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Review article: Biomedical intelligence

Vol. 145 No. 0506 (2015)

Hepatitis C: a changing epidemic

  • Gilles Wandeler
  • Jean-François Dufour
  • Philip Bruggmann
  • Andri Rauch
Cite this as:
Swiss Med Wkly. 2015;145:w14093


Approximately 3% of the world population is estimated to have a chronic hepatitis C virus (HCV) infection and 500,000 individuals die from its consequences yearly. Persons who inject drugs (PWID) bear the majority of the disease burden in high-income countries. Drug substitution programmes have helped reduce HCV transmissions among PWID. However, recent epidemics of sexually transmitted HCV infections in HIV-infected men who have sex with men demonstrated the changing nature of the HCV epidemic. HCV therapy is undergoing a revolution, as new interferon-free, oral treatments eradicate HCV infections in almost all treated patients. As a consequence, the eradication of HCV has become a matter of debate and is becoming an important future public health target. However, for this to be achieved, many challenges need to be addressed, including the poor uptake of HCV testing, the high cost of the new antiviral combinations and the high frequency of re-infections after treatment in some populations.


  1. Rakela J, Redeker AG. Chronic liver disease after acute non-A, non-B viral hepatitis. Gastroenterology. 1979;77(6):1200–2.
  2. Choo QL, Kuo G, Weiner AJ, Overby LR, Bradley DW, Houghton M. Isolation of a cDNA clone derived from a blood-borne non-A, non-B viral hepatitis genome. Science. 1989;244(4902):359–62.
  3. Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet.2012;380(9859):2095–128.
  4. Mohd Hanafiah K, Groeger J, Flaxman AD, Wiersma ST. Global epidemiology of hepatitis C virus infection: new estimates of age-specific antibody to HCV seroprevalence. Hepatology. 2013;57(4):1333–42.
  5. Ly KN, Xing J, Klevens RM, Jiles RB, Ward JW, Holmberg SD. The increasing burden of mortality from viral hepatitis in the United States between 1999 and 2007. Ann Intern Med. 2012;156(4):271–8.
  6. Grebely J, Page K, Sacks-Davis R, et al. The effects of female sex, viral genotype, and IL28B genotype on spontaneous clearance of acute hepatitis C virus infection. Hepatology. 2014;59(1):109–20.
  7. Thein HH, Yi Q, Dore GJ, Krahn MD. Estimation of stage-specific fibrosis progression rates in chronic hepatitis C virus infection: a meta-analysis and meta-regression. Hepatology. 2008;48(2):418–31.
  8. McCaughan GW, George J. Fibrosis progression in chronic hepatitis C virus infection. Gut. 2004;53(3):318–21.
  9. Patin E, Kutalik Z, Guergnon J, et al. Genome-wide association study identifies variants associated with progression of liver fibrosis from HCV infection. Gastroenterology. 2012;143(5):1244–52 e1–12.
  10. Sulkowski MS, Mehta SH, Torbenson MS, et al. Rapid fibrosis progression among HIV/hepatitis C virus-co-infected adults. AIDS. 2007;21(16):2209–16.
  11. Graham CS, Baden LR, Yu E, et al. Influence of human immunodeficiency virus infection on the course of hepatitis C virus infection: a meta-analysis. Clin Infect Dis. 2001;33(4):562–9.
  12. Merchante N, Giron-Gonzalez JA, Gonzalez-Serrano M, et al. Survival and prognostic factors of HIV-infected patients with HCV-related end-stage liver disease. AIDS. 2006;20(1):49–57.
  13. Grebely J, Prins M, Hellard M, et al. Hepatitis C virus clearance, reinfection, and persistence, with insights from studies of injecting drug users: towards a vaccine. Lancet Infect Dis. 2012;12(5):408–14.
  14. Browne R, Asboe D, Gilleece Y, et al. Increased numbers of acute hepatitis C infections in HIV positive homosexual men; is sexual transmission feeding the increase? Sex Transm Infect. 2004;80(4):326–7.
