Chronic hepatitis C in the Czech Republic: Forecasting the disease burden

Abstract

Objective: Chronic HCV infection is associated with cirrhosis of the liver, hepatocellular carcinoma (HCC), and liver transplantation. HCV disease burden and the impact of new potent direct acting antivirals (DAAs) in the Czech Republic are unknown. Methods: Using a modelling framework, HCV disease progression in the Czech Republic was predicted to 2030 under the current standard of care treatment structure. In addition, two strategies to reduce the future burden of HCV infection were modelled: an incremental increase in treatment annually and WHO targets. Results: The number of viremic infected individuals in the Czech Republic is estimated to peak in 2026 (n = 55,130) and to decline by 0.5% by 2030 (n = 54,840). The number of individuals with compensated cirrhosis (n = 1,400), decompensated cirrhosis (n = 80), HCC (n = 70), and liverrelated deaths (n = 60) is estimated to more than double by 2030. Through aggressive increases in diagnosis and treatment, HCV related mortality may decrease by 70% by 2030. Conclusions: Disease burden associated with chronic HCV infection is projected to peak in the Czech Republic in 30-40 years. Assuming that the current portion of DAAs used remains constant, a significant reduction in HCV disease burden is possible through increased diagnosis and treatment through 2030. This analysis provides evidence in order to facilitate the development of national strategies for HCV care and management in the Czech Republic.

Therapy of chronic hepatitis C in people who inject drugs: focus on adherence

“…The aim of our study was to support the evidence that the efficacy of therapy in PWID is high and that the financial resources are invested effectively. Achieving cure of people in the epidemiologically high-risk group, we decrease the risk of disease transmission [ 4 , 20 , 21 ].…”

“…The PWID group patients in our cohort were significantly younger, with a less advanced liver disease. Achieving cure of HCV infection, we can prevent progression of liver disease with future decrease of liver-related morbidity and mortality [ 4 , 29 ].…”

“…Hepatitis C virus infection (HCV) is a significant source of preventable morbidity and mortality among persons who inject drugs (PWID) [ 1 , 2 ]. In Western countries, as well as in the Czech Republic, intravenous drug use (IVDU) represents the major factor of HCV transmission, responsible for 50–80% of newly diagnosed cases [ 3 , 4 ].…”

“…The prevalence of HCV infection in the population of PWID is high in comparison with general population and increases with the amount of time of ongoing IVDU [ 5 , 6 ]. The Czech Republic is a country with low HCV prevalence (estimated prevalence in 2017: 0.5%); however, the rate of anti-HCV-positive PWID is high: 67.5% [ 4 , 7 , 8 ]. This group represents the most important epidemiologic risk of transmission of the virus in the population [ 1 ].…”

How close are we to hepatitis C virus elimination in Central Europe?

“…HCV elimination has already been achieved in all solid organ transplant recipients and in haemodialyzed patients. A national action plan of elimination of viral hepatitis C in PWID was approved by the Government Council for Drug Policy Coordination in August 2019, and guidance for prevention and control of viral hepatitis in the Czech Republic endorsed by the Ministry of Health and the Czech Society of Hepatology (written according to WHO guidelines) will be launched in March 2020 [16,17].…”