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Hepatitis C elimination: less than 25% of people with hepatitis C diagnosed globally

Keith Alcorn
15 November 2021
Image: Jarun Ontakrai/

The global prevalence of hepatitis C has declined since 2015, partly due to scale-up of direct-acting antiviral treatment, but fewer than one in four people with hepatitis C has been diagnosed, preventing millions from being cured of the infection, Sarah Blach, HCV Group Leader at the Center for Disease Analysis Foundation, reported to The Liver Meeting on Sunday.

The findings come from modelling of hepatitis C epidemics in 110 countries, based on published and unpublished data for hepatitis C prevalence, disease burden and cascade of care, carried out by the Center for Disease Analysis Foundation.

The study was designed to evaluate global progress towards the elimination of hepatitis C since 2015.

The global estimate of the number of people with viraemic, or chronic, hepatitis C infection shows that prevalence has fallen since 2015, from 63.7 million to 56.9 million. The researchers downgraded their previous estimate of 2015 prevalence as a result of updated prevalence estimates for Egypt, Brazil and Nigeria, as well as new data for the Democratic Republic of Congo, all showing lower prevalence than previous estimates.

Since 2015, approximately 7.5 million people have acquired hepatitis C, 5.5 million people with hepatitis C have died and 8.8 million have been cured by treatment.

Hepatitis C prevalence is highest in eastern Europe and central Asia, and Pakistan, where at least 1.3% of the population are living with hepatitis C. However, more than half of people with hepatitis C are in five countries: China, India, Pakistan, the Russian Federation and the United States.

Hepatitis C treatment initiation peaked in 2019, when approximately 2.9 million people started treatment, 1.9 million of them in Egypt. More than a third of all treatments between 2015 and 2020 took place in Egypt.

The Center for Disease Analysis Foundation projects that approximately one million people will start direct-acting antiviral treatment each year for the rest of the decade, which is not enough to reach the global hepatitis C elimination target of treating 80% of those eligible by 2030. Dr Blach said that to reach the target, nine million people need to be treated each year up to 2030.

People with hepatitis C will remain untreated if they are not diagnosed. Country data indicate that less than one in four people with chronic hepatitis C have been diagnosed. In high-income countries, approximately 6 million people were living with hepatitis C in 2020. The Center for Disease Analysis Foundation estimates that 47% have already been diagnosed.

But in the countries with the highest absolute burden of hepatitis C – upper-middle-income and lower-middle-income countries – the rates of hepatitis C diagnosis are much lower. The Center for Disease Analysis Foundation estimates that only 17% of the 26 million people with hepatitis in lower-middle-income countries and 22% of the 20 million people people with hepatitis C in upper-middle-income countries have been diagnosed.

“Low diagnosis and lack of large-scale screening programmes remain a barrier for elimination,” Sarah Blach concluded.


Blach S et al. Global status update on the HCV prevalence and cascade of care entering 2020. The Liver Meeting, abstract 66, 2021, (Hepatology, 74 (S1): 46A, 2021.)