Burden & Prevalence of HCV

Decline of HIV and HCV in IDUs in Amsterdam
Anneke S. de Vos, Jannie J. van der Helm, Amy Matser, Maria Prins& Mirjam E. E. Kretzschmar; © 2013 The Authors, Addiction © 2013 Society for the Study of Addiction

In Amsterdam, HIV prevalence has nearly halved among injecting drug users (IDU) since 1990. Hepatitis C virus (HCV) prevalence also declined; HIV and HCV incidence dropped to nearly zero. We examined possible explanations for these time trends, among which the implementation of harm reduction measures aimed at reducing the risk behaviour of IDU.

Drug use health consequences 2014
UNODC 2014

Recent Statistics and Trend Analysis of the Illicit Drug Market

Estimates on HCV Disease Burden Worldwide
H. Wedemeyer,G. J. Doreand J. W. Ward; Journal of Viral Hepatitis, 2015, 22, (Suppl. S1), 1–5; doi:10.1111/jvh.12371

As resources are limited, solid data to estimate the disease burden caused by HCV are urgently needed. Epidemiology data and disease burden analyses for 16 countries are presented.

Global Regional National Incidence of Infectious Disease
The Lancet · June 2015· Doi: 10.1016/S0140-6736(15)60692-4

Up-to-date evidence about levels and trends in disease and injury incidence, prevalence, and years lived with disability (YLDs) is an essential input into global, regional, and national health policies. In the Global Burden of Disease Study 2013 (GBD 2013), we estimated these quantities for acute and chronic diseases and injuries for 188 countries between 1990 and 2013.

Global State of Harm Reduction 2014
Harm Reduction International

The Global State of Harm Reduction 2014 continues to map the response to drug-related HIV, viral hepatitis and tuberculosis. It also integrates updated information on harm reduction services into each regional chapter, including on needle and syringe programmes (NSPs) and opioid substitution therapy (OST) provision; harm reduction services in the prison setting; access to antiretroviral therapy for people who inject drugs; regional overdose responses; policy developments; civil society developments; and information relating to funding for harm reduction.

HCV Healthcare Economic Burden in UK
Bhanu Patruni, Ellen Nolte, RAND Europe 2013

Work presented in this report sought to assess the healthcare and economic burden of the hepatitis C virus (HCV) infection in the United Kingdom. It used a cohort simulation model to estimate the prevalence of HCV infection in the UK, including the number of persons who live with HCV infection at different disease stages, and the number of deaths that can be attributed to HCV infection through to 2035.

HCV in MSM London Survey
H Price, R Gilson,D Mercey,A Copas,J Parry,A Nardone,A Johnsonand G Hart; HIV Medicine (2013), 14, 578–580

This study provides the first examination of the association between HIV and HCV serostatus in a sample of MSM recruited in community settings.

HCV infection and reinfection in PWID
Evan B. Cunningham, Tanya L. Applegate, Andrew R. Lloyd, Gregory J. Dore and Jason Grebely; Nat. Rev. Gastroenterol. Hepatol. 17 March 2015; doi:10.1038/nrgastro.2015.36

This Review characterizes the epidemiology and natural history of mixed infection and reinfection among PWID, methodologies for detection, the potential implications for HCV treatment and considerations for the design of future studies.

Strategies to Manage HCV Burden
E. Gane et al. Journal of Viral Hepatitis, 2015, 22, (Suppl. S1), 46–73

Increasing levels of diagnosis and treatment, in combination with improved treatment efficacy, were critical for achieving substantial reductions in disease burden. In most countries, the annual treated population had to increase several fold to achieve the largest reductions in HCV-related morbidity and mortality. This suggests that increased capacity for screening and treatment will be critical in many countries.

Surveillance of HCV in EU 2006 2012
E. F. Duffell et al. Journal of Viral Hepatitis, 2015, 22, 590–595

Data collected from 2006 to 2012 indicate a high burden of disease with great variation in reported cases between countries. Most cases occurred among young adult males, and although injecting drug use dominated across all cases, there were increasing numbers of acute cases reported among men who have sex with men

Where Next for Hepatitis B and C Surveillance
S. Z. Wiktor, Journal of Viral Hepatitis, 2015, 22, 571–573

There is a lack of quality data on the burden of disease due to these infections. One approach to informing policy makers on trends in hepatitis B and C is through case reporting of diagnosed cases. Data on these cases can identify outbreaks of hepatitis and monitor trends in acute and chronic infection.

