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Global HCV Report HCV/IDUs/PWID - HCV in the USA [New NHANES HCV report] (27% African-Americans, that is double the 13% in the US population), PWIDs in the USA (6.6 million ever - 770,00 in last year injected drugs). Latest Report on Latinos in USA with HCV: men and women of Puerto Rican background in the Bronx had the highest HCV prevalence (14.2% and 4.1%, respectively)
  Reported by Jules Levin, NATAP
(1) WHO Global Partner's Meeting on Hepatitis - convened by WHO March 2014 Geneva - Call To Action - Screening, care, treatment
5 June - Participants of the first global partners' meeting on hepatitis convened by WHO in March 2014 agree on a historic "Call to action to scale up global hepatitis response". The "call to action" presses the global community for immediate and concerted action to increase access to prevention, diagnosis and treatment of viral hepatitis. Globally, close to 500 million people are affected by chronic viral hepatitis and they are at risk of developing severe liver disease such as cirrhosis or liver cancer without access to care. The resolution was cosponsored by a range of countries, including Brazil and Egypt. During the meeting 50 countries spoke in favour of the resolution after which it was endorsed by all 194 countries represented at the Assembly.
The concerted action focuses on the following areas:
· Advocacy and awareness;
· Knowledge and evidence;
· Prevention of transmission; and
· Screening, care and treatment.
(2) WHO issues its first hepatitis C treatment guidelines News release
- these guidelines were announced & issued at EASL, the annual meeting in London this year - European Association for the Study of Liver Diseases
9 April 2014 | London, United Kingdom
WHO Guidelines for the screening, care and treatment of persons with hepatitis C infection
The new guidelines make nine key recommendations. These include approaches to increase the number of people screened for hepatitis C infection, advice as to how to mitigate liver damage for those who are infected and how to select and provide appropriate treatments for chronic hepatitis C infection.
(3) New Published Study Discusses Global Epidemiology of PWID, People Who Inject Drugs, & HIV & HCV Prevalence......"This paper examined the epidemiology of HIV infection among people who inject drugs (PWID) in the Middle East and North Africa (MENA) and HCV as well to a lesser degree......The prevalence of HCV (31%-64%) and of sexually transmitted infections suggest high levels of risk behavior indicative of the potential for more and larger HIV epidemics." http://www.natap.org/2014/HCV/062314_04.htm
Hepatitis C in the USA - New NHANES Report, HCV Among African-Americans/Latinos/IDUs - latest published data
Hepatitis C virus infection in USA: an estimate of true prevalence - 'estimated 5.2 to 7.1 million HCV+ in USA'........http://www.natap.org/2011/HCV/092611_01.htm
HCV: who/how to screen-HCV is a Disease of the Marginalized......http://www.natap.org/2014/HCV/011614_01.htm


