Epidemiological and Clinical Characteristics of Hepatitis C Virus Infection in South Korea from 2007 to 2017: A Prospective Multicenter Cohort Study

Abstract

Background/aims: This study aimed to elucidate the epidemiological and clinical characteristics of chronic hepatitis C (CHC) patients in South Korea from 2007 to 2017 and to compare the treatment patterns between two periods before and after the first approval of direct-acting antivirals (DAA) in South Korea in 2015.

Methods: This prospective, multicenter cohort enrolled 2,758 patients with hepatitis C virus (HCV) viremia at seven tertiary centers, and clinical data were prospectively collected with questionnaire surveys focused on lifetime risk factors related to HCV infection.

Results: The HCV patients had a mean age of 57.3 years (50.8% male). Among them, 14.3% showed a positive history of transfusion before HCV screening and 5.6% reported intravenous drug use (IVDU), with significant differences in these risk factors between men and women. The proportions of patients with chronic hepatitis, liver cirrhosis and hepatocellular carcinoma (HCC) were 69.5%, 18.9%, and 11.5%, respectively. The mean alanine aminotransaminase level was within the upper normal limit at 49.9%, and the major genotypes were 1b (48.2%) and 2 (46.4%). The overall treatment rate was 53.8%, showing a rapid transition from interferon-based therapy to DAA therapy. In the post-DAA-approval era, the untreated group was older, had a higher prevalence of HCC, and had less education than the treated group.

Conclusions: More than 90% of CHC patients were over 40 years old, the major genotypes were 1b and 2, and IVDU was observed in less than 6% of CHC patients. Approximately half of the patients underwent antiviral therapy even in the DAA era, showing an unmet need with regard to HCV elimination.

Keywords: Carcinoma, hepatocellular; Cohort study; Epidemiology; Hepatitis C virus; Therapeutics.

Fig. 1

Inclusion and exclusion criteria for the subjects. In total, 2,910 hepatitis C virus (HCV) cohort patients were identified, of whom 152 did not meet the inclusion criteria. Ultimately, 2,758 patients were analyzed in this study.

Fig. 2

Distribution of the stages of fibrosis according to liver biopsy stratified by the age group of hepatitis C virus patients. The proportion of those with advanced fibrosis (stages 3 and 4) increased significantly as age increased: 12% at age ≤40 years, 27% at age 41–60 years, and 44% at age ≥61 years (all p<0.05, comparison of the advanced fibrosis proportion F3 and F4).

Fig. 3

Treatment patterns in the Korean hepatitis C virus cohort from 2007 to 2017. The antiviral regimen was based on interferon (IFN) for 25.5% and was based on direct-acting antivirals (DAA) for 28.3%, of whom 23.4% were IFN-naïve patients, and 4.9% had experience with IFN.

Fig. 4

Comparison of treatment patterns in the pre- and post-DAA approval periods in the Korean hepatitis C virus cohort. In the pre-DAA approval period, 34.8% received interferon (IFN)-based therapy. In the post-DAA approval period, only 3.1% of the patients underwent IFN-based therapy, while 44.9% received DAA therapy. DAA, direct-acting antivirals.