Incidence of cirrhosis in Iceland—impact of the TraP HepC nationwide HCV elimination program

In 2016, a nationwide elimination program for hepatitis C virus (HCV) was initiated in Iceland, entitled Treatment as Prevention for Hepatitis C (TraP HepC), providing unrestricted access to antiviral treatment. The aims were to describe the changes in etiology and epidemiology of cirrhosis in Iceland and to assess the trends in HCV-related cirrhosis following TraP HepC. The study included all patients newly diagnosed with cirrhosis in 2016–2022. Diagnosis was based on liver elastography, histology, or 2 of 4 criteria: cirrhosis on imaging, ascites, varices, or elevated international normalized ratio (INR). Over the study period, 342 new cirrhosis patients were identified, 223 (65%) males, median age 62 years. The crude overall incidence was 13.8 cases per 100,000 inhabitants annually. The most common etiologies were alcohol-related liver disease (ALD) (40%), metabolic dysfunction-associated steatotic liver disease (MASLD) (28%), and HCV with or without alcohol overconsumption (15%). The number of HCV cirrhosis cases was unusually high in 2016 (n = 23) due to intensified case-finding, but decreased significantly over the study period (p n = 1 (2021) and n = 2 (2022). The overall 5-year survival was 55% (95% CI 48.9–62.3%). The most common causes of death were hepatocellular carcinoma (26%) and liver failure (25%). During the past two decades, the incidence of cirrhosis has increased extraordinarily in Iceland, associated with increased alcohol consumption, obesity, and HCV. ALD and MASLD now collectively make up two thirds of cases in Iceland. Following a nationwide elimination program, incidence of HCV cirrhosis has dropped rapidly in Iceland.</p

HEPATITIS C PREVENTION.

<p>HEPATITIS C PREVENTION.</p

HEPATITIS C TESTING AND LINKAGE TO CARE.

<p>HEPATITIS C TESTING AND LINKAGE TO CARE.</p

HEPATITIS C TREATMENT.

<p>HEPATITIS C TREATMENT.</p

Incidence of stakeholder disagreement by country and survey domain.

<p>Incidence of stakeholder disagreement by country and survey domain.</p

Groups that should be routinely offered HCV testing according to national guidelines.

<p>Groups that should be routinely offered HCV testing according to national guidelines.</p

Etiologic causes of community acquired pneumonia (CAP) identified during the 12-month study, by quarters.

<p>The proportion of total pneumonia admissions accounted for by each etiology for each quartile is shown. Influenza during the first and second quartiles was caused by seasonal influenza H3N2 whereas all influenza cases during the third and fourth quartiles were pandemic influenza (H1N1). Less frequently encountered pathogens listed as “other” included <i>M. catarrhalis</i>, <i>S. aureus</i>, <i>C. pneumoniae</i>, <i>Legionella</i> species, <i>P. aeruginosa</i> as well as various streptococcal species.</p

Comparison of CAP Patients by Etiology – Treatment and Outcome.

<p>CAP, community acquired pneumonia; CI, confidence interval; IV, intravenous; abx, antibiotic; UAT, urine antigen test;; ICU, intensive care unit; BAL, bronchoalveolar lavage.</p>a<p>P-values<.05 shown in bold.</p>b<p>Atypical coverage denotes empiric antimicrobial treatment including coverage for “atypical” bacterial organisms.</p

Epidemiology of influenza in Iceland, December 2008-December 2009, showing the number of reported cases of influenza-like illness (ILI) and confirmed influenza A 2009 (H1N1) (left y-axis) and weekly ILI incidence per 100 000 population (right y-axis).

<p>In Iceland approximately 62% of all virologically confirmed cases and ILI were in Reykjavik <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0046816#pone.0046816-Sigmundsdottir1" target="_blank">[21]</a>. (Ref: <a href="http://www.influensa.is/pages/1505" target="_blank">http://www.influensa.is/pages/1505</a>).</p

Comparison of CAP Patients by Etiology – Symptoms, Test Results and Severity Scores.

<p>CAP, community acquired pneumonia; CI, confidence interval; BP, blood pressure; MAP, mean arterial pressure; RR, respiratory rate; SpO2, pulse-oximetry; WBC, white blood cell; CRP, C-reactive protein; PSI, pneumonia severity index.</p>a<p>P-values<.05 shown in bold.</p>b<p>Worst value denotes the worst noted value during the first 24 hours of admission.</p