More than 20 years have passed since the hepatitis C virus (HCV) was identified as the pathogen formerly known as non-A, non-B hepatitis. During that time, the pathophysiology and sequelae of chronic HCV infection, including extra-hepatic manifestations, cirrhosis, end-stage liver disease and hepatocellular carcinoma, were described. In general, treatments have improved incrementally over those years.
Since 2011, great strides have been made therapeutically and most individuals with HCV may now be considered curable. This article will update the reader on these treatments and the implications for both life and living benefits insurance products and claims.
Hepatitis C is a major global health issue. The main burdens of morbidity and
mortality come from the sequelae of chronic infection.
It is estimated that approximately 170 million people are infected worldwide, and that 350,000 deaths occur annually due to all HCV-related causes. Current high prevalence areas (> 3.5%) include Central and East Asia, and North Africa/Middle East. Moderate prevalence areas (1.5-3.5%) include: South and Southeast Asia; Andean, Central, and Southern Latin America; Australasia (including Australia and New Zealand), the Caribbean, Oceania (the Pacific islands); Central, Eastern, and Western Europe; and sub-Saharan Africa. The lowest prevalence areas (< 1.5%) are Asia Pacific (encompassing Brunei, Japan, South Korea and Singapore), tropical Latin America and North America.1
The causes of high prevalence are several. Egypt for example, has the highest prevalence rate (~10%) in the world due to inadequate infection control during medical and dental procedures. The mass campaigns to control schistosomiasis, which generally spreads through contaminated water, may have also exposed many to the HCV via improperly sterilized glass syringes.2
Risk factors for hepatitis C transmission vary among the world’s developed and developing regions. Prior to 1992, most hepatitis C infections in developed countries were acquired through blood transfusions and blood products. In developing countries, blood products and unsafe medical practices continue to play a major role in transmission. HCV is also transmitted via injecting drug use, body piercing, tattooing, religious scarification, and sharing of personal care items such as razors, toothbrushes and manicure tools. Worldwide, there is also little doubt that sexual transmission can occur, and the risk increases for individuals who have had multiple partners, in the presence of sexually transmitted infections, and for men who have sex with men.
After epidemiologic investigation, no risk factors can be identified in up to 20% of those infected with hepatitis C.4, 5