A recent CDC report states that the total number of reported acute HCV cases tripled from 2009 to 2018 and was highest among people ages 20–39. Their rates of acute infection increased about 300% during that period. Among adults ages 30 to 39, rates increased about 400%. In 2018, the largest proportion of chronic HCV cases occurred among people ages 20–39 and those ages 50–69, who had almost equal infection rates. Only about 61% of adults with HCV knew that they were infected.
These viruses can spread from person to person through shared contaminated needles, unprotected sex, and childbirth. The American Association for the Study of Liver Diseases/Infectious Diseases Society of America HCV recommends one-time, routine, opt-out HCV testing for all individuals aged 18 years and older; one-time HCV testing for all persons less than 18 years old with behaviors, exposures, or conditions or circumstances associated with an increased risk of HCV infection (e.g. injection drug use); annual HCV testing for all persons who inject drugs and for HIV-infected men who have unprotected sex with men.
Preventing HCV and HBV infection in people who have not been immunized begins with understanding how these infections occur.
The CDC recommends that individuals get tested for HCV if:
- They were born from 1945 through 1965
- Ever injected drugs, even once or a long time ago
- Required blood-clotting medicine before 1987
- Received a blood transfusion or organ transplant before July 1992
- Were on long-term hemodialysis
- Infected with HIV
- Exposed to hepatitis C in the last six months through sex or share needles during drug use
Identify Chronic Illness Earlier
A large proportion of chronically HCV-infected persons in the U.S. are now about 50 – 70 years old and have lived with HCV infection for about 25 – 45 years. The diagnosis of HCV in this group can identify those with long-duration chronic disease, who were at risk for the most advanced forms of liver disease.
For patients facing one or more chronic diseases, including HCV, nonalcoholic fatty liver disease (NAFLD)—the accumulation of excess fat in the liver of people who drink little or no alcohol—and its more severe form nonalcoholic steatohepatitis (NASH), it’s important to encourage testing and noninvasive exams to determine liver health.
Liver Disease Epidemic
Nearly one-third of Americans have asymptomatic liver disease. Approximately 85 million Americans have NAFLD, and 20% have NASH. More than one-third of HCV-infected individuals progress to advanced fibrosis and cirrhosis, and among those with cirrhosis, about 3 – 5% per year develop decompensated cirrhosis and/or hepatocellular carcinoma (HCC).
One study on how NAFLD impacts patients treated and cured for HCV found that NAFLD identified in patients prior to treatment persisted after curing their HCV infection. Among those with NAFLD before treatment, 6.25% still had significant liver scarring after their HCV infection was cured. 
Prevention and Treatment
NAFLD can be reversible if caught in the early stages. Research suggests that weight management is the best approach to controlling or reversing NAFLD. Even a loss of 3-5% can improve liver health. Also, exercise and diet therapy can reduce the fat accumulation in the liver and improve hyperlipidemia, hypertension, and insulin resistance.
Vibration-controlled transient elastography (VCTE), the most commonly used imaging-based fibrosis assessment method in the United States, is a non-invasive, painless, and quick examination. What’s more, VCTE tools are covered by Medicare, Medicaid, and many insurance plans, and can be operated by a medical assistant for immediate interpretation by a healthcare professional.
FibroScan, for example, is a medical non-imaging modality that quantifies the stiffness of liver tissue. A growing number of providers use these rapid results and test scores to gain additional information and data they can use in real-time to refer patients to a specialist or recommend changes to their overall care plans if needed.
 With Spike in Hepatitis C Virus Infections, CDC Recommends Screening for All Adults. Testimg.com [Article]
 Chung, Raymond. Contributor Baby boomers and hepatitis C: What’s the connection? Harvard Health Blog; May 1, 2019. [Article]
 Nonalcoholic fatty liver disease (NAFLD); American Liver Foundation. Online. Last accessed on November 19, 2021.
 Oliver E. The ‘epidemic of the 21st century’ — Why nonalcoholic steatohepatitis is one of the largest issues in GI today. Friday, February 7th, 2020 [Article]
 Noureddin M, Wong MM, Todo T, Lu SC, Sanyal AJ, Mena EA. Fatty liver in hepatitis C patients post-sustained virological response with direct-acting antivirals. World J Gastroenterol. 2018 Mar 21;24(11):1269-1277. doi: 10.3748/wjg.v24.i11.1269. PMID: 29568207; PMCID: PMC5859229.
Featured image: Handling histological liver tissue sample. Photo Courtesey: © 2016 – 2021 Fotolia/Adobe. Used with peermission.