  15. Gotz HM, van Doornum G, Niesters HG, den Hollander JG, Thio HB, de Zwart O. A cluster of acute hepatitis C virus infection among men who have sex with men – results from contact tracing and public health implications. AIDS. 2005;19(9):969–74.
  16. Gambotti L, Batisse D, Colin-de-Verdiere N, et al. Acute hepatitis C infection in HIV positive men who have sex with men in Paris, France, 2001–2004. Euro surveillance: bulletin europeen sur les maladies transmissibles = European communicable disease bulletin. 2005;10(5):115–7.
  17. Danta M, Brown D, Bhagani S, et al. Recent epidemic of acute hepatitis C virus in HIV-positive men who have sex with men linked to high-risk sexual behaviours. AIDS. 2007;21(8):983–91.
  18. van de Laar TJ, van der Bij AK, Prins M, et al. Increase in HCV incidence among men who have sex with men in Amsterdam most likely caused by sexual transmission. J Infect Dis. 2007;196(2):230–8.
  19. Vogel M, Deterding K, Wiegand J, et al. Initial presentation of acute hepatitis C virus (HCV) infection among HIV-negative and HIV-positive individuals-experience from 2 large German networks on the study of acute HCV infection. Clin Infect Dis. 2009;49(2):317–9; author reply 9.
  20. Wandeler G, Gsponer T, Bregenzer A, et al. Hepatitis C Virus Infections in the Swiss HIV Cohort Study: A Rapidly Evolving Epidemic. Clin Infect Dis. 2012;55(10):1408–16.
  21. Dore GJ, Ward J, Thursz M. Hepatitis C disease burden and strategies to manage the burden (Guest Editors Mark Thursz, Gregory Dore and John Ward). J Viral Hepat. 2014;21(Suppl 1):1–4.
  22. Rauch A, Egger M, Reichen J, Furrer H. Chronic hepatitis C in HIV-infected patients: low eligibility and applicability of therapy with pegylated interferon-alpha plus ribavirin. J Acquir Immune Defic Syndr. 2005;38(2):238–40.
  23. Grint D, Peters L, Schwarze-Zander C, et al. Temporal changes and regional differences in treatment uptake of hepatitis C therapy in EuroSIDA. HIV Med. 2013;14(10):614–23.
  24. Clark PJ, Thompson AJ, Patel K, Muir AJ, Volk ML. Trends in hepatitis C treatment uptake in the United States. Hepatology. 2014 Jun 18.
  25. Pawlotsky JM. New hepatitis C therapies: the toolbox, strategies, and challenges. Gastroenterology. 2014;146(5):1176–92.
  26. Chung RT, Baumert TF. Curing chronic hepatitis C – the arc of a medical triumph. N Engl J Med. 2014;370(17):1576–8.
  27. Nelson PK, Mathers BM, Cowie B, et al. Global epidemiology of hepatitis B and hepatitis C in people who inject drugs: results of systematic reviews. Lancet. 2011;378(9791):571–83.
  28. Bruggmann P, Richard JL. Birth year distribution in reported hepatitis C cases in Switzerland. Eur J Public Health. 2014 Jul 23.
  29. Degenhardt L, Mathers B, Vickerman P, Rhodes T, Latkin C, Hickman M. Prevention of HIV infection for people who inject drugs: why individual, structural, and combination approaches are needed. Lancet. 2010;376(9737):285–301.
  30. Hagan H, Pouget ER, Des Jarlais DC. A systematic review and meta-analysis of interventions to prevent hepatitis C virus infection in people who inject drugs. J Infect Dis. 2011;204(1):74–83.
  31. Grebely J, Bruggmann P, Backmund M, Dore GJ. Moving the agenda forward: the prevention and management of hepatitis C virus infection among people who inject drugs. Clin Infect Dis. 2013;57(Suppl 2):S29–31.
  32. Iversen J, Grebely J, Topp L, Wand H, Dore G, Maher L. Uptake of hepatitis C treatment among people who inject drugs attending Needle and Syringe Programs in Australia, 1999–2011. J Viral Hepat. 2014;21(3):198–207.
