title: Disease burden of chronic hepatitis C in Brazil.
abstract: BACKGROUND
  Hepatitis C virus infection is a major cause of cirrhosis; hepatocellular carcinoma; and liver transplantation. The aim of this study was to estimate hepatitis C virus disease progression and the burden of disease from a nationwide perspective.
  
  
  METHODS
  Using a model developed to forecast hepatitis C virus disease progression and the number of cases at each stage of liver disease; hepatitis C virus-infected population and associated disease progression in Brazil were quantified. The impact of two different strategies was compared: higher sustained virological response and treatment eligibility rates (1) or higher diagnosis and treatment rates associated with increased sustained virological response rates (2).
  
  
  RESULTS
  The number of infected individuals is estimated to decline by 35% by 2030 (1,255,000 individuals); while the number of cases of compensated (n=325,900) and decompensated (n=45,000) cirrhosis; hepatocellular carcinoma (n=19,100); and liver-related deaths (n=16,700) is supposed to peak between 2028 and 2032. In strategy 2; treated cases increased over tenfold in 2020 (118,800 treated) as compared to 2013 (11,740 treated); with sustained virological response increased to 90% and treatment eligibility to 95%. Under this strategy; the number of infected individuals decreased by 90% between 2013 and 2030. Compared to the base case; liver-related deaths decreased by 70% by 2030; while hepatitis C virus-related liver cancer and decompensated cirrhosis decreased by 75 and 80%; respectively.
  
  
  CONCLUSIONS
  While the incidence and prevalence of hepatitis C virus in Brazil are decreasing; cases of advanced liver disease continue to rise. Besides higher sustained virological response rates; new strategies focused on increasing the proportion of diagnosed patients and eligibility to treatment should be adopted in order to reduce the burden of hepatitis C virus infection in Brazil.
authors.affiliation: Division of Infectious Disease, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil. Electronic address: paulo.abrao.ferreira@gmail.com.
authors.forename: Paulo Roberto Abrão
authors.initials: PR
authors.lastname: Ferreira
authors.affiliation: Department of Gastroenterology, Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro, RJ, Brazil.
authors.forename: Carlos Eduardo
authors.initials: CE
authors.lastname: Brandão-Mello
authors.affiliation: Center for Disease Analysis (CDA), Louisville, CO, USA.
authors.forename: Chris
authors.initials: C
authors.lastname: Estes
authors.affiliation: Grupo de Estudo das Hepatites, Disciplina de Doenças Infecciosas, Departamento de Clínica Médica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (UNICAMP), São Paulo, SP, Brazil.
authors.forename: Fernando Lopes
authors.initials: FL
authors.lastname: Gonçales Júnior
authors.affiliation: Department of Clinical Medicine, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.
authors.forename: Henrique Sérgio Moraes
authors.initials: HS
authors.lastname: Coelho
authors.affiliation: Center for Disease Analysis (CDA), Louisville, CO, USA.
authors.forename: Homie
authors.initials: H
authors.lastname: Razavi
authors.affiliation: Hospital das Clínicas da Universidade Federal do Rio Grande do Sul (UFRS), Porto Alegre, RS, Brazil.
authors.forename: Hugo
authors.initials: H
authors.lastname: Cheinquer
authors.affiliation: Hospital das Clínicas da Universidade Federal do Rio Grande do Sul (UFRS), Porto Alegre, RS, Brazil.
authors.forename: Fernando Herz
authors.initials: FH
authors.lastname: Wolff
authors.affiliation: Division of Gastroenterology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
authors.forename: Maria Lúcia Gomes
authors.initials: ML
authors.lastname: Ferraz
authors.affiliation: Division of Gastroenterology and Hepatology, Escola de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil.
authors.forename: Mário Guimarães
authors.initials: MG
authors.lastname: Pessoa
authors.affiliation: Escola de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil.
authors.forename: Maria Cássia
authors.initials: MC
authors.lastname: Mendes-Correa
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000998:Antiviral Agents; D001938:Brazil / Q000453:epidemiology; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology / Q000821:virology*; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008103:Liver Cirrhosis / Q000453:epidemiology / Q000821:virology*; D008113:Liver Neoplasms / Q000453:epidemiology / Q000821:virology*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D015995:Prevalence; D012307:Risk Factors; D055815:Young Adult
chemical_list: D000998:Antiviral Agents
keywords: Brazil; Disease burden; Epidemiology; HCV; Incidence