While the worldwide number of hepatitis C virus (HCV) infections has declined between 2015 and 2020, many countries are still far from achieving HCV global elimination goals, according to study data on the global trends in the spread and treatment of HCV published in the Lancet Gastroenterology & Hepatology.
The study integrated a literature review, Delphi process, and mathematical modeling to estimate the prevalence of HCV for the years 2015 through 2030. Epidemiological data were collected from published studies and grey literature and were sent to country and territory experts for validation. A Markov model was used to forecast HCV disease burden and care cascade from 1950 to 2050 for countries and territories with available data. These estimates were then leveraged to calculate population-weighted regional averages, which were applied to countries without their own HCV data.
Models were built for 110 countries and territories; 83 were approved by local experts and 27 used data published in the literature. Per these models, the global prevalence of HCV was estimated at 0.7% (95% uncertainty interval [UI], 0.7-0.9%), or 56.8 (95% UI, 55.2-67.8) million infections on January 1, 2020. The January 2015 prevalence ratio was significantly higher, at 0.9% (95% UI, 0.8-1.0%), corresponding to 63.6 million (95% UI, 61.8-75.8) estimated infections. Regional prevalence rates were greatest in eastern Europe (2.9%; 95% UI, 2.3-3.2%) and central Asia (2.6%; 95% UI, 2.4-2.8), while the greatest numbers of absolute infections were in south Asia (14.5 million; 95% UI, 13.2-24.2) and east Asia (10.0 million; 95% UI, 8.6-11.9).
Per care cascade analyses, an estimated 9.5 (95% UI, 9.2-11.3) million patients initiated HCV treatment between 2015 and 2019, among whom 3.5 million (36%) were in Egypt. Of the 56.8 million global cases in 2020, just 12.9 million (23%) were estimated to have received a diagnosis of HCV, and only 641,000 were predicted to have begun treatment. If the annual number of patients receiving treatment remains below 1 million, the proportion of liver-related deaths and end-stage outcomes is expected to increase 14-17% by 2030.
Per these data, the global prevalence of HCV has declined since 2015, though the number of patients entering the care cascade remains suboptimal.
Study limitations included the varying availability and quality of HCV data from each country.
“With less than 10 years remaining to meet the World Health Assembly’s target of eliminating viral hepatitis as a public health threat by 2030, substantial effort is needed to eliminate HCV,” the investigators wrote. “As decision makers evaluate their HCV elimination efforts and progress following the COVID-19 pandemic, this study provides an updated baseline for future activities.”
Disclosure: This research was supported by Gilead Sciences and AbbVie. Please see the original reference for a full list of disclosures.
Polaris Observatory HCV Collaborators. Global change in hepatitis C virus prevalence and cascade of care between 2015 and 2020: a modelling study. Lancet Gastroenterol Hepatol. Published online February 15, 2022. doi:10.1016/S2468-1253(21)00472-6