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Global status update on the HCV prevalence and cascade of care entering 2020 - lack of progress
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Global HCV Prevalence Falls Almost 7 Million From 2015 to 2020
AASLD, The Liver Meeting, November 12-15, 2021
Mark Mascolini
Prevalence of viremic HCV infection (people with detectable HCV RNA) dropped from 63.7 million at the start of 2015 to 56.9 million at the beginning of 2020, according to an updated analysis by the Center for Disease Analysis (CDA) Foundation [1]. These researchers estimated that fewer than 25% of global viremic HCV infections have been diagnosed and fewer than 10% started treatment.
Many countries had been making progress toward HCV elimination since 2015, when global elimination targets were set, say experts from the CDA Foundation, which aims to speed elimination of HCV and HBV infection through data collection, modeling, and intervention [2]. But the COVID-19 pandemic disrupted that progress. The CDA group hopes to spur resumed work toward HCV elimination by estimating national, regional, and global progress at the start of 2020-a "reset point" before the COVID-19 pandemic flashed across the world.
Researchers collected epidemiologic data from published and unpublished sources and the Delphi process (consultation with experts [3]) "to collect, score and validate country- and territory-level input data" on HCV prevalence and care. They entered collected data into country- and territory-specific Markov models (the HCV Bright model) that used the natural history of HCV infection to estimate HCV prevalence, disease burden, and cascade of care. For countries without enough data to create a model, the researchers extrapolated from regional and global averages pertinent to each of these countries.
Viremic infections (those with active HCV RNA replication) fell by 10% from 63.7 million at the beginning of 2015 (a year after the dawn of the DAA era) to 56.9 million at the start of 2020. The researchers revised the former 2015 prevalence estimate downward because of updated estimates from Egypt, Brazil, and Nigeria, and a new estimate for the Democratic Republic of the Congo.
From 2015 through 2019, the CDA team estimated 7.5 million new chronic HCV infections, 8.8 million cured infections, and 5.5 million all-cause and liver-related deaths. Despite the overall 10% fall in HCV prevalence, in most countries prevalence rose or fell less than 10%. Prevalence remained highest in Eastern Europe and Central Asia. China, Pakistan, India, Russia, and the United States accounted for more than half of global viremic HCV infections in 2020.
From 2015 to 2020, HCV prevalence stayed at the lowest levels in Western Europe, Canada, Brazil, and much of Central and Southern Africa. Over the 5-year study period, Egypt improved its prevalence status from the highest of 5 brackets considered (above 2.8%) to the lowest bracket (below 0.61%). Among more than 10 million people who started DAAs between 2015 and 2020, more than one third lived in Egypt.
Among 18 countries with the highest HCV prevalence, Egypt improved its ranking from 5th highest in 2015 to 17th in 2020. Moving in the opposite direction, Ethiopia jumped from 17th place in 2015 to 13th in 2020, and Bangladesh climbed from 15th to 11th. China, Pakistan, India, and Russia remained stalled in 1st, 2nd, 3rd, and 4th places on the prevalence scale from 2015 to 2019. The United States shifted from 6th place in 2015 to 5th in 2019.
Across the world, more than three quarters of viremic HCV infections remained undiagnosed at the start of 2020, and more than 90% of viremic people remained untreated. In high-income countries in 2020, the CDA investigators estimated that 6 million people had viremic HCV infection, 47% of whom were currently diagnosed, and 11% of those diagnosed were treated. Estimates for 2020 viremic HCV prevalence, percentage diagnosed, and percentage of diagnosed treated were 20 million, 27%, and 3% in upper middle-income countries; 25 million, 15%, and 4% in lower middle-income countries; and 5 million, 16%, and 4% in low-income countries.
The researchers concluded that 57 million people across the world had viremic HCV infection at the start of 2020; treatment is highly concentrated in just a few countries; and "low diagnosis rates and lack of large-scale screening programs remain a barrier to elimination."
References
1. Blach S, et al. Center for Disease Analysis Foundation. Global status update on the HCV prevalence and cascade of care entering 2020. AASLD, The Liver Meeting, November 12-15, 2021. Parallel session 14: Hepatitis C Oral Session.
2. CDA Foundation. https://cdafound.org/
3. Investopedia. Delphi method. https://www.investopedia.com/terms/d/delphi-method.asp
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