Saturday, September 16, 2017

Future complications of HCV in a low-risk area - projections from the hepatitis c study in Northern Norway

BMC Infectious Diseases

Future complications of chronic hepatitis C in a low-risk area: projections from the hepatitis c study in Northern Norway
H. Kileng, L. Bernfort, T. Gutteberg, O.S. Moen, M.G. Kristiansen, E.J. Paulssen, L.K. Berg, J. Florholmen and R. Goll
Received: 6 January 2017
Accepted: 8 September 2017
Published: 16 September 2017

"Based on the registration of patients with HCV in a low risk area, we estimate a relatively slow fibrosis progression within the first 20–25 years of infection, followed by an accelerated fibrosis progression, especially in subjects with HCV genotype 3. This may have important implications in the clinical management of patients infected with genotype 3. Furthermore, we estimate a gradual increase in future complications with an estimated peak around 2040. The projected scenario implies a substantial increase in HCV-related morbidity and mortality in the coming years. An increased number of patients need to be treated to have an impact on the future burden of HCV disease."

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Hepatitis C (HCV) infection causes an asymptomatic chronic hepatitis in most affected individuals, which often remains undetected until cirrhosis and cirrhosis-related complications occur. Screening of high-risk subjects in Northern Norway has revealed a relatively low prevalence in the general population (0.24%). Despite this, late complications of HCV infection are increasing. Our object was to estimate the future prevalence and complications of chronic HCV infection in the period 2013–2050 in a low-risk area.

We have entered available data into a prognostic Markov model to project future complications to HCV infection.

The model extrapolates the prevalence in the present cohort of HCV-infected individuals, and assumes a stable low incidence in the projection period. We predict an almost three-fold increase in the incidence of cirrhosis (68 per 100,000), of decompensated cirrhosis (21 per 100,000) and of hepatocellular carcinoma (4 per 100,000) by 2050, as well as a six-fold increase in the cumulated number of deaths from HCV-related liver disease (170 per 100,000 inhabitants). All estimates are made assuming an unchanged treatment coverage of approximately 15%. The estimated numbers can be reduced by approximately 50% for cirrhosis, and by approximately one third for the other endpoints if treatment coverage is raised to 50%.

These projections from a low-prevalence area indicate a substantial rise in HCV-related morbidity and mortality in the coming years. The global HCV epidemic is of great concern and increased treatment coverage is necessary to reduce the burden of the disease.

Keywords Disease burden Fibrosis development Hepatitis C Markov modelling Natural course

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