Nearly 27 percent of homeless adults surveyed and tested in downtown Los Angeles’ skid row were infected with hepatitis C virus (HCV)—more than 10 times the 2 percent rate among the general U.S. population—according to a new study by University of California at Los Angeles (UCLA) researchers published in the July/August 2012 issue of Public Health Reports.

The researchers, led by Lillian Gelberg, MD, MSPH, of UCLA’s David Geffen School of Medicine, also found that of those surveyed, 46 percent were unaware they were living with hepatitis C. Roughly 4 percent of the more than 500 homeless adults tested were also found to be living with HIV.

“Their hepatitis C can result in high costs to the public and the health care system if progression of their disease is not halted through treatment,” said Gelberg in a UCLA news article, adding that less than 3 percent of those who knew they were infected with HCV had ever been treated. “The costs of their untreated hepatitis C may start escalating soon, as many are approaching 20 years of infection, which is the point at which we see escalating risk for liver cirrhosis and end-stage liver disease, requiring expensive health services utilization and liver transplantation.”
The study surveyed 534 homeless adults from 41 shelters and meal programs in the skid row area between June 2003 and February 2004. Most volunteers were male and African American. Each was tested for hepatitis B and C and for HIV.

Overall, the researchers found that HCV prevalence was significantly higher among those homeless individuals who had injected drugs; slightly more than 20 percent of the surveyed and tested volunteers had injected illicit drugs, 78 percent of whom tested positive for HCV.

Among those who had injected drugs, HCV infection was associated with older age and a prison history.

Among those who never used injection drugs, 14 percent had HCV. Infection rates were significantly higher among non-injectors if they were older, had less education, used serious non-injection drugs (excluding marijuana), had three or more tattoos, or had been in prison.

Overall, after adjusting the data for other factors, Gelberg and her colleagues failed to find an association between sexual behaviors and HCV infection.

The researchers note that their findings may not be applicable beyond the population and geographic area studied, though they also point out that their sample’s demographics were similar to those of other urban homeless populations that have been studied.

“This and previous studies demonstrate that urban homeless adults in the U.S. are at high risk for HCV infection,” the researchers concluded. “About half of those infected with HCV were unaware of their infection status. Homeless adults need interventions that include HCV education, counseling, voluntary testing and treatment services. HCV prevention and treatment programs could be modeled after relevant successful interventions developed for U.S. homeless persons with HIV/AIDS.”