Gaps in Viral Hepatitis Awareness in the United States in a Population-based Study

  • Kali Zhou
    Division of Gastroenterology, Department of Medicine, University of California, San Francisco, San Francisco, California
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  • Norah A. Terrault
    Reprint requests Address requests for reprints to: Norah A. Terrault, MD, MPH, Keck Medicine at University of Southern California, 1450 St. Pablo Street, HC4, Room 3056, Los Angeles, California 90033. fax: (415) 476-0659.
    Division of Gastroenterology and Liver Diseases, Department of Medicine, University of Southern California, Los Angeles, California
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      Background & Aims

      The benefits of highly effective therapies for chronic hepatitis B virus (HBV) or HCV infection can only be realized if infected individuals are identified and linked to care. We sought to identify gaps in awareness of diagnosis of HBV or HCV infection in a population-based sample of adults living in the United States (US).


      Using National Health and Nutrition Examinations Surveys data, we examined factors associated with HBV and HCV awareness. Participants surveyed from 2013 through 2016, age ≥20 years, with complete serologic analyses were included. HBV and HCV infections were defined by detection of serum HBsAg and anti-HCV, respectively. The primary outcome was awareness of infection—if participants replied “yes” to the question: “Has a doctor or other health professional ever told you that you have hepatitis B or C?”


      Of 14,745 participants, 68 had HBV and 211 had HCV infection, corresponding to prevalence values of 0.7% and 1.8%, respectively. Among HBV-infected persons, 32% reported awareness, and 28% of aware persons reported treatment. Among HCV-infected persons, 49% reported awareness, 45% of aware persons were treated, and 59% of treated patients achieved a sustained virologic response. Factors associated with greater awareness in multivariable models included US citizenship, higher education, and abnormal level of alanine aminotransferase for HBV-infected participants and non-Hispanic race, income above the poverty line, not married, and history of injection drug use for HCV-infected participants.


      Fewer than half of US adults with HBV or HCV infection are aware of their infection. Opportunities to increase awareness include provider education on cut-off values for abnormal level of alanine aminotransferase that should prompt screening, and expansion of existing screening interventions to under-recognized at-risk groups.


      Abbreviations used in this paper:

      ALT (alanine aminotransferase), CI (confidence interval), FIB-4 (Fibrosis-4 score), anti-HBc (hepatitis B core antibody), HBsAg (hepatitis B surface antigen), HBV (hepatitis B virus), HCV (hepatitis C virus), IDU (injection drug use), MSM (men who have sex with men), NCHS (National Center for Health Statistics), NHANES (National Health and Nutrition Examination Survey), OR (odds ratio)
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