CHI Report – Innovation in Hepatitis C Treatment – Page – 3
The Hepatitis C Epidemic in the US
Hep C is a viral disease that infects the liver. Because the virus spreads throughout the body, it is also associated with a variety of disorders outside the liver. The disease is transmitted through contact with an infected person’s blood and is most often contracted in health care settings although some infections are spread through sexual contact or sharing of needles among intravenous-drug users. The majority of people in the US infected with the disease today contracted it through contaminated blood in the 1970s and 1980s, before routine blood screening for the virus became available in the early 1990s (Exhibit 1). It is estimated that 75 percent of the US hep C burden is carried by baby boomers 3. It is also thought that roughly 75 percent of all HCV infections in the US are genotype 1, the ‘form’ of the disease that is hardest to treat. vi
The CDC estimates that today 4.1 million people in the US have been exposed to HCV and 3.2 million (more than the combined populations of Dallas, San Francisco, Boston, and Atlanta) are chronically infected, meaning that they will not be able to eliminate the virus in their bodies without targeted treatment. Other researchers place their estimates at 5.2 million people in the US exposed to the virus, after including prison inmates and the homeless vii. Today, the rate of new infection is thought to be relatively low. The CDC estimates that 17,000 new infections occurred in the US in 2011, although it notes that this is likely an underestimate, for two main reasons: in many people who are infected symptoms do not become evident for years and CDC epidemiology tends to exclude certain high-risk populations from analyses.i 4, In fact, a rising infection rate has recently been reported among young drug users viii; these reports are concerning, particularly given that many of these patients are not linked to the health care system.
Hep C does not affect all people to the same degree; its impact falls disproportionately on low-income communities, intravenous-drug users, prisoners, veterans, and other vulnerable populations. Those below the poverty line are three times more likely to have been exposed to HCV than those with higher incomes. 5 People who have used injection drugs are 150 times more likely than those who have not to be infected with HCV.ix Worse yet, the poor are disproportionately unaware of their HCV infection status. As just one example, although data on prevalence rates in US prison populations is sparse, some studies suggest that up to 39 percent of all prisoners are infected with HCV, which is particularly disturbing given that there are currently no screening or treatment requirements for hep C in the US prison system. x When it comes to health coverage, approximately 480,000 people in the US who are infected with HCV are uninsured, and an additional 430,000 are on Medicaid insurance, the government’s program for low-income individuals and families. States that expand Medicaid under the Affordable Care Act (ACA) are expected to cover many thousands of additional patients. x