Hospitalizations Related to Hepatitis C Infection in Spain: Epidemiology and Comorbidities

Abstract

IntroductionHepatitis C Virus (HCV) infection is an important and increasing public health problem for most countries in the world. Total global HCV prevalence is estimated at 2.5% (177.5 million of HCV infected adults), ranging from 1.3% in Americas to 2.9% in Africa, with a global viraemic rate of 67% (118.9 million of HCV RNA positive cases), varying from 64.4% in Asia to 74.8% in Australasia [1].To the date, no national study to assess the real situation of HCV infection has been performed in Spain, although based on the limited regional studies published, the global prevalence is estimated to be around 1.5% [2,3]. HCV primary infection causes an acute hepatitis that is often clinically unnoticed and evolves in more than 80% of the cases to chronicity [4,5]. The chronic affectation of the hepatic parenchyma can develop inflammation in the liver and the development of cirrhosis after 20-30 years. Up to 5% of the patients will develop a hepatocellular carcinoma. Several clinical conditions such as immunodepression or HIV coinfection favor a faster progression to these severe outcomes of hepatic disease [6]. Chronic HCV infection is the main cause of hepatic cirrhosis in Spain and responsible of 32% of the hepatic transplants [2,3]. Liver cancer is among the leading causes of cancer deaths in many countries and most of these cases can be prevented through vaccination, antiviral treatment, safe blood transfusion and injection practices, as well as interventions to reduce excessive alcohol use [7].HCV infection can not only affect the liver, but also other organs. It is known that up to 74% of the patients will develop at least one extrahepatic complication during the disease duration, being quite often this extrahepatic symptom the first signal for the suspicion of the HCV infection [8,9]. These extrahepatic manifestations comprise a huge variety of pathologies among which mixed cryoglobulinemia, non-Hodking lymphoma, type II diabetes and several renal, dermatologic, neurologic and thyroid disorders are the most frequent [8][9][10]. All of them contribute to deteriorate the HCV patient's state and increase the need of hospitalization and medical care.The treatment of hepatitis C has quickly evolved in the last years. It started with interferon in monotherapy. More recently, HCV NS5B polymerase inhibitor sofosbuvir has shown to result in suppression of HCV replication and has emerged as an important component of currently recommended regimens. In 2014, the FDA approved an all oral regimen of simeprevir plus sofosbuvir for treatment-naive or