1 and 5 year survival estimates for people with cirrhosis of the liver in England, 1998–2009- A large population study
Sonia Rati, Kate M. Fleming, Colin J. Crooks, Guruprasad P. Aithal, Joe West: EASL Journal of Hepatology October 2013

This study aimed to report 1- and 5-year average survival rates for people with cirrhosis to be used in a clinical and in healthcare policy settings

Best Strategies for Global HCV Eradication
Liesl M. Hagan and Raymond F. Schinazi: Liver International 2013

Worldwide eradication of hepatitis C virus (HCV) is possible through a combination of prevention education, universal clinical and targeted community screening, effective linkage to care and treatment with promising new directacting antiviral drug regimens.   Increasing awareness of HCV infection through screening, improving treatment uptake and cure rates by providing linkage to care and more effective treatment, and ultimately combining education efforts with vaccination campaigns to prevent transmission and reinfection can slow and eventually stop the ‘silent epidemic’.

Burden of Hepatitis C in Europe from the Patients’ Perspective
Jeffrey Vietri, Girish Prajapati, Antoine Khoury: BMC Gastroenterology 2013

This study was conducted to assess the burden of HCV infection in terms of work productivity loss, activity impairment, health-related quality of life, healthcare resource utilization, and associated costs.

The Burden of Liver Disease in Europe: A review of available epidemiological data
Martin Blachier, Henri Leleu, Markus Peck-Radosavljevic,Dominique-Charles Valla,Françoise Roudot-Thoraval: EASL Journal of Hepatology 2013

To survey the burden of liver disease in Europe and its causes 260 epidemiological studies published in the last five years were reviewed.

Can Antiviral Therapy For Hepatitis C Reduce The Prevalence of HCV Among Injecting Drug User Populations? A Modeling Analysis of its Prevention Utility:
Natasha K. Martin, Peter Vickerman, Graham R. Foster, Sharon J. Hutchinson,David J. Goldberg, Matthew Hickman: Journal of Hepatology 2011 vol. 54 j 1137–1144

Hepatitis C virus antiviral treatment is effective for individual patients but few active injecting drug users are treated. We considered the utility of antiviral treatment for primary prevention of hepatitis C. Despite the possibility of re-infection, modest rates of hepatitis C treatment among active injecting drug users could effectively reduce transmission. Evaluating and extending strategies to treat hepatitis C among active injectors are warranted.

The Changing Epidemiology of Hepatitis C Virus Infection in Europe:
Juan I. Esteban, Silvia Sauleda, Josep Quer: Journal of Hepatology 48 (2008) 148-162

The epidemic of HCV infection in Europe is continuously evolving and epidemiological parameters (prevalence, incidence, disease transmission patterns and genotype distribution) have changed substantially during the last 15 years. Hence, prevalence data from studies conducted a decade ago may not be useful to estimate the current and future burden of HCV infection and additional epidemiological studies should be conducted, as well as new preventive strategies implemented to control the silent epidemic. This review summarizes recently published data on the epidemiology of HCV infection in Europe focusing on the factors currently shaping the epidemic.

Global Burden Of Disease Attributable To Illicit Drug Use And Dependence: Findings From The Global Burden Of Disease Study 2010:
Louisa Degenhardt, Harvey A Whiteford, Alize J Ferrari, Amanda J Baxter, Fiona J Charlson, Wayne D Hall, Greg Freedman, Roy Burstein, Nicole Johns, Rebecca E Engell, Abraham Flaxman, Christopher J L Murray, Theo Vos.

No systematic attempts have been made to estimate the global and regional prevalence of amphetamine, cannabis, cocaine, and opioid dependence, and quantify their burden. This publication aims to assess the prevalence and burden of drug dependence, as measured in years of life lived with disability (YLDs), years of life lost (YLLs), and disability adjusted life years (DALYs).

