Atif Zaman, MD, MPH reviewing Goldberg D et al. Gastroenterology 2017 Jan 13.

As HCV infection decreases, obesity- and alcohol-related liver disorders account for increasing proportions of advanced liver disease.

With the advent of highly effective therapies for hepatitis C virus (HCV) infection and the ongoing obesity epidemic, the proportional burdens of HCV infection, nonalcoholic fatty liver disease (NAFLD), and alcohol-related liver disease (ALD) on liver disease and liver transplantation waiting times are expected to change.

To evaluate those changes, investigators analyzed data from a nationally representative U.S. health examination survey (data periods, 2010 and 2013–2014); a research database comprising data on commercially insured patients with cirrhosis, including decompensated disease (2006–2014); and national transplantation data (2013–2015). Results were as follows:

The prevalence of HCV infection (HCV RNA positivity) in the U.S. declined significantly from 0.64% in 2010 to 0.50% in 2013–2014.

Among patients with compensated cirrhosis, the percentages with HCV infection and ALD decreased while the prevalence of nonalcoholic steatohepatitis (NASH) increased. This pattern also was seen among patients with decompensated cirrhosis and hepatocellular carcinoma (HCC).

Among patients newly listed for transplantation for chronic liver failure, the absolute number of HCV-infected patients remained consistent from 2004 to 2014 but dropped dramatically from 2013 to 2015. Conversely, the number of these patients who had NASH or ALD continued to increase during this time period.

CITATION(S):

Goldberg D et al. Changes in the prevalence of hepatitis C virus infection, non-alcoholic steatohepatitis, and alcoholic liver disease among patients with cirrhosis or liver failure on the waitlist for liver transplantation. Gastroenterology 2017 Jan 13; [e-pub].

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