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  • Review Article
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Global epidemiology and burden of HCV infection and HCV-related disease

Nature Reviews Gastroenterology & Hepatology volume 14, pages 122–132 (2017)Cite this article

Subjects

Key Points

  • Over 184 million people worldwide have chronic HCV infection, most HCV cases remain undetected; HCV prevalence increases with increasing age until the peak prevalence at 55–64 years

  • HCV genotype 1 is the predominant type in most countries; genotype 3 is common in South Asia and genotype 4 has the highest frequency in Central Africa to the Middle East

  • The annual incidence of HCV infection has reached its peak in most countries (except Russia); however, in the USA, there has been a nationwide increase in cases of acute HCV infection

  • In patients with chronic HCV infection, progressive hepatic fibrosis leading to cirrhosis (in 15–35% after 25–30 years) is responsible for most of the HCV-related morbidity and mortality, including hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma

  • HCV infection duration, gender and ageing are major risk factors for severe fibrosis, cirrhosis and HCC; other factors include HCV genotype 3 infection, host genetic polymorphisms, hepatic steatosis, diabetes and obesity

  • Virologic cure of HCV results in reduction of hepatic and extrahepatic complications; however, residual elevated risk remains in several subgroups of cured patients

Abstract

Chronic HCV infection is a global health problem that affects >184 million people worldwide. HCV is associated with several hepatic and extrahepatic disorders, including several malignancies. The burden of HCV-related disorders is influenced by the number of new and existing cases, number of existing cases and the natural history of the infection. The natural history of HCV is affected by several demographic, virological, clinical and lifestyle factors. Major variations exist in the burden of HCV among different populations and geographical regions, as well as over time. With the advent of new and efficacious antiviral treatments, it is important to learn the determinants of HCV burden to design appropriate strategies for detection, prognostication and treatment. Furthermore, with the expected growth of patients cured of HCV, it is essential to learn about the possible change in natural history and burden of disease in these patients. In this Review, we will discuss the global epidemiology and burden of HCV and its complications, as well as the natural history and clinical course of chronic and cured HCV infection.

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Figure 1: Number of HCV-infected individuals in the countries with the highest burden of HCV infection.
Figure 2: Regional estimates of HCV seroprevalence attributable to each HCV genotype.
Figure 3: Year of peak incidence in HCV infection across sample countries.
Figure 4: The prevalence of HCC stratified by risk factors (NAFLD, alcohol abuse, HCV and HBV) over time in a US Veterans Affairs population.

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Acknowledgements

H.B.E.-S. acknowledges grant support from NIH DK58338, DK24-04-107, CA190776, P30DK56338 and CPRIT RP150587, and VA HFP90-020.

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Authors and Affiliations

  1. Department of Medicine, Section of Gastroenterology and Hepatology, Baylor College of Medicine, 7200 Cambridge Street, Suite 10C, Houston, Texas, USA

    Aaron P. Thrift, Hashem B. El-Serag & Fasiha Kanwal

  2. Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas, USA

    Aaron P. Thrift

  3. Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA

    Hashem B. El-Serag & Fasiha Kanwal

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  1. Aaron P. Thrift
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  2. Hashem B. El-Serag
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All authors contributed equally to all aspects of this manuscript.

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Correspondence to Hashem B. El-Serag.

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Thrift, A., El-Serag, H. & Kanwal, F. Global epidemiology and burden of HCV infection and HCV-related disease. Nat Rev Gastroenterol Hepatol 14, 122–132 (2017). https://doi.org/10.1038/nrgastro.2016.176

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