1. Hepatitis C: Overview and Epidemiology
Heidar Sharafi, PhDc
Baqiyatallah Research Center for Gastroenterology and Liver Disease (BRCGL)

2. Hepatitis C Virus Virus Hepatitis C Family Flaviviridae Virion
60 nm spherical
Envelope
Yes
Genome
ssRNA
Genome size
9.4 kb

3. Natural History of Hepatitis C
Exposure
Acute or Early Phase
Chronic HCV 65-80%
Resolved 20-35%
Cirrhosis 5-25%
Stable 75-95%
Stable %/yr
HCC or Decompensation 1-3%/yr
Hajarizadeh et al. Nat Rev Gastroenterol Hepatol

4. Pattern of Acute HCV Infection with Progression to Chronic Infection
anti-HCV
Symptoms +/-
HCV RNA
Titer
ALT
Normal 1 2 3 4 5 6 1 2 3 4
Months
Years
Time after Exposure

5. Pattern of Acute HCV Infection with Progression to Spontaneous Clearance
anti-HCV
Symptoms +/-
HCV RNA
Titer
ALT
Normal 1 2 3 4 5 6 1 2 3 4
Months
Years
Time after Exposure

6. Mortality Rates Due to HIV, HCV, and HBV Infections in the US7 6 5 4 3 2 1
HIV
Rate per 100,000
PY*
Hepatitis C
Hepatitis B Yr
Ly KN, et al. Ann Intern Med. 2012

7. Given the high coverage of HBV vaccination in infants and implementation of HBV vaccination programs among adolescent in Iran, HCV seems to emerge as the leading cause of viral hepatitis-related advanced liver disease and death in the near future.

8. First study investigated prevalence of HCV in Iran was performed by Rezvan et al and found 0.3% of blood donors in Tehran to be positive for HCV antibody.
Rezvan et al. Vox Sang 1994

9. The Main Risk Factors of HCV in Iranian Blood Donors
No apparent risk factors could be demonstrated in 24.5% of the positive cases.
0.12% were HCV positive
Alavian et al. J Gastroenterol Hepatol. 2002

10. HCV in Drug Users Drug users with an injection history, 45% (37–54%)
Drug users without an injection history, 8% (4–13%)

11. HCV in Inherited Disorders of Hemoglobin
Its Seroepidemiology ranged from 2 to 32%. Pooled HCV infection rate was 18%
Alavian et al. Iran Red Cres Med J. 2010

12. After initiation of donors screening for HCV in 1996 and exclusion of high-risk groups from donation pool, the prevalence of HCV infection in thalassemia patients had decreased significantly in Iran.
Alavian et al. Transfusion Today. 2003

13. HCV in Inherited Bleeding Disorders
The estimate of HCV infection among patients with inherited coagulation disorders was 48.07% in Iran.

14. HCV in Hemodialysis Patients
Alavian et al. J Public Health (Oxf)

15. Prevalence of positive HCV Abs in patients on hemodialysis decreased from 14.4% in 1999 to 4.5% in 2006.

16. In a study in three prisons in three central provinces of Iran (Isfahan, Lorestan, Chaharmahal va Bakhtiari) in 2003 in male prisoners who were arrested because of their addiction
3.5% were HBs Ag positive and 35.8% were HCV antibody.
According the age, the infection with HBV and HCV were more common in younger than 30 yrs. old.
Isfahan , Lorestan and Chaharmahal va Bakhtiari: Addicted
respectively, 28.5%, 50% , 53% HCV infected
IUDs, Tattooing history, In jail more than 5 years were important
arrested
Javadi et al. Iran J Public Health. 2006

17. HCV in General Population of Iran
Merat et al. found 0.5% HCV seropositivity in a population-based study in 2006.
Mirminachi et al. estimated seroprevalence of HCV as 0.6% among Iranian general population based on a systematic review.
With 0.5% prevalence, population of 82,000,000 and 70% viremia, there will be infected cases needs treatment.
Hajarizadeh et al. estimated the total number of infected cases with viremia to be

18. Distribution of HCV Genotypes in Iran
Ghaderi-Zefrehi et al. Hepat mon

19. The projection of HCV disease burden by 2030, assuming the current diagnosis (6000) and treatment uptake (4500) and utilising interferon-based treatment
Number of individuals living with HCV infection (Shaded area represents
95% confidence interval)
Number of individuals with HCV-related
decompensated cirrhosis and hepatocellular carcinoma
Hajarizadeh et al. Hepat Mon

20. The projection of HCV disease burden by 2030, assuming the increasing diagnosis and treatment uptake and utilising interferon-free treatment
Stepwise Increase in diagnosis
6,000 ( )
12,000 ( )
24,000 ( )
Stepwise treatment increase
9,000 ( )
18,000 ( )
Hajarizadeh et al. Hepat Mon

21. The projection of HCV disease burden by 2030, assuming the increasing diagnosis and treatment uptake and utilising interferon-free treatment
Stepwise Increase in diagnosis
6,000 ( )
12,000 ( )
24,000 ( )
Stepwise treatment increase
9,000 ( )
18,000 ( )
Hajarizadeh et al. Hepat Mon

22. Special Thanks to Prof. Seyed Moayed Alavian
Dr. Mohammad Saeid Rezaee-Zavareh
Dr. Behzad Hajarizadeh