The impact of the prevention programme of hepatitis C over more than a decade: the French experience

• Published in: Journal of viral hepatitis 2010-06, Vol.17 (6), p.435-443
• Main Authors: Delarocque-Astagneau, E., Meffre, C., Dubois, F., Pioche, C., Le Strat, Y., Roudot-Thoraval, F., Hillon, P., Silvain, C., Dhumeaux, D., Desenclos, J. -C.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Alcoholism; Alcoholism - epidemiology; anti-HCV antibodies; Cirrhosis; Communicable Disease Control; Communicable Disease Control - methods; Comorbidity; Data processing; epidemiology; Ethanol; Female; France; France - epidemiology; HCV RNA; Hepatitis C; Hepatitis C - complications; Hepatitis C - epidemiology; Hepatitis C - prevention & control; Hepatitis C Antibodies; Hepatitis C Antibodies - blood; Hepatitis C virus; HIV Infections; HIV Infections - epidemiology; Human health and pathology; Human immunodeficiency virus; Humans; Hépatology and Gastroenterology; Life Sciences; Liver Cirrhosis; Liver Cirrhosis - epidemiology; Liver Cirrhosis - virology; Male; Middle Aged; Population levels; prevalence; RNA; RNA, Viral; RNA, Viral - blood; screening; Seroepidemiologic Studies; surveillance; treatment; Young Adult
• ISSN: 1352-0504; 1365-2893
• DOI: 10.1111/j.1365-2893.2009.01196.x

To assess the impact of the French national hepatitis C prevention programme initiated in 1999, we analysed trends in hepatitis C virus (HCV) prevalence, testing and characteristics of HCV‐infected patient at first referral from 1994 to 2006. We used four data sources: Two national population‐based sero‐prevalence surveys carried out in 1994 and 2004; two surveillance networks, one based on public and private laboratories throughout France and the other on hepatology reference centres, which aim to monitor, respectively, trends of anti‐HCV screening and of epidemiological–clinical characteristics of HCV patients at first referral.Between 1994 and 2004, the anti‐HCV prevalence for adults aged 20–59 years decreased from 1.05 (95% confidence interval 0.75–1.34) to 0.71 (0.52–0.97). During the same period, those anti‐HCV positive with detectable HCV RNA decreased from 81 to 57%, whereas, the proportion of anti‐HCV positive persons aware of their status evolved from 24 to 56%. Anti‐HCV screening activity increased by 45% from 2000 to 2005, but decreased in 2006 (−10%), while HCV positivity among those tested decreased from 4.3 to 2.9%. The proportion of cirrhosis at first referral remains around 10% between 2001 and 2006, with many patients with excessive alcohol consumption (34.7% among males) or viral co‐infections (HIV seropositivity for 5.2% patients). Our analysis indicates that the national programme had a positive impact at the population level through improved prevention, screening and management. There is still a need to identify timely those at risk for earlier interventions, to assess co‐morbidities better and for a multidisciplinary approach to HCV management.