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. (Gut Liver 2020;14:207-217)

Comorbidities and Prescribed Medications in Korean Patients with Chronic Hepatitis C: A Nationwide, Population-Based Study

“…In addition, because of complexity of data, we did not compare the data in HCV patients with a non-HCV population. Nevertheless, patients' baseline characteristics in this study are very similar to that of the recent prospective multicenter cohort study in Korea, 14 supporting that this data are representative of Korean CHC patients. Indeed, this study can provide physicians with information about comorbidities and comedications that might be taken into consideration when treating CHC patients.…”

A Survey of the Knowledge of and Testing Rate for Hepatitis C in the General Population in South Korea

“…More than 90% of Korean patients with chronic HCV infection were over 40 years of age, and more than half of the patients were asymptomatic or showing alanine aminotransferase levels within normal limits at their diagnosis of chronic hepatitis C. The major HCV genotypes are 1b (48%) and 2 (46%). 17 It was reported that a one-time HCV screening and DAA treatment of the Korean population aged 40 to 65 years would be highly cost-effective and significantly reduce the HCV-related morbidity and mortality (incremental cost-effectiveness ratio of 7,435 USD compared with no screening). 18 , 19 However, the anti-HCV test is not integrated in the National Health Examination system yet, which is the most efficient way of achieving HCV screening in Korea.…”

Awareness and Access to Therapy in Hepatitis C Virus Infected Patients, Key Barriers to Eliminate the Virus?

“…In this issue, Nam et al 2 investigated the changing epidemiological and clinical characteristics of HCV infection in South Korea between 2007 and 2017. A total of 2,758 patients with HCV viremia were prospectively enrolled at seven tertiary hospitals.…”

“…4 This article also confirms that multiple factors such as tattooing, piercing, blood transfusion and needle stick injuries contribute to HCV infection in South Korea. 2 There was an epidemiological difference between males and females, showing a higher frequencies of intravenous drug use experiences, needle stick injuries and multiple sexual partners in males. Whereas such risk factors as history of transfusion, tattooing, piercing and acupuncture were more closely related to HCV infection in females, suggesting different risk factors by gender depend on the behavioral characteristics and degree of risk exposure.…”

“…In this article, the overall treatment uptake rates were 52.8% and 56.1% in pre-DAA and post-DAA period, respectively. 2 The reasons why there is not apparent increase in the treatment uptake rates in post-DAA period compared to pre-DAA period are (1) the years from 2015 to 2017 are relatively short and early period of DAA era, (2) the efficacy of DAA regimen at that period was not accepted to be perfect by physicians, thereby postponing initiation of treatment. A subsequent study with a longer post-DAA duration is necessary to address this issue.…”