New NHANES: The Changing Epidemiology of Hepatitis C Virus Infection in the United States: National Health and Nutrition Examination Survey 2001 through 2010.....http://www.natap.org/2013/HCV/011314_12.htm.....Based on RIBA testing, the prevalence of anti-HCV positivity in the United States was 1.3 %( 0.9-1.8%), which translates into approximately 3.5 million persons in the US general population as of 2010.....As of 2010, 67.9% and 22.1% cases were genotypes 1 and 2 respectively.....The prevalence was higher in men than women (1.9% vs. 1.1%, P<0.001). By age, greater than two thirds (70.1%) of those infected were in the 45years to 65years old group, corresponding to the 1945 to 1965 birth cohort in 2010.....The prevalence in this age group was 3.5% (95% CI 2.2% to 4.8%). Figure 1 shows the burden of anti-HCV by age group as of 2010. The prevalence was noted to be highest among male non-Hispanic Blacks (2.2%) compared to Non-Hispanic whites (1.3%)[but among Black men the prevalence was 2.9% & among Black women 1.7%] My analysis: the US population is about 315 million, 13% are African-American/Black, that is about 40 million, 2.2% of this is 880,000, so if there are 3.5 million with HCV in the USA 27% with HCV in the USA are African-American/Black, that is double the US population of African-Americans - 13% vs 27% ......Overall, there was a trend for decreasing prevalence of anti-HCV over time; from 1.9% (95% CI 1.5%-2.5%) in 2001-2002 to 1.3% (95% CI 1.0%-1.8%) in 2005-2006 cycles. However, since 2006, the prevalence of anti-HCV has remained stable at 1.3% as of April 1, 2010......In 2001-2002, most of the persons with anti-HCV were born in the USA (2.2% Vs 0.3%). The prevalence of anti-HCV decreased significantly among US born persons throughout the study period to about 1.4% in 2009-2010. Overall, there was a trend toward increase in the prevalence of anti-HCV among persons born outside of the USA. The prevalence increased from 0.3% to 0.8% between 2001 and 2006. However, it decreased to 0.4% in 2007 but as of 2010, it was up to 1.0%".......The strongest risk factors for having anti-HCV included people aged 45 to 65 years old, being born in the United States, less than high school education, lifetime drug use, abnormal alanine aminotransferase levels(ALT>39U/L) and having antibodies to herpes simplex virus type 2. The positive predictive value for ALT for persons less than 70 years old and for the 1945-1965 birth cohort were 5.14% and 6.7% respectively.
Hepatitis C in the United States Perspective (screening/care) (CDC)
An examination of the prevalence of chronic HCV infection in the United States during the period 1999 through 2002, based on NHANES data and factoring in persons who were institutionalized, incarcerated, or homeless, suggested that there were about 3.5 million HCV-infected U.S. residents. According to an as-yet unpublished study by Denniston et al., a more recent prevalence estimate based on NHANES data from 2003 through 2010 reveals the effect of increasing mortality on this population. These analyses indicate that a reasonable estimate of the current number of infected people in the United States is about 3.2 million. In the population on which the CHeCS draws, less than half of people who had had two or more abnormal alanine aminotransferase results were subsequently tested for HCV infection.2........ From these data it seems reasonable to deduce that 63 to 77% of people who have tested positive for HCV antibodies - 32 to 38% of all HCV-infected people in the United States - received follow-up hepatitis care.
HCV in Latinos/Puerto Ricans.......http://www.natap.org/2014/HCV/012214_03.htm....."men and women of Puerto Rican background in the Bronx had the highest HCV prevalence (14.2% and 4.1%, respectively). In comparison, HCV prevalences among men and women of Puerto Rican background in Chicago were 4.7% and 1.3%, respectively......A recent study of 9579 patients receiving care at Bronx primary care clinics estimated HCV prevalence to be 4.6%-7.7%. prevalence of HCV was high in those of Puerto Rican background, low in those of South American background, and intermediate in those of Mexican, Dominican, Cuban, and Central American backgrounds (Supplementary Tables 1 and 2)."
Hepatitis C Virus (HCV)-Infected Persons in the United States and Estimated Rates of Detection, Referral to Care, and Treatment.



Estimating the Number of Persons Who Inject Drugs in the United States by Meta-Analysis to Calculate National Rates of HIV and Hepatitis C Virus Infections ......http://www.natap.org/2014/HCV/053014_01.htm"The prevalence estimate points to the importance of national efforts to raise awareness of HCV testing among persons who have injected drugs......the prevalence data may be an under-estimate of the population proportion of PWID.....In an era of improved treatment, it is also important that those who are infected are linked to appropriate care [11]. CDC recommends integrated prevention services for PWID, which address risk for HIV and HCV infections and are expected to result in increased access to services, improved timeliness of service delivery, and increased effectiveness of prevention efforts [26]."
"Using data from national population-based U.S. surveys, we estimated that persons who ever injected drugs comprised 2.6% (CI: 1.8%-3.3%) of the U.S. population....in 2011......we estimate that approximately 6,612,488 adults and adolescents ever injected drugs, with a range from 4,583,188 to 8,641,788 persons.....The combined estimate for males was 3.6% (CI: 2.4%-4.8%) and for females was 1.6% (95% CI: 1.1%-2.0%).......for 2011, we estimate that approximately 774,434 adults and adolescents (range: 494,605-1,054,263) injected drugs in the past year in the United States."
Our HCV infection prevalence rate among PWID aged 40-65 years was 43,126 per 100,000 population, reflecting the substantial impact of injection drug use on acquiring HCV infection. The HCV infection prevalence we found (43.1%) was similar to a previous NHANES estimate of 48%...
Table 4: Estimated proportion of persons who inject drugs (PWID) in the United States, by sex, race/ethnicity, and age group-meta-analysis of 3 national surveys.*
Based on a 2013 US population of about 316 million, 13% are Black or African-American but this study reports similar percentages of PWIDs who are White (3.8%) & African-American/Black (3.4%).


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