Half of Medicaid beneficiaries with chronic hepatitis C (HCV) had at least one mental health disorder or substance use disorder, according to new findings presented at the annual Conference on Retroviruses and Opportunistic Infections (CROI 2025).

 

HCV is a contagious but curable disease caused by a virus that infects the liver. It can cause lifelong infection, liver fibrosis, cirrhosis, liver cancer, liver failure and death. HCV is most easily transmitted through direct blood-to-blood contact.

 

People with HIV, people who inject drugs, people with lower incomes or unstable housing and people with mental health conditions are disproportionately impacted by HCV. These populations also face increased risk for HCV-related comorbidities, meaning the presence of one or more other health conditions in addition to HCV.

 

Angela Estadt, PhD, MPH, of the Centers for Disease Control and Prevention, and colleagues defined HCV-related comorbidities as HIV, sexually transmitted infections (STIs), drug overdoses, mental health disorders and substance use disorders occurring within 12 months of an HCV diagnosis.

 

Titled “Comorbidities among Medicaid Enrollees with Chronic Hepatitis C, 2016–2020,” the study aimed to determine the prevalence of HCV-related comorbidities within one year of a Medicaid beneficiary’s HCV diagnosis.

 

Using cross-sectional data from the 2016 to 2021 U.S. Centers for Medicare & Medicaid Services Transformed Medicaid Statistical Information System, researchers assessed associations between comorbidities and age (18 to 44 years compared with 45 to 64 years).

 

Researchers found that STIs, drug overdoses and mental health disorders were common among people with chronic HCV enrolled in Medicaid and observed distinct patterns by age group.

 

Findings showed that 59% of beneficiaries with chronic HCV were ages 45 to 64. Older beneficiaries were more likely to have HIV and schizophrenia and experience alcohol-related outcomes.

 

Younger beneficiaries were less likely to have an HIV diagnosis, an alcohol use disorder or experience an alcohol overdose compared with the older group but more likely to be diagnosed with comorbidities, including chlamydia, and to have at least one drug overdose and mental health disorder.

 

“We observed distinct patterns of comorbidities among beneficiaries with chronic hepatitis C by age group, with younger beneficiaries having a higher burden of most comorbidities than older beneficiaries,” authors wrote. “Comprehensive or targeted services may help younger beneficiaries address the multiple comorbidities they may be experiencing, such as STIs, overdoses and substance use disorders and linkage to hepatitis C treatment.”

 

Unlike hepatitis A and B, there is no vaccine for HCV, so the best ways to prevent HCV infection and its complications are avoiding exposure, timely testing and prompt treatment.

 

Guidelines now recommend that all adults should be tested for HCV at least once. Women should be tested during each pregnancy, and people with ongoing risk should be tested regularly.

 

To learn more, click #Hepatitis C or read Hep’s Health Basics on Hepatitis C Prevention. It reads in part:

 

Knowing your HCV status is the first step toward treatment and a cure, which eliminates the virus so you can’t pass it on. 

 

Here are some HCV prevention tips:

 

  • Not injecting drugs would eliminate the most common route of HCV transmission. If you do inject drugs, use a new sterile syringe and other equipment every time. In addition to syringes, HCV can be transmitted via cookers, water and other injection supplies.
  • Obtain new needles and supplies from a syringe exchange or distribution program.
  • If you must share syringes, cleaning them thoroughly with bleach may reduce the risk of HCV transmission, but not as much as using new ones.
  • Do not share non-injection drug equipment, such as straws or pipes.
  • Do not share toothbrushes, razors or other personal care items that could have come in contact with blood.
  • If you are considering a tattoo or body piercing, have it done by a reputable, licensed professional who follows hygiene procedures and uses sterile equipment.
  • Condoms can reduce the risk of HCV transmission during sex, but they do not offer complete protection.
  • If you have hepatitis C, cover any cuts or wounds. Clean blood on surface with a bleach solution or other effective disinfectant.

Click here for more news from CROI 2025.