HCV Epidemiology

1
HCV Epidemiology
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Why Is HCV epidemiology and care so inadequate?

• Lack of support/funding
• Little funding for testing/counseling/prevention
  (federal or state)
• Nearly nonexistent funding for treatment for the
  uninsured
• HIV (access to treatment enhances testing)
• Remarkably shallow funding for HCV treatment in
  HIV/HCV coinfected
• Flat funding for 8 years makes addition of new
  services difficult
• Efficacy/burden cost benefit is hard sell to
  funders/patients
• Likely revolution in treatment efficacy 5-10
  years

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Hepatitis C Prevalence, U.S.

• Overall prevalence of anti-HCV in the U.S.
  population from NHANES (1999-2002)
• 3.8 million (1.6)1
• Correcting for patient groups not surveyed or
  under-represented in NHANES, the current estimate
  of patients with HCV viremia approaches
• 5 million (2.4)

1Armstrong et al. AASLD 2004 poster 31. 2Alter
et al. N Engl J Med. 1999341(8)556-562.
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HCV Disease Burden

• Forty to 60 of chronic liver disease in the U.S.
  is related to chronic hepatitis C infection.
• Chronic HCV is the leading cause of adult liver
  transplantation.

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HCV-Related Deaths, U.S.

• Approximately 10-12,000 people die each year of
  HCV-related liver disease.
• This number is expected to triple by 2020.
• HCV-related liver disease is the leading cause of
  death among persons with HIV disease.

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Source Centers for Disease Control Prevention
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HCV/HIV Co-Infection NationalEstimate

• HCV tests performed on stored blood samples from
  gt200 HIV patients enrolled in U.S. Adult AIDS
  Clinical Trial Group
• Results
• Overall weighted co-infection prevalence 16
• Highest risk (hemophiliac, IDUs) 73
• Lower risk (MSM, hetero, HCW) 3.5
• First attempt to estimate overall co-infection
  prevalence
• Sherman KE, et al. Clin Infect Dis. 200234
  831-7. Mar 15, 2002