Comparing the public health burden of chronic hepatitis C and HIV infection in France.
OBJECTIVE
In France, the prevalence of hepatitis C virus (HCV) exceeds that of HIV, but in the absence of treatment, HIV infection progresses more rapidly than HCV. More HIV-infected patients, however, have received treatment. Using reported public health data in France and natural history models, we applied the back-calculation method to project future mortality from HCV and HIV incorporating current therapies.


METHODS
The HCV model was based on literature data for the natural history of HCV and reports of hepatocellular carcinoma mortality. The HIV model used estimates from the French Hospital Database on HIV and reported AIDS cases and deaths.


RESULTS
Peak annual mortality from HIV at 5000 occurred in 1994 and was 1000 in 1998, but HCV mortality likely increased through the 1990s and reached 3000 in 1998. Considering only HCV infections occurring until 1998 and currently available therapy, our model suggested that annual HCV-related mortality would continue to rise and would reach 4500 deaths in 2022. In contrast, AIDS-related deaths began to decrease in 1997.


CONCLUSIONS
The public health burden of HCV is likely on the rise, while the burden of HIV, given the fairly widespread use of effective medications, may be on the decline. These results may help health policymakers in planning their responses to these epidemics.
Deuffic-Burban
Sylvie
S
Unité de Recherche Epidémiologie et Sciences de l'Information INSERM U444, Faculté de Médecine Saint-Antoine, 27 rue Chaligny, 75 571 Paris Cedex 12, France. sylvie.burban@libertysurf.fr
Wong
John B
JB
Valleron
Alain-Jacques
AJ
Costagliola
Dominique
D
Delfraissy
Jean-François
JF
Poynard
Thierry
T
D000163:Acquired Immunodeficiency Syndrome / Q000401:mortality* / Q000628:therapy; D000328:Adult; D000368:Aged; D003431:Cross-Cultural Comparison; D004196:Disease Outbreaks / Q000706:statistics & numerical data; D005260:Female; D005602:France / Q000453:epidemiology; D019698:Hepatitis C, Chronic / Q000401:mortality* / Q000628:therapy; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011634:Public Health / Q000706:statistics & numerical data*