Volume 138, Issue 2, Pages 513-521.e6 (February 2010) Aging of Hepatitis C Virus (HCV)-Infected Persons in the United States: A Multiple Cohort Model of HCV Prevalence and Disease Progression  Gary L. Davis, Miriam J. Alter, Hashem El–Serag, Thierry Poynard, Linda W. Jennings  Gastroenterology  Volume 138, Issue 2, Pages 513-521.e6 (February 2010) DOI: 10.1053/j.gastro.2009.09.067 Copyright © 2010 Terms and Conditions

Figure 1 Estimates by year of prevalent cases ever infected (top line), with chronic hepatitis C (open circles), and cirrhosis (solid squares). Acute infections (solid gray line) peaked between 1970 and 1990. The peak of chronic hepatitis prevalence was 2001, while the highest prevalence of cirrhosis is projected to be between 2010 and 2030, about 40 years after the peak of acute infections. Gastroenterology 2010 138, 513-521.e6DOI: (10.1053/j.gastro.2009.09.067) Copyright © 2010 Terms and Conditions

Figure 2 Distribution of histologic stages of fibrosis by year in persons with chronic hepatitis C (F0 = closed black squares, F1 = closed gray diamonds, F2 = open triangles, F3 = solid gray, and cirrhosis (including decompensated and hepatocellular carcinoma) = fine line with closed circles). Gastroenterology 2010 138, 513-521.e6DOI: (10.1053/j.gastro.2009.09.067) Copyright © 2010 Terms and Conditions

Figure 3 Stacked prevalence curves showing number of cases by year with cirrhosis according to gender and age at time of initial hepatitis C virus infection. Gastroenterology 2010 138, 513-521.e6DOI: (10.1053/j.gastro.2009.09.067) Copyright © 2010 Terms and Conditions

Figure 4 Projected number of cases by year of decompensated cirrhosis (black) and hepatocellular carcinoma (gray). The model assumes a first year mortality of 80% to 85%, so in contrast to the decompensated cirrhosis projection, the number of cases of hepatocellular carcinoma the prevalence demonstrated here closely resembles annual incidence of liver cancer. Gastroenterology 2010 138, 513-521.e6DOI: (10.1053/j.gastro.2009.09.067) Copyright © 2010 Terms and Conditions

Figure 5 Estimated reductions in cirrhosis (5A) and liver-related death (5B) by 2020 assuming incremental treatment of zero to 100 percent of infected persons and sustained viral response (SVR) rates of 40%, 60% and 80%. Gastroenterology 2010 138, 513-521.e6DOI: (10.1053/j.gastro.2009.09.067) Copyright © 2010 Terms and Conditions

Supplementary Figure 1 Bubble diagram showing the transition states incorporated into our Markov model. Subjects moved from left-to-right in 1-year cycles. Each state with the exceptions of acute infection and fulminant hepatitis could resolve to itself (no progression) for periods ranging from 1 year to indefinitely. Each state is subject to normal age- and gender-related mortality based on the age of acute infection plus the number of cycles that had occurred (accrued age). Interventions such as antiviral therapy, tumor ablation, or liver transplantation were not allowed in the model (see text). Gastroenterology 2010 138, 513-521.e6DOI: (10.1053/j.gastro.2009.09.067) Copyright © 2010 Terms and Conditions

Supplementary Figure 2 Schematic of the Markov model developed for each of 6 cohorts. Transitions states are listed in the first order branches along the left. All subjects started as acute infection. Subjects move right and downward over time. Possible transitions states for subsequent years after a particular state are listed in the branches to the right of a given state. Gastroenterology 2010 138, 513-521.e6DOI: (10.1053/j.gastro.2009.09.067) Copyright © 2010 Terms and Conditions