Prevalence and Challenges of Liver Diseases in Patients with Chronic Hepatitis C Virus Infection

Ira M. JAcobson; Gary L. Davis; Hashem El–Serag; Francesco Negro; Christian trépo

Disclosures

Clin Gastroenterol Hepatol. 2010;8(11):924-933. 

In This Article

Abstract and Introduction

Abstract

Hepatitis C virus (HCV) infections pose a growing challenge to health care systems. Although chronic HCV infection begins as an asymptomatic condition with few short-term effects, it can progress to cirrhosis, hepatic decompensation, hepatocellular carcinoma (HCC), and death. The rate of new HCV infections is decreasing, yet the number of infected people with complications of the disease is increasing. In the United States, people born between 1945 and 1964 (baby boomers) are developing more complications of infection. Men and African Americans have a higher prevalence of HCV infection. Progression of fibrosis can be accelerated by factors such as older age, duration of HCV infection, sex, and alcohol intake. Furthermore, insulin resistance can cause hepatic steatosis and is associated with fibrosis progression and inflammation. If more effective therapies are not adopted for HCV, more than 1 million patients could develop HCV-related cirrhosis, hepatic decompensation, or HCC by 2020, which will impact the US health care system. It is important to recognize the impact of HCV on liver disease progression and apply new therapeutic strategies.

Introduction

Approximately 180 million people worldwide are infected with hepatitis C virus (HCV)[1] and are at risk of developing serious hepatic complications such as cirrhosis, hepatocellular carcinoma (HCC), or decompensation. In the United States, HCV-related end-stage liver disease is the most common indication for transplantation,[2] and HCV markers are frequently found in cases of HCC.[3,4] Although some data suggest that hepatitis C does not increase overall mortality,[5] it has been postulated that HCV infection could result in an 8- to 12-year reduction in life expectancy.[6] It is estimated that HCV caused more than 86,000 deaths in the European region in 2002.[7] The prevalence of hepatitis C–related cirrhosis and its complications is expected to continue to increase through the next decade.[8] In addition, demographic changes are expected to result in an increasing incidence of severe HCV-related liver disease as the population ages.

Less than half (42%–46%) of patients infected with HCV genotype 1,[9,10] the major genotype in the USA,[11] achieve a sustained virologic response (SVR) with currently available treatment (peginterferon/ribavirin for 48 weeks). There is also evidence to suggest that HCV infection is both underdiagnosed and undertreated.[12–14] The lack of access to effective, welltolerated therapies has serious implications for the current and future burden of HCV. A recent report commissioned by the Institute of Medicine (IOM) of the National Academies highlighted shortcomings in care for viral hepatitis, including the estimate that up to 75% of HCV-infected persons have not even been diagnosed. The report includes sweeping recommendations for prevention, identification, control, and surveillance of HCV in the general population and identifies major gaps in services for specific populations that are disproportionately affected.[15]

In light of the public health threat posed by HCV, efforts are needed to heighten awareness of its impact on patients. Numerous extrahepatic morbidities are associated with HCV infection; these and their consequences are reviewed elsewhere.[16] Here we summarize the latest evidence for the burden of chronic hepatitis C (CHC) in the United States, focusing on hepatic complications.

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