Hepatitis C cases declined in the US. Health officials aren’t sure if it’s a blip or a trend

The number of new hepatitis C infections in the U.S. fell slightly in 2022, a surprising improvement after more than a decade of steady increases, federal health officials said Wednesday.

Experts are unsure whether the 6% drop is a statistical problem or the start of a downward trend. Seeing data from 2023 and 2024, when it becomes available, will help public health officials understand what’s going on, said Daniel Raymond, policy director at the National Viral Hepatitis Roundtable, an advocacy group.

“We’ve had 10 years of bad news… I’m cautiously encouraged,” he said. “You always want to hope that something like that is real, and a possible sign that the tide has turned.”

Infection rates were not across the board. They fell for white Americans but continued to rise in black, Latino and Native American communities, according to Dr. Neil Gupta, who oversees the Centers for Disease Control and Prevention’s division that tracks viral hepatitis.

The hepatitis C virus is spread through contact with blood from an infected person. The virus does most of its damage by infecting the liver and, if left untreated, can lead to cirrhosis or liver cancer. Infections are mainly caused by people who inject illegal drugs.

Data released by the CDC for 2022 shows 4,848 new infections, compared to the 5,023 reported the year before. The CDC estimates that approximately 67,000 new hepatitis C infections will have occurred in 2022 because many people who become infected do not realize it, meaning most new infections go undiagnosed and unreported. But that has also fallen, from an estimated 70,000 for 2021.

The new infection rate – used to better compare data from one year to the next – fell by 6%. While the decline is encouraging, Gupta says, the 2022 statistics are still twice what the nation saw in 2015.

The number of cases had been rising steadily since 2013 during the long-standing opioid epidemic due to drug users turning to heroin and fentanyl. Experts say a number of factors may have contributed to a decline in 2022, including successful prevention efforts and needle exchanges.

The North American Syringe Exchange Network maintains a folder of U.S. programs, and the number of listings has grown from about 300 to nearly 500 in recent years, says Paul LaKosky, executive director of NASEN. Many programs have also boosted testing for hepatitis C and found ways to get infected people treated, he noted.

But LaKosky and others think there may be something else going on: Drug users are switching from injecting to smoking. A recent CDC report shows that between early 2020 and the end of 2022, the percentage of overdose deaths with evidence of smoking increased by 74%, while the percentage of deaths with evidence of injection decreased by 29%.

Fewer people injecting drugs like fentanyl means fewer chances of spreading hepatitis C, experts noted.

“There’s been a huge shift in the way people are consuming their drugs. There’s been a decrease in demand for syringes. We’ve seen this nationwide,” said LaKosky, who added that drug snorting supplies are in greater demand or to smoke.

More than two million Americans have been infected with hepatitis C, some of whom have lived with infections for many years, the CDC estimates. About 12,700 Americans died from hepatitis C-related causes in 2022, the CDC said.

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