Hepatitis C Disease Burden and Strategies to Manage the Burden:
Mark Thursz, Gregory Dore and John Ward; Journal of Viral Hepatitis, 2014, 21 (Suppl. 1), 1–4

This study covers epidemiological data collection, detailed expert opinion input and country-specific mathematical modelling of the HCV epidemic and potential impact of improved HCV treatment strategies in 16 countries.

Hepatitis C Could Be Virtually Eliminated By 2030,Experts Believe:
Geoff Watts: BMJ 2014;348:g2700 doi: 10.1136/bmj.g2700 (Published 10 April 2014)

Hepatitis C may no longer be considered a serious public health concern within the next few decades if new drugs are as effective as early signs have shown and concerted action is taken to diagnose the condition in more patients so that they can be treated, experts in the field have predicted.

HCV-related Burden of Disease in Europe: a systematic assessment of incidence, prevalence, morbidity, and mortality:
Nikolai Mühlberger, Ruth Schwarzer, Beate Lettmeier, Gaby Sroczynski,Stefan Zeuzem2 and Uwe Siebert: BMC Public Health 2009

Hepatitis C virus (HCV) is a leading cause of chronic liver disease, end-stage cirrhosis, and liver cancer, but little is known about the burden of disease caused by the virus. This study summarised burden of disease data presently available for Europe, compared the data to current expert estimates, and identified areas in which better data is needed.

The Impact of Chronic Hepatitis C Virus Infection on Mortality:
Kenrad E. Nelson: The Journal of Infectious Diseases, July 2012

Lee and colleagues report the overall and cause-specific mortality among a cohort of 1095 persons with chronic hepatitis C virus (HCV) infection who were identified by community screening. The increased mortality among persons with chronic HCV infections also may be related to several underlying causes in addition to chronic liver diseases and liver cancer [12]. In countries where most HCV infections are from injection drug use, a substantial proportion (eg, from 15% to 27%) of deaths have been drug related [9]. In addition, many persons with chronic HCV acquired by injection drug use also have HIV infections, which contribute to their mortality

Impact of New Hepatitis C Treatments in Different Regions of the World:
Drs Wei Zhang & Hui-ying Rao: Gastroenterology 2014 www.gastrojournal.org, and at http:// dx.doi.org/10.1053/j.gastro.2014.03.008.

The rapid development of new antiviral drugs for HCV and the availability of interferon-free and soon ribavirin-free treatment regimens of 12 weeks duration with sustained virologic response (SVR) rates of >90% has stimulated predictions that HCV will be eradicated. This commentary discusses the impact of these new treatments in different regions of the world and the barriers to HCV eradication.

The Risk of Long-term Morbidity and Mortality in Patients With Chronic Hepatitis C Results From an Analysis of Data From a Department of Veterans Affairs Clinical Registry:
JeffreyMcCombs, PhD; Tara Matsuda, BA; Ivy Tonnu-Mihara, PharmD; Sammy Saab, MD; Patricia Hines, BA;Gilbert L’Italien, PhD; Timothy Juday, PhD; Yong Yuan, PhD: JAMA Intern Med. doi:10.1001/jamainternmed.2013.12505 Published online November 5, 2013.

The impact of viral load suppression, genotype, race, and other factors on the risk of late-stage liver-related events in patients with hepatitis C (HCV) has been assessed previously using data from small observational cohorts or clinical trials. The primary outcomes were time to death and time to a composite of liver-related clinical events. Secondary outcomes included the components of the composite clinical outcome. Outcomes were measured using a time-to-event format and were analyzed using Cox proportional hazards models.

Mortality due to Viral Hepatitis in Global Burden of Disease Study 2010: new evidence of an urgent global public health priority demanding action
Benjamin C. Cowie, Kylie S. Carville, Jennifer H. MacLachlan: Antiviral Therapy 2013

The recently published Global Burden of Disease Study 2010 contains accurate, contemporary estimates of human morbidity and mortality, with substantial changes in the patterns of illness observed over the last two decades. One of the most significant alterations to these estimates has been the recognition that viral hepatitis is a leading cause of human mortality, with an estimated 1.29 million deaths worldwide in 2010. The global community must act to address emerging health priorities identified by GBD 2010, including the need to provide treatment and care to people living with viral hepatitis, especially in resource-poor settings.

