Abstract
BackgroundHepatitis C infection is a major public health concern in low- and middle-income countries where an estimated 71.1 million individuals are living with chronic infection. The World Health Organization (WHO) has recently released new guidance for hepatitis C virus (HCV) treatment programs, which include improving the access to new direct-acting antiviral agents. In Vietnam, a highly populated middle-income country, the seroprevalence of HCV infection is approximately 4% and multiple genotypes co-circulate in the general population. Here we review what is currently known regarding the epidemiology of HCV in Vietnam and outline options for reducing the significant burden of morbidity and mortality in our setting.MethodsWe performed a systematic review of the currently available literature to evaluate what has been achieved to date with efforts to control HCV infection in Vietnam.ResultsThis search retrieved few publications specific to Vietnam indicating a significant gap in baseline epidemiological and public health data. Key knowledge gaps identified included an understanding of the prevalence in specific high-risk groups, characterization of circulating HCV genotypes in the population and likely response to treatment, and the extent to which HCV treatment is available, accessed and utilized.ConclusionsWe conclude that there is an urgent need to perform up to date assessments of HCV disease burden in Vietnam, especially in high-risk groups, in whom incidence is high and cross infection with multiple genotypes is likely to be frequent. Coordinating renewed surveillance measures with forthcoming HCV treatment studies should initiate the traction required to achieve the WHO goal of eliminating HCV as a public health threat by 2030, at least in this region.
Highlights
Hepatitis C infection is a major public health concern in low- and middle-income countries where an estimated 71.1 million individuals are living with chronic infection
The data suggests while the hepatitis C virus (HCV) seroprevalence in the general population is approximately 4% (18/511; 95% CI, 2.3%–5.6%) in Hanoi and 9% (43/ 491; 95% CI, 6.4%–11.5%) in Ho Chi Minh City, which is high in comparison to America or Europe [63, 64], this is likely to be even higher in injecting drug users (IDU) (55.6%, n = 556/ 1000; 95% CI, 52.8%–58.3%), Men Who Have Sex With Men (MSM) (38.8%; n = 1558; 95% CI, 36.3%–41.2%), and hemodialysis patients (26.6%, n = 153/575; 95% CI, 22.4%–29.5%) [23, 31, 53, 57]
There are still substantial gaps in our understanding of the molecular epidemiology of HCV infection in Vietnam, the limited findings from the few studies that have been conducted suggest that multiple (≥4) HCV genotypes and subtypes are circulating in the population [25, 37]
Summary
Hepatitis C infection is a major public health concern in low- and middle-income countries where an estimated 71.1 million individuals are living with chronic infection. The prevalence of hepatitis C infection is estimated to be 1%, the highest burden (85%) of Hepatitis C virus (HCV), a single-stranded positive RNA virus, can cause individual infection with multiple subtypes, and knowledge of viral genotype is important for predicting virological and clinical treatment response. Treatment regimes containing drugs from this new class have demonstrated significantly higher rates of sustained virological response (SVR) compared to standard interferon- (IFN) and ribavirin-focused regimes [6, 7]. Additional benefits of this class include shorter treatment durations, oral administration and fewer side-effects. It has been estimated that, with unrestricted access to these costly DAA-containing regimes, more than 90% of HCV infected patients could attain SVR and achieve a definitive cure [8]
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