The Prevalence of Hepatitis C Virus Infection in the United States, 1988 through 1994

doi:10.1056/NEJM199908193410802

Volume 341:556-562		August 19, 1999		Number 8

The Prevalence of Hepatitis C Virus Infection in the United States, 1988 through 1994

Miriam J. Alter, Ph.D., Deanna Kruszon-Moran, M.S., Omana V. Nainan, Ph.D., Geraldine M. McQuillan, Ph.D., Fengxiang Gao, M.D., Linda A. Moyer, B.S., Richard A. Kaslow, M.D., M.P.H., and Harold S. Margolis, M.D.

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ABSTRACT

Background Because many persons with chronic hepatitis C virus(HCV) infection are asymptomatic, population-based serologicstudies are needed to estimate the prevalence of the infectionand to develop and evaluate prevention efforts.

Methods We performed tests for antibody to HCV (anti-HCV) onserum samples from 21,241 persons six years old or older whoparticipated in the third National Health and Nutrition ExaminationSurvey, conducted during 1988 through 1994. We determined theprevalence of HCV RNA by means of nucleic acid amplificationand the genotype by means of sequencing.

Results The overall prevalence of anti-HCV was 1.8 percent,corresponding to an estimated 3.9 million persons nationwide(95 percent confidence interval, 3.1 million to 4.8 million)with HCV infection. Sixty-five percent of the persons with HCVinfection were 30 to 49 years old. Seventy-four percent werepositive for HCV RNA, indicating that an estimated 2.7 millionpersons in the United States (95 percent confidence interval,2.4 million to 3.0 million) were chronically infected, of whom73.7 percent were infected with genotype 1 (56.7 percent withgenotype 1a, and 17.0 percent with genotype 1b). Among subjects17 to 59 years of age, the strongest factors independently associatedwith HCV infection were illegal drug use and high-risk sexualbehavior. Other factors independently associated with infectionincluded poverty, having had 12 or fewer years of education,and having been divorced or separated. Neither sex nor racial–ethnicgroup was independently associated with HCV infection.

Conclusions In the United States, about 2.7 million personsare chronically infected with HCV. People who use illegal drugsor engage in high-risk sexual behavior account for most personswith HCV infection.

Source Information

From the Hepatitis Branch, Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta (M.J.A., O.V.N., F.G., L.A.M., H.S.M.); the National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Md. (D.K.-M., G.M.M.); and the National Institute of Allergy and Infectious Diseases, Bethesda, Md. (R.A.K.).

Address reprint requests to Dr. Alter at the Hepatitis Branch, Mailstop G37, Centers for Disease Control and Prevention, Atlanta, GA 30333.

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N Engl J Med 1999; 341:2093-2095, Dec 30, 1999. Correspondence

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