The Negative Impact Of The War On Drugs on Public Health:
The Hidden Hepatitis C Epidemic Global Commission on Drug Policy, May 2013

In 2012 the Global Commission on Drug Policy released a report that outlined how the ‘war on drugs’ is driving the HIV epidemic among people who use drugs. The present report focuses on hepatitis C as it represents another massive and deadly epidemic for this population. It provides a brief overview of the hepatitis C virus, before exploring how the ‘war on drugs’ and repressive drug policies are failing to drive transmission down.

The Present and Future Disease Burden Of Hepatitis C Infection with Today’s Treatment Paradigm:
H. Razavi, I. Waked, et al.: Journal of Viral Hepatitis, 2014, 21, (Suppl. 1), 34–59

The disease burden of HCV is expected to increase as the infected population ages. A modeling approach was used to estimate the total number of viral infections, diagnosed, treated and new infections in 2013. In addition, the model was used to estimate the change in the total number of HCV infections, the disease progression and mortality in 2013–2030. Finally, an expert panel consensus was used to capture current treatment practices in each country. Using today’s treatment paradigm, the total number of HCV infections is projected to decline or remain flat in all countries studied.

The Present and Future Disease Burden of Hepatitis C Virus (HCV) Infection with Today’s Treatment Paradigm;
H. Razavi, et al.; Journal of Viral Hepatitis, 2014, 21, (Suppl. 1), 34–59

A modeling approach was used to estimate the total number of viremic infections, diagnosed, treated and new infections in 2013. In addition, the model was used to estimate the change in the total number of HCV infections, the disease progression and mortality in 2013–2030. Finally, expert panel consensus was used to capture current treatment practices in each country. Using today’s treatment paradigm, the total number of HCV infections is projected to decline or remain flat in all countries studied. However, in the same time period, the number of individuals with late-stage liver disease is projected to increase.

Strategies To Manage Hepatitis C Virus Disease Burden:
H. Wedemeyer,A. S. Duberg, et. al.: Journal of Viral Hepatitis, 2014, 21, (Suppl. 1), 60–89

This analysis suggests that successful diagnosis and treatment of a small proportion of patients can contribute significantly to the reduction of disease burden in the countries studied. The largest reduction in HCV related morbidity and mortality occurs when increased treatment is combined with higher efficacy therapies, generally in combination with increased diagnosis. With a treatment rate of approximately 10%, this analysis suggests it is possible to achieve elimination of HCV (defined as a >90% decline in total infections by 2030). However, for most countries presented, this will require a 3–5 fold increase in diagnosis and/or treatment. Thus, building the public health and clinical provider capacity for improved diagnosis and treatment will be critical.

The Burden of Viral Hepatitis C in Europe: a propensity analysis of patient outcomes:
Marco daCosta DiBonaventuraa, Yong Yuanb, Jan-Samuel Wagnera, Gilbert J. L’Italienb,d, Benedicte Lescrauwaete ,Paul Langleyc: European Journal of Gastroenterology & Hepatology 2012, 24:869–877

The aim of the current study is to examine the burden of HCV in the European Union (EU) from a patient perspective.

Treatment as prevention and cure towards global eradication of hepatitis C virus
Liesl M. Hagan, Paul Root Wolpe, and Raymond F. Schinazi: Trends in Microbiology, December 2013, Vol. 21, #12

The availability of curative, direct-acting antiviral drugs against hepatitis C virus (HCV) sparks an ethical call for HCV eradication and provides essential tools to spearhead the effort. Challenges include increasing awareness of the chronic hepatitis C epidemic, garnering sufficient public, private, and governmental financial will to invest in the necessary resources, developing pangenotypic drug regimens for global application, and mitigating ethical concerns. To achieve these goals, stakeholders including clinicians, public health professionals, legislators, advocates, and industry can employ a variety of strategies such as increasing HCV screening, implementing treatment as prevention, and improving linkage to care, as well as developing innovative pricing and payment solutions, stimulating innovation through local drug development in high-prevalence regions, continuing vaccine development, and creating efficiencies in the marketing and distribution of educational materials and drug treatments.