) U/L in those aware of their infection (P = .041).

Although the researchers found an improvement in patient awareness of HCV infection over the study period, they noted that almost 40% of the US population remains unaware. Despite increased awareness, the absolute numbers of those with HCV infection have remained high over time because of the increasing number of people living with HCV infection. To truly minimize the impact of HCV, the number of diagnoses must increase first, the researchers explained.

“Since HCV tends to be asymptomatic, more aggressive measures in the form of public health messaging and outreach camps for screening, diagnosis, and referrals are paramount,” the authors wrote. “Early diagnosis of these asymptomatic patients will help initiate treatment in patients at early stages of fibrosis. This has been shown to have better sustained virological response and outcomes.”

The researchers also acknowledged their study’s limitations, one being that they created their study population using the NHANES, which is only a sampling of the US population. Because of this, the results may not be globally generalizable. Additionally, the NHANES does not represent several high-risk groups for HCV, including the institutionalized, homeless, and those in nursing homes. Consequently, this might underrepresent the burden of disease, the number of those with HCV infection, and those who remain undiagnosed and untreated.

“With advancements in HCV treatment, it is essential to diagnose these cases early to avoid liver damage and progress toward the WHO goal of eliminating the disease,” the authors concluded. “Future studies and projects directed toward underprivileged and high-risk populations might help understand and eliminate barriers specific to these populations.”


Gnanapandithan K, Ghali MP. Self-awareness of hepatitis C infection in the United States: A cross-sectional study based on the National Health Nutrition and Examination Survey. PLoS One. 2023;18(10):e0293315. Published 2023 Oct 24. doi:10.1371/journal.pone.0293315

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