Prevalence of Hepatitis C Virus Infection in the United States

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Abstract
Alter et al. (Aug. 19 issue)1 present valuable data on the prevalence of hepatitis C virus (HCV) infection in the United States. However, their analyses of risk factors for HCV infection are flawed because the third National Health and Nutrition Examination Survey (NHANES III) data did not contain information necessary to control for confounding by the single most important risk factor for HCV infection — namely, injection-drug use. Their conclusions regarding the transmission of HCV by illegal drug use and sexual promiscuity should not be used to counsel patients or to set public health policy.