Abstract
Given recent profound improvements in the effectiveness of antiviral treatment for chronic Hepatitis C virus (HCV) infection, we aimed to describe the characteristics of patients referred to hepatology expert centres in France from 2000 to 2007 and from 2010 to 2014, and to identify factors associated with severe liver disease at their first visit for evaluation. We analysed data from two sources covering all of France: the former hepatitis C surveillance network, which included patients between 2000 and 2007, and the ANRS CO22 HEPATHER multi-centre cohort, which included patients between 2012 and 2014. Severe liver disease (SLD) was defined as the presence of either cirrhosis (histological, biochemical or clinical) or hepatocellular carcinoma. Multivariable Poisson regression models were used to identify the factors associated with SLD in complete-case analysis and after multiple imputation. Overall, 16,851 patients were included in the analysis and SLD was diagnosed in 11.6%. SLD at first visit was significantly associated with known risk factors (male sex, history of excessive alcohol intake, HCV genotype 3), late referral to hepatologists after diagnosis and HCV diagnosis at an older age. Providing earlier specialised care and treatment may be an important target for public health action.
Highlights
French public health policies have targeted hepatitis C virus (HCV) infection since the mid-1990s
The main objective of our study is to describe the chronic Hepatitis C virus (HCV)-infected population seeking care at the hepatology expert centres in France from 2000 to 2007 and from 2010 to 2014, and to identify the factors associated with having HCV infection-related Severe liver disease (SLD) at the time of their first evaluation there
In 18.7% of all patients, known exposure to a HCV risk factor was what led to HCV infection diagnosis and in 49.5% of cases, it came through systematic screening such as blood donor screening, pre-surgery and pretransfusion screening, prenatal testing, screening for insurance contract
Summary
French public health policies have targeted hepatitis C virus (HCV) infection since the mid-1990s. Health authorities have promoted HCV-screening among individuals at risk of infection, and have enhanced and improved access to specialised care and antiviral treatment. They have effectively reduced HCV transmission in the following contexts: blood transfusion [1], healthcare and PWID (people who inject drugs) [2]. In 2004, the prevalence of chronic HCV infection in the general population was estimated at 0.53% (95% confidence interval (CI): 0.40–0.70), corresponding to 232,196 adults (95% CI: 167,869–296,523) 18–80 years of age, nearly 43% of whom were unaware of their infection [3]. The estimated number of undiagnosed chronically HCVinfected individuals has decreased (72,102 adults in 2014) [5]
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