Prevalence and Screening of Hepatitis C in Belgium in 2015
Prevalence and Screening of Hepatitis C in Belgium in 2015
Hepatitis C is caused by the hepatitis C virus (HCV) that causes inflammation of the liver
 that can lead to diminished liver function or liver failure.

 The number of chronically infected persons worldwide is estimated to be about 170 million
 that is 2.35% of the world population. Most people infected with the hepatitis C virus have
 no symptoms of the disease until the advanced stages of liver disease have occurred, which
 may take several years. The long-term impact of HCV infection is highly variable, from
 minimal changes to extensive fibrosis and cirrhosis with or without hepatocellular carcinoma
 (HCC).

 Advanced liver disease (ALD) can lead to significant clinical and economic consequences,
 including liver transplantation. HCV can reduce life expectancy and impair quality of life.
 HCV-related complications as well as the highly debilitating effects on patients represent a
 significant item of expenditure for the National Health Service. Because of the latency of
 infection, numerous country-specific population analyses suggest that HCV will cause an
 increasing number of liver-related deaths despite the dramatic drop in incidence and
 prevalence. These deaths will be related to prevalent HCV infection especially during and
 after World War II through indiscreet and widespread treatment with intravenous injection
 using contaminated syringes, needles and remunerated blood donors. Eradicating HCV infection
 can prevent the complications of HCV-related liver and extrahepatic diseases, including liver
 necroinflammation, fibrosis, cirrhosis, HCC, and death.

 Newly discovered hepatitis C virus (HCV) therapy with direct acting antiviral agents (DAA)
 like Simeprevir, sofosbuvir open a new chapter in the treatment of chronic hepatitis C. Those
 new treatment regimens promise oral dosing, higher SVR, shorter duration of treatment and
 fewer side effects. In a near future all patients should qualify for future all-oral
 therapies.

 However recent analysis have shown that increasing efficacy of treatment alone will not be
 able to reduce the HCV disease burden. The largest reduction in HCV-related morbidity and
 mortality can be obtained when higher efficacy therapies is combined with increased diagnosis
 and treatment rate. With a treatment rate of 10% it is possible to achieve a > 90% decline in
 total infections by 2030. This would require a 3-5 fold increase in diagnosis and/or
 treatment for most countries.

 The implementation of screening criteria for hepatitis C virus (HCV) such as targeting birth
 cohorts has potential effect on reducing the progression of hepatitis C virus (HCV) to
 advanced liver disease (ALD) and could avoid unnecessary high financial costs and preserve
 quality of life.

 Robust data from public health surveillance, surveys of the general and risk populations are
 required to make decisions in allocating public health resources to diagnose, assess and
 treat HCV infection.

 In Belgium no recent prevalence studies have been conducted. The most cited anti-HCV
 prevalence is 0.87% based on a study in the Flemish population published in 1997 but
 collected in 1994. In a French Belgian population there was an overall seroprevalence of
 0.6%. However, the population under study was not representative for the whole French
 community, because the recruited subjects were significantly younger.

 A survey among cirrhotic and hepatocellular patients in the French community revealed that
 20% of cirrhosis and 47% of hepatocellular cancer were related to hepatitis C. The diagnosis
 rate of HCV in Belgium is estimated at 43%, signifying that more than 50% of HCV patients
 remains undiagnosed.

 Several studies have already mentioned that aged population especially those born after
 Second World War are carriers of hepatitis C virus infection. Early detection of HCV
 infection and treating before progress to advanced liver disease (ALD) is an excellent
 opportunity to rationalize resource allocation and to improve patients' quality of life.

 Recently birth cohort screening recommendations were developed in the United States. In
 Belgium, no formal screening strategy exists. However the Belgian association of the study of
 the liver (BASL) recommends targeted HCV screening for high-risk populations (including
 individuals with a blood transfusion or major medical event prior to 1 july 1990, intranasal
 or IDU and dialysis patients) in addition to nontargeted screening among pre-operative
 patients and pregnant women. A birth cohort analysis based on a model suggests a birth cohort
 between 1950 and 1975 in Belgium. This population should reflect 70% of the viremic
 population.

 In this study, the investigators want to estimate the prevalence of hepatitis C in Belgium in
 2014 and to confirm the proposed targeted birth cohort and other risk factors. These data
 could provide an efficient source of identifying newly diagnosed patients as part of a
 national screening strategy.
Inclusion Criteria:

 -  All patients admitted to the one day clinic for surgery and gastroenterology.

 Exclusion Criteria:

 -  none