title: Increasing prevalence of HCC and cirrhosis in patients with chronic hepatitis C virus infection.
abstract: OBJECTIVE
  Patients with hepatitis C virus (HCV) infection are at risk for developing costly and morbid complications, although the actual prevalence of these complications is unknown. We examined time trends in the prevalence of cirrhosis and its related complications, such as hepatic decompensation and hepatocellular carcinoma (HCC).
  
  
  METHODS
  We calculated the annual prevalence of cirrhosis, decompensated cirrhosis, and HCC in a national sample of veterans diagnosed with HCV between 1996 and 2006. Patients with HCV who had at least one physician visit in a given calendar year were included in the analysis of prevalence for that year. We used direct standardization to adjust the prevalence of cirrhosis and related complications for increasing age of the cohort as well as sex and changes in clinical characteristics.
  
  
  RESULTS
  In this cohort, the number of individuals with HCV increased from 17,261 in 1996 to 106,242 in 2006. The prevalence of cirrhosis increased from 9% in 1996 to 18.5% in 2006. The prevalence of patients with decompensated cirrhosis doubled, from 5% in 1996 to 11% in 2006, whereas the prevalence of HCC increased approximately 20-fold (0.07% in 1996 to 1.3% in 2006). After adjustment, the time trend in the prevalence of cirrhosis (and its complications) was lower than the crude trend, although it still increased significantly.
  
  
  CONCLUSIONS
  The prevalence of cirrhosis and HCC in HCV-infected patients has increased significantly over the past 10 years. An aging cohort of patients with HCV could partly explain our findings. Clinicians and health care systems should develop strategies to provide timely and effective care to this high-risk population of patients.
authors.affiliation: Department of Gastroenterology and Hepatology, John Cochran VA Medical Center, Saint Louis University, St Louis, Missouri, USA. fasiha.kanwal@va.gov
authors.forename: Fasiha
authors.initials: F
authors.lastname: Kanwal
authors.forename: Tuyen
authors.initials: T
authors.lastname: Hoang
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Kramer
authors.forename: Steven M
authors.initials: SM
authors.lastname: Asch
authors.forename: Matthew Bidwell
authors.initials: MB
authors.lastname: Goetz
authors.forename: Angelique
authors.initials: A
authors.lastname: Zeringue
authors.forename: Peter
authors.initials: P
authors.lastname: Richardson
authors.forename: Hashem B
authors.initials: HB
authors.lastname: El-Serag
mesh_terms: D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology* / Q000821:virology*; D015331:Cohort Studies; D005260:Female; D019698:Hepatitis C, Chronic / Q000453:epidemiology*; D006801:Humans; D008103:Liver Cirrhosis / Q000453:epidemiology / Q000821:virology; D008113:Liver Neoplasms / Q000453:epidemiology* / Q000821:virology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012042:Registries / Q000706:statistics & numerical data; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data