Epidemiology

Hepatitis C appears to be endemic in most parts of the world, although the prevalence is not evenly distributed. Globally, an estimated 50 million people have chronic hepatitis C, with about 1 million new infections occurring per year. The highest burden of diease is in the Eastern Mediterranean region.[7][8]​ Among patients with cirrhosis globally, 21% had hepatitis C.[9]

There is considerable geographical and age variation in the incidence and prevalence of infection and of genotypes.[10][11]​ The prevalence may be as high as 5% to 15% in some parts of the world, and different regions have a different risk profile and age demographic.[12] Genotype 1 is the most prevalent worldwide, accounting for 46% of all cases, followed by genotype 3 (22%) and genotypes 2 and 4 (13% each).[10]​ Genotype 4 is more prevalent in sub-Saharan and North Africa, and is responsible for more than 90% of infections in Egypt.[13]

In the US, the annual rate of acute infection increased from 0.3 per 100,000 population in 2009 to 1.2 per 100,000 population in 2018, with the highest rate among people aged 20 to 39 years. The largest proportion of chronic hepatitis C infection cases was in people aged 20 to 39 years and 50 to 69 years.[14] In 2021, the rate of acute hepatitis C decreased from the prior year with 4848 cases reported and an estimated 67,400 acute infections. The largest proportion of acute cases was in males, those in the 30 to 39 year age group, and non-Hispanic American Indian/Alaska Native people. The most common risk factor was injection drug use. During 2022, 93,805 new cases of chronic hepatitis C infection were reported, with the rate highest among men, those in the 25 to 45 and 55 to 70 age groups, and non-Hispanic American Indian/Alaska Native people.[15] ​

In the UK, approximately 62,600 adults over the age of 16 years were estimated to be living with chronic hepatitis C at the end of 2022 (prevalence 0.14%), a 52% decrease on the number from 2015, largely due to increased testing and improved access to direct-acting antivirals. Injecting drug use continues to be the most important risk factor for infection.[16]​ In Europe, the prevalence ranges from 0.5% to 2.0%.[17]​ There were an estimated 0.49 million incident cases of acute hepatitis C in Europe in 2019.[18]

The prevalence is higher in specific populations such as people who are incarcerated or institutionalised, and men who have sex with men.[19][20]​ Cases in women of reproductive age have doubled to approximately 30,000 cases in the US from 2006 to 2014, with an estimated 1700 infants born with hepatitis C virus (HCV) between 2011 and 2014.[21] An estimated 14,860,000 women of child-bearing age (15 to 49 years) had hepatitis worldwide in 2019, corresponding to a prevalence of 0.78%. Prevalence increased with age, from 0.25% in women aged 15 to 19 years, to 1.21% in those aged 45 to 49 years.[22] In people living with HIV, approximately 2.4% had HCV coinfection within general population samples. The rate was higher for men who have sex with men (6.4%) and people who inject drugs (82.4%).[23]​​

The true incidence of HCV is likely to be higher because those who develop new infections are usually asymptomatic.[24]​ Approximately 75% of people living with chronic HCV are unaware of their infection.[25]

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