Hepatitis C

BackgroundThis global systematic review assesses the prevalence of injecting drug use (IDU) and key infectious diseases (HIV, hepatitis C virus [HCV], tuberculosis and hepatitis B virus [HBV]) among people who are incarcerated.MethodsWe conducted a systematic search of peer-reviewed (Medline, Embase, PsycINFO), internet, and grey literature databases, from January 2000 through 2nd June 2025 and engaged international experts and relevant agencies liaising with key agencies focused on incarcerated populations (WHO, UNODC, UNAIDS and EUDA). Data on study methods, size of incarcerated populations and demographic characteristics, and prevalence of IDU, HIV, HCV, HBV and tuberculosis among incarcerated populations were extracted. Meta-analyses pooled data where multiple estimates were available for a country; regional and global estimates were calculated, weighted by incarcerated population size. We present overall country, regional and global prevalence estimates for each variable examined, stratified by sex. We then estimated the ratio of IDU, HIV, HCV, HBV and tuberculosis prevalence among incarcerated populations compared to the general population.ResultsOf 75,755 screened documents, 2,968 were eligible for data extraction. There are approximately 11,322,000 people aged 15-64 years incarcerated globally with their incarceration rate being 221 per 100,000 (29 per 100,000 among females and 404 per 100,000 among males). Substantial variation in rates across countries and regions were observed with the highest regional rate being in North America. Globally, we estimate that 11·9% of people who are incarcerated have ever injected drugs (1,348,000; 95%CI 1,061,500-1,687,000), 51·4 times higher than the general population. We estimate that 3·7% (95%CI 2·5-5·4) of people who are incarcerated globally are living with HIV (25.1· times higher than the general population); 11·7% (95%CI 7·7-17·1) have current HCV infection (15·6 times higher); 4·4% (95%CI 2·4-7·7) have current HBV infection (2·2 times higher) and 2·5% (95%CI 1·5-3·8) have active tuberculosis (45·3 times higher than the general population). There is substantial variation geographically and among females and males.ConclusionThe substantial concentration of people with multiple risks and comorbidities requires improved strategies to screen, evaluate, treat and prevent these adverse consequences, which is crucial for global control efforts.FundingAustralian National Health and Medical Research Council.

BackgroundEquine hepacivirus (EqHV) is closely related to hepatitis C virus (HCV), which causes persistent infection and chronic hepatitis in people. Information on persistent EqHV infection and hepatitis is limited.ObjectivesTo report 19 cases of chronic hepatitis and persistent EqHV infection.Study designMixed retrospective and prospective case series.MethodsInclusion criteria were: (1) chronic hepatitis, defined as persistently increased serum liver biomarkers, increased serum liver biomarkers accompanied by histopathological evidence of chronicity, for example, fibrosis, or both; (2) positive serum or liver EqHV RT-qPCR; and (3) available liver histopathology. Horses were excluded if they became serum EqHV RT-qPCR undetectable, died, or were euthanised within 6 months of EqHV detection. Liver biopsies were independently reviewed.ResultsTwenty-nine horses met inclusion criteria. Ten were subsequently excluded (two cleared EqHV, 8 died within 6 months). For the remaining 19 horses, the median duration of documented hepatitis was 18.4 (range, 5.2-120) months and documented EqHV viremia was 14.8 (range, 6.9-55.6) months. Histopathological findings mirrored those seen in humans with chronic HCV including fibrosis, lymphocytic infiltrate, lymphoid aggregates, and individual hepatocyte necrosis. One horse was diagnosed with bacterial cholangiohepatitis, and the remainder had no definitive etiologic diagnosis. Bacterial infection, equine parvovirus-hepatitis infection, and equine multinodular pulmonary fibrosis were frequent comorbidities.Main limitationsA direct causal link between EqHV viremia and hepatitis cannot be made from these data.ConclusionsSome horses with persistent EqHV infection develop chronic hepatitis and liver failure, with clinical and histopathological findings resembling HCV in humans.

ImportanceExpanded screening and treatment options as part of national guidelines and statewide policy initiatives have the potential to eliminate hepatitis C virus (HCV).ObjectiveTo describe trends in HCV screening, prevalence, treatment, and costs before and after Washington State's HCV elimination initiative.Design, setting, and participantsThis case series is an observational analysis of retrospective claims data aggregated at the individual-month level. The dataset included individuals in the Washington State All Payers Claims Database between January 2017 and September 2022. Analyses were conducted from August to November 2025.ExposuresIn July 2019, as part of a directive from the governor, the Washington State Department of Health released a comprehensive HCV elimination strategy. The plan included discounted and subscription-based payment models and removal of restrictive prior authorization and specialist consultation requirements.Main outcomes and measuresInternational Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) and Current Procedural Terminology codes were used to identify HCV testing or screening, ICD-10 diagnosis codes were used for HCV infections, and the National Drug Codes were used for HCV direct-acting antiviral medications. An individual was considered to have newly diagnosed HCV at the earliest month in which they had an HCV test claim followed by 2 HCV diagnosis codes within the subsequent 12 months and no HCV diagnosis during the 6 months before the test month. Total health care costs per month were computed, excluding cost of HCV direct-acting antiviral medications. Interrupted time-series approaches computed trends over time using the second quarter (Q2) of 2019 as a reference time point.ResultsMore than 21 million unique individuals (mean [SD] age, 44 [26] years; 11 085 080 female [53%]) were included in the data extraction. The number of HCV tests per month was stable during the preinitiative and immediate postinitiative period. Beginning in 2020 Q3, screening increased significantly from the reference quarter by 10.5 additional tests per month per 1000 Washington enrollees (95% CI, 8.8 to 12.2 tests per month per 1000 enrollees; P ConclusionsIn this longitudinal case series analysis of claims data, Washington State's elimination initiative, combined with revised national screening guidelines and improved treatment options, contributed to expansion of HCV screening and changes over time in the proportion of people identified and treated for HCV, as well as decreased overall care costs.