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Chronic Hepatitis C Complications are Increasing, Especially among People Older than 60 Years

The proportion of people with chronic hepatitis C virus (HCV) infection who will develop advanced liver disease including cirrhosis, decompensation, and liver cancer is likely to increase over the next 10-20 years as people infected decades ago reach the stage of developing advanced disease; these complications are expected to be especially common among people over age 60. But more widespread treatment could significantly lower projected rates of disease progression, according to a study published in the February 2010 issue of Gastroenterology.

While hepatitis C incidence (new cases) has fallen dramatically since HCV was discovered in the late 1980s, a growing number of people who were infected decades ago are now developing advanced disease.

A typical scenario would be an individual who experimented with injection drugs a couple of times when he was in his twenties in the late 1960s. Hepatitis C is often asymptomatic at early stages and screening is not routinely done, so many people remain unaware that they are infected until years later when they develop symptoms indicating advanced liver damage.

In the present study, Gary Davis from the University of Texas Medical Branch and colleagues developed a mathematical model to project the future prevalence (total cases) of chronic hepatitis C and its complications, including cirrhosis, decompensation (characterized by symptoms such as ascites, portal hypertension, and bleeding esophageal varices), and hepatocellular carcinoma (liver cancer).

Results

• According to the model, prevalence of chronic hepatitis C peaked in 2001, at 3.6 million people.
• Fibrosis progression was inversely related to age at infection, so cirrhosis and its complications were most common after age 60 -- regardless of when infection actually occurred.
• The proportion of individuals with chronic hepatitis C who will develop cirrhosis is projected to reach 25% in 2010 and 45% in 2030.
• The total number of people with HCV-related cirrhosis is expected to peak at 1.0 million -- about 30% higher than the current level -- in 2020, and then begin to decline.
• The model suggests that rates of liver cancer and hepatic decompensation will continue to increase for another 10 to 13 years.
• However, treatment of all HCV-infected patients in 2010 -- assuming current rates of treatment response -- could dramatically reduce the risk of adverse clinical outcomes by 2020, according to the model:
• o   Cirrhosis: 16% reduction;
• o   Decompensation: 42% reduction;
• o   Liver cancer: 31% reduction;
• o   Liver-related death: 36% reduction.

Based on these findings, the researchers concluded, "Incidence of hepatitis C cirrhosis and its complications will continue to increase through the next decade and will mostly affect those older than 60 years of age."

"Current treatment patterns will have little effect on these complications," they continued, "but wider application of antiviral treatment and better responses with new agents could significantly reduce the impact of this disease in coming years."

Infectious Disease Epidemiology Program, University of Texas Medical Branch, Galveston, TX; Division of Hepatology, Baylor University Medical Center and Baylor Regional Transplant Institute, Dallas, TX; Assistance Publique Hôpitaux de Paris, Université Pierre et Marie Curie Liver Center, Paris, France;Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX.

3/30/10

Reference

GL Davis, MJ Alter, H El-Serag, and others. Aging of the Hepatitis C Virus-Infected Persons in the United States: A Multiple Cohort Model of HCV Prevalence and Disease Progression. Gastroenterology 138(2): 513-521. February 2010.