Hepatitis C virus (HCV) infection is now the most common bloodborne infection in the United States. The authors wished to update estimates of HCV prevalence among all adults aged ≥18 years and therefore they examined 2013-2016 data from the National Health and Nutrition Examination Survey (NHANES) to estimate prevalence in the non-institutionalised civilian population. They then used a combination of literature reviews and population size estimation to estimate prevalence in four additional populations: incarcerated people, unsheltered homeless people, active-duty military personnel and nursing home residents. The authors estimated that during 2013-2016, 1.7% of all adults in the US, approximately 4.1 million people, were HCV antibody-positive and 1.0% of all adults, approximately 2.4 million people, were HCV RNA-positive. This figure is made up of 3.7 million non-institutionalised civilians with HCV antibodies and 2.1 million with HCV RNA, plus an additional 0.38 million HCV antibody-positive and 0.25 million HCV RNA-positive people in the other populations. Therefore over 2 million people in the US had current HCV infections during 2013-2016. Compared with past estimates based on similar methodology, this suggests that HCV antibody prevalence may have increased while RNA prevalence may have decreased. This could be due to the combination of the opioid crisis, curative treatment for HCV infection and mortality among HCV-infected people.
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