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HCV Testing and Treatment of Adults in the United States: 2014 Through 2021-Data From Two National Commercial Testing Laboratories: 12.8% treated in 2021
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29 September 2025
In 2021, the most recent year of observation, a total of 10,167,524 persons were tested for HCV antibody, of whom 407,795 (4%) were positive; 284,220 persons were tested for HCV RNA, of whom 165,142 (58.1%) were positive. An estimated 21,136 (12.8%) HCV RNA positive persons were treated, of whom 19,584 (92.7%) were cured (Figure 3).
In 2021, the number of persons screened for HCV antibody exhibited a bimodal age distribution, with age
group 30-34 years representing the largest number (1,287,974) tested, and another peak in the age group 50-54 years (838,009). The age distribution of persons who tested positive for HCV RNA displayed a similar bimodal pattern, with the highest positivity rate among those aged 30-39 years followed by those aged 60-64 years (Figure 4).
ABSTRACT
Data on the hepatitis C virus (HCV) care cascade are crucial for determining if the United States (U.S.) is on track to meet 2016 World Health Organization elimination goals. De-identified data were analysed from persons who were screened for HCV antibody and/or tested for HCV RNA by two large U.S. commercial laboratories from 1/1/2014 to 12/31/2021. Validated imputation algorithms were used to identify persons who initiated treatment and who achieved virological cure based on viral load decline and continued negative HCV RNA test results. The 3-digit ZIP code was used to map treatment rates by U.S. state.
During 1/1/2014 to 12/31/2021, a total of 46,646,661 persons were tested for HCV antibody of whom 2,253,500 (4.8%) were positive. Among 3,117,372 persons tested for HCV RNA, 1,951,742 (62.6%) were viremic.
Cumulatively, a total of 672,745/1,951,742 (34.5%) viremic persons were treated; an estimated 643,043 (96%) were cured. Treatment rates increased with older age, higher fibrosis scores, HIV positivity, residing in an urban area and in the Northeast. Persons diagnosed by reflex testing had higher treatment rates.
Comparing COVID-19 pandemic (2021) to pre-pandemic (2019) periods, 24% more HCV antibody tests were performed (10,167,524 vs. 7,727,318), but fewer persons were treated (21,136 vs. 26,124, 23% decline) and cured (19,584 vs. 24,480, 25.0% decline) in 2021, respectively.
In 2021, primary care providers diagnosed and treated the greatest proportion of persons. Treatment uptake across the U.S. remains low, underscoring the need for additional measures to expand access to testing and treatment, necessary to reach the U.S. goals for HCV elimination by 2030.
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