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. 2011 Apr;140(4):1182-1188.e1.
doi: 10.1053/j.gastro.2010.12.032. Epub 2010 Dec 22.

Increasing prevalence of HCC and cirrhosis in patients with chronic hepatitis C virus infection

Fasiha Kanwal  1 , Tuyen Hoang, Jennifer R Kramer, Steven M Asch, Matthew Bidwell Goetz, Angelique Zeringue, Peter Richardson, Hashem B El-Serag
Affiliations

Increasing prevalence of HCC and cirrhosis in patients with chronic hepatitis C virus infection

Fasiha Kanwal et al. Gastroenterology. 2011 Apr.

Abstract

Background & aims: Patients with hepatitis C virus (HCV) infection are at risk for developing costly and morbid complications, although the actual prevalence of these complications is unknown. We examined time trends in the prevalence of cirrhosis and its related complications, such as hepatic decompensation and hepatocellular carcinoma (HCC).

Methods: We calculated the annual prevalence of cirrhosis, decompensated cirrhosis, and HCC in a national sample of veterans diagnosed with HCV between 1996 and 2006. Patients with HCV who had at least one physician visit in a given calendar year were included in the analysis of prevalence for that year. We used direct standardization to adjust the prevalence of cirrhosis and related complications for increasing age of the cohort as well as sex and changes in clinical characteristics.

Results: In this cohort, the number of individuals with HCV increased from 17,261 in 1996 to 106,242 in 2006. The prevalence of cirrhosis increased from 9% in 1996 to 18.5% in 2006. The prevalence of patients with decompensated cirrhosis doubled, from 5% in 1996 to 11% in 2006, whereas the prevalence of HCC increased approximately 20-fold (0.07% in 1996 to 1.3% in 2006). After adjustment, the time trend in the prevalence of cirrhosis (and its complications) was lower than the crude trend, although it still increased significantly.

Conclusions: The prevalence of cirrhosis and HCC in HCV-infected patients has increased significantly over the past 10 years. An aging cohort of patients with HCV could partly explain our findings. Clinicians and health care systems should develop strategies to provide timely and effective care to this high-risk population of patients.

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Figures

Figure 1
Figure 1
Change in Hepatitis C (HCV) Cohort Size 1996–2006
Figure 2
Figure 2
Crude Prevalence of Cirrhosis, Decompensated Cirrhosis, and Hepatocellular Cancer---1996–2006.
Figure 3
Figure 3
Annual Mortality in Patients with Cirrhosis––1996–2006
Figure 4
Figure 4
Changes in the Demographic and Clinical Characteristics 1996–2006. We plotted the crude prevalence of demographic (such as race) and clinical (such as diabetes, HIV, alcohol use, etc.) characteristics (left vertical axis) and mean age (right vertical axis) against each year from 1996 to 2006.
Figure 5
Figure 5
Age and Gender Adjusted Prevalence of Cirrhosis and Hepatocellular Cancer. The error bars represent 95% confidence intervals. Reference population is the HCV-infected VA cohort in 1996.
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