  33. Bruggmann P, Litwin AH. Models of care for the management of hepatitis C virus among people who inject drugs: one size does not fit all. Clin Infect Dis. 2013;57(Suppl 2):S56–61.
  34. Tedder RS, Gilson RJ, Briggs M, et al. Hepatitis C virus: evidence for sexual transmission. BMJ. 1991;302(6788):1299–302.
  35. Buchbinder SP, Katz MH, Hessol NA, Liu J, O’Malley PM, Alter MJ. Hepatitis C virus infection in sexually active homosexual men. J Infect. 1994;29(3):263–9.
  36. Marx MA, Murugavel KG, Tarwater PM, et al. Association of hepatitis C virus infection with sexual exposure in southern India. Clin Infect Dis. 2003;37(4):514–20.
  37. Bodsworth NJ, Cunningham P, Kaldor J, Donovan B. Hepatitis C virus infection in a large cohort of homosexually active men: independent associations with HIV-1 infection and injecting drug use but not sexual behaviour. Genitourinary medicine. 1996;72(2):118–22.
  38. van der Helm JJ, Prins M, del Amo J, et al. The hepatitis C epidemic among HIV-positive MSM: incidence estimates from 1990 to 2007. AIDS. 2011;25(8):1083–91.
  39. Schmidt AJ, Rockstroh JK, Vogel M, et al. Trouble with bleeding: risk factors for acute hepatitis C among HIV-positive gay men from Germany – a case-control study. PLoS One. 2011;6(3):e17781.
  40. Vogel M, van de Laar T, Kupfer B, et al. Phylogenetic analysis of acute hepatitis C virus genotype 4 infections among human immunodeficiency virus-positive men who have sex with men in Germany. Liver Int. 2010;30(8):1169–72.
  41. van de Laar T, Pybus O, Bruisten S, et al. Evidence of a large, international network of HCV transmission in HIV-positive men who have sex with men. Gastroenterology. 2009;136(5):1609–17.
  42. Kouyos RD, Rauch A, Boni J, et al. Clustering of HCV coinfections on HIV phylogeny indicates domestic and sexual transmission of HCV. Int J Epidemiol. 2014 Jan 22.
  43. Snowden JM, Raymond HF, McFarland W. Seroadaptive behaviours among men who have sex with men in San Francisco: the situation in 2008. Sex Transm Infect. 2011;87(2):162–4.
  44. Hasse B, Ledergerber B, Hirschel B, et al. Frequency and determinants of unprotected sex among HIV-infected persons: the Swiss HIV cohort study. Clin Infect Dis. 2010;51(11):1314–22.
  45. Kouyos RD, Rauch A, Braun DL, et al. Higher Risk of Incident Hepatitis C Virus Coinfection Among Men Who Have Sex With Men, in Whom the HIV Genetic Bottleneck at Transmission Was Wide. J Infect Dis. 2014 Jun 18.
  46. Shepard CW, Finelli L, Alter MJ. Global epidemiology of hepatitis C virus infection. Lancet Infect Dis. 2005;5(9):558–67.
  47. Tohme RA, Holmberg SD. Transmission of hepatitis C virus infection through tattooing and piercing: a critical review. Clin Infect Dis. 2012;54(8):1167–78.
  48. Bruggmann P, Negro F, Bihl F, et al. The disease burden of chronic hepatitis C virus (HCV) infection in Switzerland. The International Liver Congress 2014, London, Great Britain. P1285.
  49. Frederick T, Burian P, Terrault N, et al. Factors associated with prevalent hepatitis C infection among HIV-infected women with no reported history of injection drug use: the Women’s Interagency HIV Study (WIHS). AIDS patient care and STDs. 2009;23(11):915–23.
  50. Stroffolini T, Lorenzoni U, Menniti-Ippolito F, Infantolino D, Chiaramonte M. Hepatitis C virus infection in spouses: sexual transmission or common exposure to the same risk factors? Am J Gastroenterol. 2001;96(11):3138–41.
  51. Salleras L, Bruguera M, Vidal J, et al. Importance of sexual transmission of hepatitis C virus in seropositive pregnant women: a case-control study. J Med Virol. 1997;52(2):164–7.
