Chronic hepatitis C virus (HCV) infection is common and often results in slowly progressive liver disease.
Acute hepatitis C is now uncommon, however most patients with acute infection have developed chronic hepatitis. Therefore, the pool of infected patients is large.
In this study, researchers from the United States modified a previously described natural history model for HCV infection. They used this to project the number of cases of HCV infection, cirrhosis, and liver failure over the next 40 years.
|The proportion of the HCV-infected individuals with cirrhosis will increase from 16% to 32% by 2020.|
The model estimated that the prevalence of HCV infection in the United States was 3.07 x 106 in 1993. This compared with an adjusted National Health and Nutrition Evaluation Survey (NHANES) III estimate of between 2.8 to 3.5 x 106.
The researchers predict a gradual decline in the prevalence of infection by year 2040, due to aging and natural deaths among the infected pool.
However, the proportion with cirrhosis will increase from 16% to 32% by 2020 in an untreated population, as the duration of infection increases in the surviving cohort.
In addition, the complications of cirrhosis also will increase dramatically over the next 20 years. The team predicts that hepatic decompensation will increase by 106%, hepatocellular carcinoma by 81%, and liver-related deaths by 180%.
Furthermore, although current treatment regimens eradicate HCV in over 50% of cases, many more patients would need to be treated to significantly impact disease progression.
Identification and treatment of every case of HCV infection would reduce the number of cases of decompensated cirrhosis by almost half after 20 years.
Dr Gary Davis's team concluded, "Despite the declining incidence of acute HCV infection, chronic hepatitis C is common".
"The prevalence of cirrhosis and the incidence of its complications will increase over the next 10 to 20 years."
This is, "Because the duration of infection increases among those with chronic hepatitis C."
"These data emphasize the need for greater access to transplantation by expansion of the donor pool, increasing use of split livers and living donors, and novel options such as xenotransplantation".