First U.S. state-by-state analysis of hepatitis C cases

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In the infectious disease world, the liver-damaging hepatitis C virus (HCV) long has lived in the shadows of killers such as HIV/AIDS, tuberculosis, and malaria. But curative—and expensive—HCV drugs that have come to market over the past 5 years have focused new attention on the deadly disease.

Now, for the first time, researchers have mapped its U.S. prevalence state-by-state. They hope their model ultimately will help improve targeting of efforts to screen for the virus and treat the more than 3 million people in the country who are living with the infection.

The new study finds that the highest levels of HCV infection in 2010 were in the western United States. At the same time, eight states—California, Texas, Florida, New York, Pennsylvania, Tennessee, Ohio, and Washington—account for more than half the cases. HCV is spread primarily when people who inject drugs share their needles and syringes.

The work, published in Clinical Infectious Diseases today, was conducted by researchers from Emory University and the U.S. Centers for Disease Control and Prevention, both in Atlanta. The findings weave together population data from what’s known as the U.S. National Health and Nutrition Examination Survey (NHANES) and death records and numbers from the U.S. Census.

A new, interactive map created by the group, HepVu, shows the geographic distribution. But the researchers say it underestimates actual HCV prevalence. That’s in part because the study looks only at the noninstitutionalized population, which means it does not include people in prison or those living on the streets. It also does not capture sharp, recent spikes in viral spread because of the country’s opioid epidemic: Reported cases of “acute” HCV infections—which indicate recent transmission—jumped 158% between 2010 and 2014.