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PLoS One. 2015 May 11;10(5):e0126920. doi: 10.1371/journal.pone.0126920. eCollection 2015.

The undiagnosed chronically-infected HCV population in France. Implications for expanded testing recommendations in 2014.

Author information

1
Infectious Diseases Department, French Institute for Public Health Surveillance (InVS), Saint-Maurice, France.
2
Infectious Diseases Department, French Institute for Public Health Surveillance (InVS), Saint-Maurice, France; Cermes3 (Inserm U988/CNRS UMR8211/EHESS/Université Paris-Descartes), Paris, France.

Abstract

BACKGROUND:

Recent HCV therapeutic advances make effective screening crucial for potential HCV eradication. To identify the target population for a possible population-based screening strategy to complement current risk-based testing in France, we aimed to estimate the number of adults with undiagnosed chronic HCV infection and age and gender distribution at two time points: 2004 and 2014.

METHODS:

A model taking into account mortality, HCV incidence and diagnosis rates was applied to the 2004 national seroprevalence survey.

RESULTS:

In 2014, an estimated 74,102 individuals aged 18 to 80 were undiagnosed for chronic HCV infection (plausible interval: 64,920-83,283) compared with 100,868 [95%CI: 58,534-143,202] in 2004. Men aged 18-59 represented approximately half of the undiagnosed population in 2014. The proportion of undiagnosed individuals in 2004 (43%) varied from 21.9% to 74.1% in the 1945-1965 and 1924-1944 birth cohorts. Consequently, age and gender distributions between the chronically-infected (diagnosed and undiagnosed) and undiagnosed HCV populations were different, the 1945-1965 birth cohort representing 48.9% and 24.7%, respectively.

CONCLUSIONS:

Many individuals were still undiagnosed in 2014 despite a marked reduction with respect to 2004. The present work contributed to the 2014 recommendation of a new French complementary screening strategy, consisting in one-time simultaneous HCV, HBV and HIV testing in men aged 18-60. Further studies are needed to assess the cost-effectiveness and feasibility of such a strategy. We also demonstrated that data on the undiagnosed HCV population are crucial to help adapt testing strategies, as the features of the chronically-infected HCV population are very distinct.

PMID:
25961575
PMCID:
PMC4427442
DOI:
10.1371/journal.pone.0126920
[Indexed for MEDLINE]
Free PMC Article

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