Acute Hepatitis C, HCV-Related Cirrhosis on the Rise in Reproductive Age Women

Findings from a new study are shedding light on recent trends in acute hepatitis C and hepatitis C virus (HCV)-related cirrhosis among reproductive-age women, calling attention to notable increases in the global incidences of both from 1990-2019.¹

Leveraging data from the Global Burden of Disease (GBD) 2019 database, study results showed that although global age-standardized incidence rates remained stable between 1990–2019, there was a 46.45% increase in the global incidence of acute infection and a 72.74% increase in the global incidence of HCV-related cirrhosis among women of reproductive age.¹

“To our knowledge, this study is the first to assess trends of acute hepatitis C and HCV-related cirrhosis among reproductive-age women at global, regional, and national scales,” Yanzheng Zou, of the department of epidemiology at Nanjing Medical University in China, and colleagues wrote.¹ “While previous studies have explored the disease burden of hepatitis C using GBD 2019 data, our study uniquely focuses on the critical demographic of reproductive-age women.”

HCV infection in reproductive-age women poses a significant public health threat due to the potential impact on both mothers and their infants during pregnancy. Vertical transmission occurs in 5.8% of pregnancies among mothers with HCV and has been linked to worse pregnancy outcomes. Targeted prevention and treatment strategies may be necessary for reproductive-age women, but the true burden of HCV in this population is not well understood due to gaps in research.²

With this in mind, investigators sought to evaluate the geographical and temporal trends in the incidence of acute hepatitis C and HCV-related cirrhosis among reproductive-age women from 1990–2019 using data from the GBD 2019 database. Based on the World Health Organization definition, they classified women of reproductive age as those between 15-49 years of age. Data on estimates of the incidence number and rates of acute hepatitis C and HCV-related cirrhosis for this demographic was obtained from the Global Health Data Exchange.¹

Results showed a global 856,953 (95% UI, 629,470 to 1,136,117) incident cases of acute hepatitis C and 133,881 (95% UI, 91,540 to 186,809) incident cases of HCV-related cirrhosis among women of reproductive age in 2019. The age-standardized incidence rate per 100,000 population for acute hepatitis C and HCV-related cirrhosis was 43.9 (95% UI, 37.02 to 56.02) and 6.64 (95% UI, 5.10 to 9.50), respectively.¹

By sociodemographic index category, the greatest age-standardized incidence rate of acute hepatitis C among women of reproductive age was found in the low sociodemographic index region (74.32; 95% UI, 62.25 to 96.04). Investigators pointed out the highest age-standardized incidence rate of HCV-related cirrhosis was found in the high sociodemographic index region (12.13; 95% UI, 9.78 to 15.60), an area they noted the disease incidence is usually low.¹

Between 1990–2019, investigators observed a significant increase in the global incidence cases of acute infection (46.45%) and HCV-related cirrhosis (72.74%) among women of reproductive age. However, the global age-standardized incidence rate of acute hepatitis C and HCV-related cirrhosis remained stable.¹

Further analysis revealed that although the age-standardized incidence rate of acute hepatitis C among reproductive-age women remained the highest in the low sociodemographic index region from 1990–2019, it displayed a notable downward trend (average annual percent change [AAPC], –0.43; 95% CI, –0.57 to –0.29). The age-standardized incidence rate of acute infection, however, exhibited an increasing trend in the high sociodemographic index region (AAPC, 0.29; 95% CI, 0.16 to 0.42). Of note, the age-standardized incidence rate of HCV-related cirrhosis increased in the low, low-middle, and high sociodemographic index regions.¹

Investigators noted high incidence rates or increasing trends of acute infection and HCV-related cirrhosis in sub-Saharan Africa, high-income North America, Eastern Europe, and Central Asia, suggesting focused prevention and treatment efforts may be necessary in these areas.¹

However, investigators pointed out several potential limitations to these findings. These included, but were not limited to, reliance on modeling to account for absent or sparse data in certain areas, inability to assess subnational disease burden, and potential collinearity between age, period, and cohort effects impacting study results.¹

“Future studies could aim to fill the epidemiological data gaps in regions with high or rising incidence rates and assess the effectiveness of current and potential new strategies for HCV prevention and treatment,” investigators concluded.¹ “It is also crucial to investigate the socio-behavioural factors that contribute to the spread of HCV among reproductive-age women and to evaluate the impact of educational campaigns on disease awareness.”

References:

1. ^{Zou Y, Yue M, Ye X, et al. Epidemiology of acute hepatitis C and hepatitis C virus-related cirrhosis in reproductive-age women, 1990–2019: An analysis of the Global Burden of Disease study. Journal of Global Health. doi:10.7189/jogh.14.04077}
2. ^{US Centers for Disease Control and Prevention. Test for Hepatitis C During Every Pregnancy. Know More Hepatitis. May 27, 2021. Accessed May 3, 2024. https://www.cdc.gov/knowmorehepatitis/hcp/Test-For-HepC-During-Pregnancy.htm}