Epidemiology, disease burden, and treatment strategies of chronic hepatitis C virus infections in Saudi Arabia in the new treatment paradigm shift

Abstract

Background/Aims:Around 101,000 individuals are estimated to be viremic for chronic hepatitis C virus (HCV) in the Kingdom of Saudi Arabia (KSA) in 2014; however, only about 20% have been diagnosed. We aim to assess baseline epidemiology, disease burden, and evaluate strategies to eliminate HCV in KSA.Materials and Methods:The infected population and disease progression were modeled using age- and gender-defined cohorts to track HCV incidence, prevalence, hepatic complications, and mortality. Baseline assumptions and transition probabilities were extracted from the literature. The impacts of two scenarios on HCV-related disease burden were considered through increases in treatment efficacy alone or treatment and diagnosis.Results:In 2030, it is estimated by the base scenario that viremic prevalence will increase to 103,000 cases, hepatocellular carcinoma (HCC) to 470, decompensated and compensated cirrhosis cases to 1,300 and 15,400, respectively, and liver-related mortality to 670 deaths. Using high efficacy treatment alone resulted in 2030 projection of 80,700 viremic cases, 350 HCC cases, 480 liver-related deaths, and 850 and 11,500 decompensated and compensated cirrhosis cases, respectively. With an aggressive treatment strategy, in 2030 there will be about 1,700 viremic cases, 1 HCC case, about 20 liver-related deaths, and 5 and 130 cases of decompensated and compensated cirrhosis, respectively. Delaying this strategy by one year would result in 360 additional deaths by 2030.Conclusions:HCV in KSA remains constant, and cases of advanced liver disease and mortality continue to rise. Considered increases in treatment efficacy and number treated would have a significantly greater impact than increased treatment efficacy alone. The projected impact will facilitate disease forecasting, resource planning, and strategies for HCV management. Increased screening and diagnosis would likely be required as part of a national strategy.

Molecular characterization and epidemic history of hepatitis C virus using core sequences of isolates from Central Province, Saudi Arabia

“…The overall HCV prevalence in Saudi Arabia reflects how the disease burden is difficult to be controlled without remarkable changes in the available treatment paradigm [ 37 ]. HCV was the seventh (95% UI, Uncertainty Interval) leading cause of death worldwide in 2013, compared with tenth in 1990 as reported by WHO [ 38 ].…”

Hepatitis B and C virus prevalence in couples attending an in vitro fertilization clinic in a tertiary care hospital in Saudi Arabia: comparison with ten years earlier

“…The prevalence in Saudi blood donors was estimated to be 0.4–1.1%. 25 – 27 The premarital screening program showed an HCV prevalence of 0.33%. 6 These different seroprevalence results are due to different populations in each study.…”

“…Afterwards, HCV prevalence remained constant in Saudi Arabia. 27 Unlike HBV prevalence, which declined mainly due to the availability of HBV vaccine, implementation of HCV vaccination is under development. A national screening program, increased public awareness of HCV transmission, and a new generation drugs to treat HCV infection, may help to reduce the prevalence in future.…”

Hepatitis c eradication: It's now or never…let's get to work

“…in this issue of the Saudi Journal of Gastroenterology. [ 1 ] In fact, according to this study, if we continue the same diagnosis and treatment rates we currently have, the disease burden is likely to increase. Hence, something different must be done, and this particular paper offers some interesting and relevant insights regarding this important national health challenge.…”