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DALLAS -- Using a sophisticated disease prediction model, Gary L. Davis, MD, director of the division of hepatology, and colleagues on the medical staff at Baylor University Medical Center at Dallas, estimated that 387,395 Texans are infected with the hepatitis C virus (Baylor University Medical Center Proceedings, January 2005 issue, paper can be found at http://www.BaylorHealth.com). The incidence ranges from 1.25 percent to 2.63 percent in Texas counties. While incidence is highest in counties along the United States and Mexico border, the actual number of cases is highest near major metropolitan areas.
Hepatitis C (HCV), a liver disease caused by the HCV found in the blood, is an important public health issue. Most infected persons do not realize they have the virus because they do not feel ill until late in the course of the disease.
While new cases of infection will decline in the future, Davis and colleagues predict that more people who already have HCV infection will experience progression of liver disease -- to cirrhosis and hepatocellular carcinoma, for example. Chronic HCV is the most common indication for liver transplantation in the United States, affecting 50 percent of all patients receiving liver transplants. And, the disease frequently recurs following liver transplantation, sometimes leading to cirrhosis and liver failure a second time.
Hepatitis C is common in Texas and will result in an increase in complications of cirrhosis in coming years. The disease will tax health care facilities and transplant units throughout the state, said Dr. Davis. To meet this challenge we need to see urgency in identifying HCV-infected patients, continue to research and develop more effective therapies, and increase long-term, recurrence-free post-transplantation survival.
On a national level, the estimated prevalence of HCV is as high as 1.8 percent or approximately 4 million people. Davis predicts that in the next two to three decades, the need for liver transplantation will continue to far exceed the capacity of transplant centers in the United States as a result of the increasing duration of HCV among the people infected with the disease. The peak time for new infections was the early 1980s, so more than half of people with chronic HCV have now had their infection for more than 20 years. As a result, they have had time to develop cirrhosis and other complications of the infection. This risk will increase even more over the next 10 to 20 years, said Davis.
In a study published by Davis in Liver Transplantation in April 2003, he emphasized that while the number of people with the disease is large, the U.S. health system can manage the current volume. But as these infected patients age and their disease progresses, he expects a large proportion of patients will develop liver failure, liver cancer and cirrhosis; the incidence of these complications may double by 2020. As a result, the burden on the healthcare system will increase substantially.
Despite the effectiveness of current antiviral treatments, our study model clearly shows that the majority of cases of advanced liver disease are not currently preventable, said Davis. Today, there are not enough organs for all of the patients who need transplants. We need for greater access to transplantation through increased organ donation and the use of living donor liver transplants. Future research into xenotransplantation (animal to human transplants), artificial liver support devices, and stem cell technology also may offer options for these patients.
Source: Baylor University Medical Center at Dallas