Ending the HCV Epidemic: A Call to Action

HCV Virus

Are you aware of the resurgence of hepatitis C virus (HCV) infections in recent years? If not, it is time to take notice. 

Although HCV infections declined in the late 1980s and early 1990s1, their rates have skyrocketed since then. In fact, by 2021, the rates of HCV infection had increased 129% over 2014 levels, and the highest rates of new infections were seen among those aged 20-39.1

The Silent Epidemic: Millions of Americans Living with Hepatitis C Unaware

The situation is alarming, considering that approximately 2.4 million Americans are believed to be living with the virus, and some estimates put the number as high as 4.7 million Americans.2,3 What is even more concerning is that an estimated 40% of those chronically infected, which is at least 1 million Americans, don't even know they have the virus, increasing their risk of deadly complications and transmitting the virus to others.2 Every year, more than 15,000 Americans die from HCV-related diseases.2 But here's an important fact: HCV infection is a curable condition.

Understanding Hepatitis C: How it Spreads and its Consequences

HCV is a bloodborne virus without a vaccine. HCV can be transmitted from mother to child during pregnancy, or by sharing personal items contaminated with small amounts of blood, like toothbrushes or razors. Sexual contact can also spread the virus, but the most common way people get infected is through injection-drug use.4 HCV infects liver cells, where it replicates.4 Following infection, the body mounts an immune response, introducing anti-HCV antibodies to the bloodstream.4 This first phase of infection is known as acute infection.4 Some people will clear the virus on their own within 6 months, but more than half of those infected will develop chronic HCV infection.4 Both acute and chronic infections are often asymptomatic or have mild, non-specific symptoms that are unlikely to prompt an individual to seek medical care.4 This makes it hard for people to know if they have the virus, which is why HCV infection is known as a “silent epidemic,” with many infected individuals unaware of their status. The consequences of not knowing can be disastrous.

HCV infections can lead to deadly complications and is the leading cause of cirrhosis and liver cancer in the US.5,6 There is hope however, HCV infection can be cured with direct-acting antivirals (DAAs) in 95% of cases.2 Testing for HCV is recommended for every adult at least once in their lifetime, which could prevent thousands of preventable deaths every year.4

Access to Nucleic Acid Amplification Tests (NAATs) for Effective Diagnosis of HCV Infection

HCV infection is initially diagnosed by serologically testing for HCV antibodies.4 However, because individuals who successfully clear the virus without treatment retain anti-HCV antibodies in their blood, further testing is needed after a positive serologic response.4 NAATs, such as the Aptima HCV Quant Dx assay, can detect active infections.* Access to NAATs is vital for the estimated 1 million Americans unaware of their HCV infection.2 Evidence shows, programs that have adopted policies like opt-out testing and the simplification of testing protocols to reduce follow-up burden have shown effective reductions in HCV infections in targeted populations.7,8

Urgent Action Needed to End the HCV Epidemic

In conclusion, the threat of HCV infections is a growing public health concern that demands immediate attention. With the necessary tools at our disposal, we must act now to ensure that small- to medium-sized and public health laboratories have access to NAATs. By decentralizing HCV NAAT, we can increase availability and reduce the time providers need to obtain the data to treat individuals infected with HCV effectively.

The cure for this deadly infection is available to us. Let's act urgently and work together to eradicate this virus and improve the health and wellbeing of our communities. The time to end the HCV epidemic has come.

    *The Aptima HCV Quant Dx assay is indicated for use as an aid in the diagnosis of active HCV infection in the following populations: individuals with antibody evidence of HCV infection with evidence of liver disease, individuals suspected to be actively infected with HCV antibody evidence, and individuals at risk for HCV infection with antibodies to HCV. Detection of HCV RNA indicates that the virus is replicating and, therefore, is evidence of active infection. Detection of HCV RNA does not discriminate between acute and chronic states of infection.

    1. Spach, DH. HCV epidemiology in the United States. Hepatitis C Online. Updated January 2, 2024. Accessed March 28, 2024. https://www.hepatitisc.uw.edu/go/screening-diagnosis/epidemiology-us/core-concept/all 2. Fleurence, R., Collins, F. A National Hepatitis C Elimination Program in the United States: A Historic Opportunity. JAMA Published online: March 9, 2023. doi:10.1001/jama.2023.3692 3. Edlin BR, Eckhardt BJ, Shu MA, Holmberg SD, Swan T. Toward a more accurate estimate of the prevalence of hepatitis C in the United States. Hepatology. 2015 Nov;62(5):1353-63. doi: 10.1002/hep.27978 4. Hepatitis C questions and answers for health professionals. Centers for Disease Control and Prevention. Updated October 21, 2023. Accessed April 4, 2024. https://www.cdc.gov/hepatitis/hcv/hcvfaq.htm 5. Xiao S, Xie W, Zhang Y, Lei L, Pan Y. Changing epidemiology of cirrhosis from 2010 to 2019: results from the Global Burden Disease study 2019. Ann Med. 2023;55(2):2252326. doi: 10.1080/07853890.2023.2252326 6. Liver cancer causes, risk factors, and prevention. National Cancer Institute. Updated June 26, 2023. Accessed April 4, 2024. https://www.cancer.gov/types/liver/what-is-liver-cancer/causes-risk-factors 7. Pamela S. Belperio, PharmD; Chartier, M. et al. Curing Hepatitis C Virus Infection: Best Practices From the U.S. Department of Veterans Affairs. Ann Intern Med. 2017;167:499-504. doi:10.7326/M17-1073 Annals.org 26 September 2017. 8. Mehta SJ, Torgersen J, Small DS, et al. Effect of a Default Order vs an Alert in the Electronic Health Record on Hepatitis C Virus Screening Among Hospitalized Patients: A Stepped-Wedge Randomized Clinical Trial. JAMA Netw Open. 2022;5(3):e222427. doi:10.1001/jamanetworkopen.2022.2427 9. Aptima HCV Quant Dx Assay. US package insert AW-14498. Hologic, Inc.;2018.