It’s well established that hepatitis C cases in the United States have been increasing because of the rise in injection drug use fueled by the opioid crisis. Less understood is the geographic distribution of hepatitis C rates, hep C risk and overdose deaths involving injection drug use.

Such data may soon come into better focus thanks to research by Eric Hall, MD, PhD, an epidemiologist and assistant professor at Portland State University’s School of Public Health. Hall received a Vu fellowship to explore these topics.

Hall’s award is one of several inaugural Vu fellowships sponsored by HepVu and AIDSVu that provide data, infographics and interactive maps for both epidemics. (Both and are produced by Emory University’s Rollins School of Public Health in partnership with pharma giant Gilead Sciences.)

The fellowships are awarded to researchers who use Vu data and work in HIV and viral hepatitis fields. In describing his project to Vu, Hall said:

In the United States, there has been an increase of hepatitis C virus [HCV] as a result of increased injection drug uses that stems from the opioid epidemic. However, our understanding of the geographic differences in HCV incidence and risk of HCV infection is limited and inconsistent. Through this fellowship, I plan to estimate the number and rate of state-level injection-involved overdose deaths as a proxy to identify areas of injecting behavior.

I am excited to have this opportunity to meet and collaborate with a wide variety of experts on the HepVu team and in the community of public health professionals that aspire to eliminate viral hepatitis.

In related HepVu news, the site recently added Q&As and graphics to its resources. One interview, “Combatting Hepatitis C Among People Who Use Drugs in Appalachia,” includes a discussion with experts following a summit on that topic. In a separate Q&A, John W. Ward, MD, updates readers on the work of the Coalition for Global Hepatitis Elimination and how the organization has grown in recent years despite the challenges posed by COVID-19.

In addition, HepVu updated its data and related infographics on Hepatitis C Treatment Restrictions. Overall, the news is good. “Hepatitis C treatment restrictions in Medicaid have become less severe over the last decade since the introduction of direct-acting antivirals,” states. “Fewer treatment restrictions allow for increased access to hepatitis C treatment for patients in Medicaid programs.”

For example, Medicaid restrictions as of January show that:

  • 34 states have eliminated or reduced fibrosis restrictions (restrictions remain in only two states: Arkansas and South Dakota)

  • 30 states have loosened sobriety restrictions (they remain in 22 states)

  • 28 states have scaled back prescriber restrictions (they remain in 15 states).

Hepatitis refers to inflammation of the liver. When untreated, it can lead to scarring of the liver (cirrhosis), liver cancer, the need for a liver transplant and death. Hepatitis can be caused by several factors, including toxins, too much alcohol, autoimmune diseases, fat in the liver, and viruses, including the three most common: hepatitis A, B and C. According to “Hepatitis C Transmission and Risk,” part of Hep’s Basics of Hepatitis, hep C is most easily spread through:

  • Sharing needles and other equipment (paraphernalia) used to inject drugs

  • Blood transfusions and organ transplants before July 1992

  • Sexual contact with someone who has hep C

  • Having a mother who had hep C when you were born.

It’s estimated that 2.4 million Americans were living with chronic hep C between 2013 and 2016 (about 1% of the adult population), according to the Centers for Disease Control and Prevention. What’s more, 14,242 people died of hepatitis C in 2019, and acute hep C cases quadrupled from 2009 to 2019.

To learn more about hepatitis where you live, check out the interactive maps on or see this one-page summary.