  52. Tohme RA, Holmberg SD. Is sexual contact a major mode of hepatitis C virus transmission? Hepatology. 2010;52(4):1497–505.
  53. Schmidt AJ, Falcato L, Zahno B, et al. Prevalence of hepatitis C in a Swiss sample of men who have sex with men: whom to screen for HCV infection? BMC Public Health. 2014;14:3.
  54. Yaphe S, Bozinoff N, Kyle R, Shivkumar S, Pai NP, Klein M. Incidence of acute hepatitis C virus infection among men who have sex with men with and without HIV infection: a systematic review. Sex Transm Infect. 2012;88(7):558–64.
  55. Thomas DL. Global control of hepatitis C: where challenge meets opportunity. Nature medicine. 2013;19(7):850–8.
  56. Grebely J, Dore GJ. Can hepatitis C virus infection be eradicated in people who inject drugs? Antiviral Res. 2014;104:62–72.
  57. Denniston MM, Klevens RM, McQuillan GM, Jiles RB. Awareness of infection, knowledge of hepatitis C, and medical follow-up among individuals testing positive for hepatitis C: National Health and Nutrition Examination Survey 2001–2008. Hepatology. 2012;55(6):1652–61.
  58. Lettmeier B, Muhlberger N, Schwarzer R, et al. Market uptake of new antiviral drugs for the treatment of hepatitis C. J Hepatol. 2008;49(4):528–36.
  59. Haubitz S SV, Ambrosioni J, Cavassini M, Stöckle M, Schmid P, Decosterd L, Metzner K, Fehr J, Rauch A Protease Inhibitors To Treat Hepatitis C in the Swiss HIV Cohort Study: High Efficacy But Low Uptake. 21st Conference on Retroviruses and Opportunistic Infections, March 3–6, 2014; abstract 658.
  60. Wandeler G RJ, Metzner KJ, Fehr J, Stöckle M, Cavassini M, Ambrosioni J, Keiser O, Furrer H, Rauch A and the Swiss HIV Cohort Study. Incident HCV Infections in the Swiss HIV Cohort Study: Natural History and Treatment Outcomes. Conference on Retroviruses and Opportunistic Infections (CROI), Boston, 3.–6. March 2014.
  61. Grady BP, Schinkel J, Thomas XV, Dalgard O. Hepatitis C virus reinfection following treatment among people who use drugs. Clin Infect Dis. 2013;57(Suppl 2):S105–10.
  62. Martin TC, Martin NK, Hickman M, et al. Hepatitis C virus reinfection incidence and treatment outcome among HIV-positive MSM. AIDS. 2013;27(16):2551–7.
  63. Lambers FA, Prins M, Thomas X, et al. Alarming incidence of hepatitis C virus re-infection after treatment of sexually acquired acute hepatitis C virus infection in HIV-infected MSM. AIDS. 2011;25(17):F21–7.
  64. Jayasekera CR, Barry M, Roberts LR, Nguyen MH. Treating hepatitis C in lower-income countries. N Engl J Med. 2014;370(20):1869–71.
  65. Ford N, Singh K, Cooke GS, et al. Expanding access to treatment for hepatitis C in resource-limited settings: lessons from HIV/AIDS. Clin Infect Dis. 2012;54(10):1465–72.
  66. Cohen MS, Chen YQ, McCauley M, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365(6):493–505.
  67. Grebely J, Matthews GV, Lloyd AR, Dore GJ. Elimination of hepatitis C virus infection among people who inject drugs through treatment as prevention: feasibility and future requirements. Clin Infect Dis. 2013;57(7):1014–20.
  68. Martin NK, Vickerman P, Grebely J, et al. Hepatitis C virus treatment for prevention among people who inject drugs: Modeling treatment scale-up in the age of direct-acting antivirals. Hepatology. 2013;58(5):1598–609.
  69. Sixty-third World Health Assembly closes after passing multiple resolutions. Available from, 2010.
  70. Danta M, Rodger AJ. Transmission of HCV in HIV-positive populations. Curr Opin HIV AIDS. 2011;6(6):451–8.

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