title: Twin epidemics of new and prevalent hepatitis C infections in Canada: BC Hepatitis Testers Cohort.
abstract: We characterized the twin epidemics of new and prevalent hepatitis C virus (HCV) infections in British Columbia, Canada to inform prevention, care and treatment programs.
  
  
  
  The BC Hepatitis Testers Cohort (BC-HTC) includes individuals tested for HCV, HIV or reported as a case of HBV, HCV, HIV or active TB between 1990-2013 linked with data on their medical visits, hospitalizations, cancers, prescription drugs and mortality. Prevalent infection was defined as being anti-HCV positive at first test. Those with a negative test followed by a positive test were considered seroconverters or new infections.
  
  
  
  Of 1,132,855 individuals tested for HCV, 64,634 (5.8 %) were positive and an additional 3092 cases tested positive elsewhere for a total of 67,726. Of 55,781 HCV positive individuals alive at the end of 2013, 7064 were seroconverters while 48,717 had prevalent infection at diagnosis. The HCV positivity rate (11.2 %) was highest in birth cohort 1945-1964 which declined over time. New infections were more likely to be male, 15-34 years of age (born 1965-1984), HIV- or HBV-coinfected, socioeconomically disadvantaged, have problematic drug and alcohol use and a mental health illness. The profile was similar for individuals with prevalent infection, except for lower odds of HBV-coinfection, major mental health diagnoses and birth cohort >1975.
  
  
  
  The HCV positivity rate is highest in birth cohort 1945-1964 which represents most prevalent infections. New infections occur in younger birth cohorts who are commonly coinfected with HIV and/or HBV, socioeconomically marginalized, and living with mental illness and addictions.
authors.affiliation: Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, BC, Canada. naveed.janjua@bccdc.ca.|School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada. naveed.janjua@bccdc.ca.
authors.forename: Naveed Zafar
authors.initials: NZ
authors.lastname: Janjua
authors.affiliation: Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, BC, Canada.
authors.forename: Amanda
authors.initials: A
authors.lastname: Yu
authors.affiliation: Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, BC, Canada.
authors.forename: Margot
authors.initials: M
authors.lastname: Kuo
authors.affiliation: Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, BC, Canada.
authors.forename: Maria
authors.initials: M
authors.lastname: Alvarez
authors.affiliation: Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, BC, Canada.
authors.forename: Darrel
authors.initials: D
authors.lastname: Cook
authors.affiliation: Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, BC, Canada.
authors.forename: Jason
authors.initials: J
authors.lastname: Wong
authors.affiliation: Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, BC, Canada.|School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Tyndall
authors.affiliation: Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, BC, Canada.|Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Mel
authors.initials: M
authors.lastname: Krajden
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000437:Alcoholism / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D002170:Canada / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D060085:Coinfection / Q000175:diagnosis / Q000453:epidemiology; D058872:Epidemics; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology; D006509:Hepatitis B / Q000175:diagnosis / Q000453:epidemiology; D006526:Hepatitis C / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D007223:Infant; D008297:Male; D001523:Mental Disorders / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D012698:Serologic Tests; D019966:Substance-Related Disorders / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D055815:Young Adult
keywords: Cohort study; Epidemiology; HCV; HIV; Hepatitis B; Screening