title: Epidemiology, disease burden, and treatment strategies of chronic hepatitis C virus infections in Saudi Arabia in the new treatment paradigm shift.
abstract: OBJECTIVE
  Around 101,000 individuals are estimated to be viremic for chronic hepatitis C virus (HCV) in the Kingdom of Saudi Arabia (KSA) in 2014; however, only about 20% have been diagnosed. We aim to assess baseline epidemiology, disease burden, and evaluate strategies to eliminate HCV in KSA.
  
  
  METHODS
  The infected population and disease progression were modeled using age- and gender-defined cohorts to track HCV incidence, prevalence, hepatic complications, and mortality. Baseline assumptions and transition probabilities were extracted from the literature. The impacts of two scenarios on HCV-related disease burden were considered through increases in treatment efficacy alone or treatment and diagnosis.
  
  
  RESULTS
  In 2030, it is estimated by the base scenario that viremic prevalence will increase to 103,000 cases, hepatocellular carcinoma (HCC) to 470, decompensated and compensated cirrhosis cases to 1,300 and 15,400, respectively, and liver-related mortality to 670 deaths. Using high efficacy treatment alone resulted in 2030 projection of 80,700 viremic cases, 350 HCC cases, 480 liver-related deaths, and 850 and 11,500 decompensated and compensated cirrhosis cases, respectively. With an aggressive treatment strategy, in 2030 there will be about 1,700 viremic cases, 1 HCC case, about 20 liver-related deaths, and 5 and 130 cases of decompensated and compensated cirrhosis, respectively. Delaying this strategy by one year would result in 360 additional deaths by 2030.
  
  
  CONCLUSIONS
  HCV in KSA remains constant, and cases of advanced liver disease and mortality continue to rise. Considered increases in treatment efficacy and number treated would have a significantly greater impact than increased treatment efficacy alone. The projected impact will facilitate disease forecasting, resource planning, and strategies for HCV management. Increased screening and diagnosis would likely be required as part of a national strategy.
authors.affiliation: Department of Hepatobiliary Sciences and Liver Transplantation, King Abdulaziz Medical City, Riyadh; King Saud bin Abdulaziz University for Health Sciences, National Guard Health Affairs, Riyadh, Kingdome of Saudi Arabia.
authors.forename: Abdulrahman A
authors.initials: AA
authors.lastname: Aljumah
authors.affiliation: Department of Liver and Small Bowel Transplantation, King Faisal Specialist Hospital and Research Center, Riyadh; Alfaisal University, Riyadh, Kingdome of Saudi Arabia.
authors.forename: Faisal
authors.initials: F
authors.lastname: Abaalkhail
authors.affiliation: Department of Medicine, King Faisal Specialist Hospital and Research Center, Riyadh; Alfaisal University, Riyadh, Kingdome of Saudi Arabia.
authors.forename: Hamad
authors.initials: H
authors.lastname: Al-Ashgar
authors.affiliation: Department of Preventive Medicine Directorate, Ministry of Health, Riyadh, Kingdome of Saudi Arabia.
authors.forename: Abdullah
authors.initials: A
authors.lastname: Assiri
authors.affiliation: Department of Medicine, Gastroenterology Unit, King Fahad Hospital, Jeddah, Kingdome of Saudi Arabia.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Babatin
authors.affiliation: Department of Medicine, King Saud University, Riyadh; Liver Disease Research Center, College of Medicine, King Saud University, Riyadh, Kingdome of Saudi Arabia.
authors.forename: Faleh
authors.initials: F
authors.lastname: Al Faleh
authors.affiliation: Department of Medicine, Gastroenterology Unit, King Fahad Hospital, Jeddah, Kingdome of Saudi Arabia.
authors.forename: Abdullah
authors.initials: A
authors.lastname: Alghamdi
authors.affiliation: Department of Preventive Medicine Directorate, Ministry of Health, Riyadh, Kingdome of Saudi Arabia.
authors.forename: Raafat
authors.initials: R
authors.lastname: Al-Hakeem
authors.affiliation: Department of Internal Medicine, Jeddah University, Jeddah, Kingdome of Saudi Arabia.
authors.forename: Almoataz
authors.initials: A
authors.lastname: Hashim
authors.affiliation: Department of Medical Specialties, Gastroenterology and Hepatology Section, King Fahad Medical City, Riyadh, Kingdome of Saudi Arabia.
authors.forename: Adel
authors.initials: A
authors.lastname: Alqutub
authors.affiliation: Center for Disease Analysis, Louisville, Colorado, USA.
authors.forename: Homie
authors.initials: H
authors.lastname: Razavi
authors.affiliation: Liver Disease Research Center, College of Medicine, King Saud University, Riyadh; Department of Medicine, Gastroenterology Division, King Abdulaziz Medical City, Jeddah, Kingdome of Saudi Arabia.
authors.forename: Faisal M
authors.initials: FM
authors.lastname: Sanai
authors.affiliation: Department of Medicine, King Saud University, Riyadh; Liver Disease Research Center, College of Medicine, King Saud University, Riyadh, Kingdome of Saudi Arabia.
authors.forename: Khalid
authors.initials: K
authors.lastname: Al-Swat
authors.affiliation: Center for Disease Analysis, Louisville, Colorado, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Schmelzer
authors.affiliation: Department of Hepatobiliary Sciences and Liver Transplantation, King Abdulaziz Medical City, Riyadh; King Saud bin Abdulaziz University for Health Sciences, National Guard Health Affairs, Riyadh, Kingdome of Saudi Arabia.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Altraif
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000188:drug therapy / Q000453:epidemiology / Q000821:virology; D018450:Disease Progression; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000453:epidemiology* / Q000473:pathology; D006801:Humans; D015994:Incidence; D008113:Liver Neoplasms / Q000188:drug therapy / Q000453:epidemiology / Q000821:virology; D015233:Models, Statistical; D015995:Prevalence; D012529:Saudi Arabia / Q000453:epidemiology; D016896:Treatment Outcome