Hepatitis C: Overview and Epidemiology Heidar Sharafi, PhDc Baqiyatallah Research Center for Gastroenterology and Liver Disease (BRCGL)

Hepatitis C Virus Virus Hepatitis C Family Flaviviridae Virion 60 nm spherical Envelope Yes Genome ssRNA Genome size 9.4 kb

Natural History of Hepatitis C Exposure Acute or Early Phase Chronic HCV 65-80% Resolved 20-35% Cirrhosis 5-25% Stable 75-95% Stable 97-99%/yr HCC or Decompensation 1-3%/yr Hajarizadeh et al. Nat Rev Gastroenterol Hepatol. 2013.

Pattern of Acute HCV Infection with Progression to Chronic Infection anti-HCV Symptoms +/- HCV RNA Titer ALT Normal 1 2 3 4 5 6 1 2 3 4 Months Years Time after Exposure

Pattern of Acute HCV Infection with Progression to Spontaneous Clearance anti-HCV Symptoms +/- HCV RNA Titer ALT Normal 1 2 3 4 5 6 1 2 3 4 Months Years Time after Exposure

Mortality Rates Due to HIV, HCV, and HBV Infections in the US 7 6 5 4 3 2 1 HIV Rate per 100,000 PY* Hepatitis C Hepatitis B Yr Ly KN, et al. Ann Intern Med. 2012

Given the high coverage of HBV vaccination in infants and implementation of HBV vaccination programs among adolescent in Iran, HCV seems to emerge as the leading cause of viral hepatitis-related advanced liver disease and death in the near future.

First study investigated prevalence of HCV in Iran was performed by Rezvan et al and found 0.3% of blood donors in Tehran to be positive for HCV antibody. Rezvan et al. Vox Sang 1994

The Main Risk Factors of HCV in Iranian Blood Donors No apparent risk factors could be demonstrated in 24.5% of the positive cases. 0.12% were HCV positive Alavian et al. J Gastroenterol Hepatol. 2002

HCV in Drug Users Drug users with an injection history, 45% (37–54%) Drug users without an injection history, 8% (4–13%)

HCV in Inherited Disorders of Hemoglobin Its Seroepidemiology ranged from 2 to 32%. Pooled HCV infection rate was 18% Alavian et al. Iran Red Cres Med J. 2010

After initiation of donors screening for HCV in 1996 and exclusion of high-risk groups from donation pool, the prevalence of HCV infection in thalassemia patients had decreased significantly in Iran. Alavian et al. Transfusion Today. 2003

HCV in Inherited Bleeding Disorders The estimate of HCV infection among patients with inherited coagulation disorders was 48.07% in Iran.

HCV in Hemodialysis Patients Alavian et al. J Public Health (Oxf). 2011.

Prevalence of positive HCV Abs in patients on hemodialysis decreased from 14.4% in 1999 to 4.5% in 2006.

In a study in three prisons in three central provinces of Iran (Isfahan, Lorestan, Chaharmahal va Bakhtiari) in 2003 in male prisoners who were arrested because of their addiction 3.5% were HBs Ag positive and 35.8% were HCV antibody. According the age, the infection with HBV and HCV were more common in younger than 30 yrs. old. Isfahan , Lorestan and Chaharmahal va Bakhtiari: Addicted respectively, 28.5%, 50% , 53% HCV infected IUDs, Tattooing history, In jail more than 5 years were important arrested Javadi et al. Iran J Public Health. 2006

HCV in General Population of Iran Merat et al. found 0.5% HCV seropositivity in a population-based study in 2006. Mirminachi et al. estimated seroprevalence of HCV as 0.6% among Iranian general population based on a systematic review. With 0.5% prevalence, population of 82,000,000 and 70% viremia, there will be 287000 infected cases needs treatment. Hajarizadeh et al. estimated the total number of infected cases with viremia to be 187000.

Distribution of HCV Genotypes in Iran Ghaderi-Zefrehi et al. Hepat mon. 2016.

The projection of HCV disease burden by 2030, assuming the current diagnosis (6000) and treatment uptake (4500) and utilising interferon-based treatment Number of individuals living with HCV infection (Shaded area represents 95% confidence interval) Number of individuals with HCV-related decompensated cirrhosis and hepatocellular carcinoma Hajarizadeh et al. Hepat Mon. 2016.

The projection of HCV disease burden by 2030, assuming the increasing diagnosis and treatment uptake and utilising interferon-free treatment Stepwise Increase in diagnosis 6,000 (2016 - 2017) 12,000 (2018 - 2019) 24,000 (2020 - 2030) Stepwise treatment increase 9,000 (2016 -2017) 18,000 (2018 - 2030) Hajarizadeh et al. Hepat Mon. 2016.

The projection of HCV disease burden by 2030, assuming the increasing diagnosis and treatment uptake and utilising interferon-free treatment Stepwise Increase in diagnosis 6,000 (2016 - 2017) 12,000 (2018 - 2019) 24,000 (2020 - 2030) Stepwise treatment increase 9,000 (2016 -2017) 18,000 (2018 - 2030) Hajarizadeh et al. Hepat Mon. 2016.

Special Thanks to Prof. Seyed Moayed Alavian Dr. Mohammad Saeid Rezaee-Zavareh Dr. Behzad Hajarizadeh