Epidemiology and risk groups

To date, it is estimated that 30 000 Belgians still have chronic hepatitis C amongst the general population.1,2The HCV seroprevalence (i.e. the existence of anti-HCV antibodies) varies per study and is estimated between 0,26%3 and 1,01%.1 The prevalence of an active HCV infection (i.e. RNA positive) ranges between 0,13%3 and 0,33%.2,

Due to the inherent HCV transmission routes, the prevalence is strongly increased in specific populations. Hence, these high-risk populations should be prioritized for screening efforts:

People who use drugs (PWUDs) / people who inject drugs (PWIDs): 30% of drug users have HCV antibodies4, and up to 70% of those have an active infection.5

Prisoners and previously incarcerated people: 15% of (previously) incarcerated people are HCV antibody positive.6

Migrants from countries with high HCV prevalence in the EU: 2% of migrants have HCV antibodies.7

 

Men having sex with men (MSMs): 1,8% of MSMs are HCV antibody positive.8

Psychiatric patients: 3,4% of psychiatric patients are seropositive.9

For more information, visit Screening for HCV section.

 

HCV Treatment in Belgium

DAA treatment is available for patients with a chronic infection in Belgium since 2015, but reimbursement has gradually been extended depending on the fibrosis score of the patient. Since January 2019, everybody who is part of the Belgian health system can be treated.

To date, the treatment itself is very simple and most often consists of an 8 to 12 week regimen with 1-3 pills daily. More details can be found on the website of the Belgian Association for the Study of the Liver (BASL): https://www.basl.be/news/treatment-options-and-diagnostic-cut-offs-for-hcv-in-belgium/.

Addiction specialists

In Belgium, chronic hepatitis C virus infection is a condition managed by specialists. However, the introduction of direct acting antiviral (DAA) medication represents a major advance in clinical medicine and has the potential to expand the role of community-based healthcare providers to the management of patients with uncomplicated, non-cirrhotic HCV. The high efficacy, short duration and good tolerability of DAAs mean that many patients now are suitable for community-based treatment and that approximately 95% of all patients who start treatment will be cured.*10-15

*A sustained virological response (SVR) defined as undetectable HCV RNA 12 weeks (SVR12) or 24 weeks (SVR24) after treatment completion.4

In order to facilitate a ‘treat all’ approach and adoption of pangenotypic DAA regimens, the WHO recommends community-based HCV management via the implementation of simplified models of service delivery. These include15:

Comprehensive national planning for the elimination of HCV infection

Simple and standardized algorithms across the continuum of care

Integration of hepatitis testing, care and treatment with other provided services

Strategies to strengthen linkage from testing to care, treatment and prevention

Decentralized services supported by task-sharing

Community engagement and peer support to address stigma and discrimination, and reach vulnerable or disadvantaged communities

Efficient procurement and supply management of medicines and diagnostics

Data systems to monitor the quality of individual care and the cascade of care

In other countries such as France and Australia and soon Israel, GPs in the addiction centers are also allowed to prescribe HCV medication, either independently or in conjunction with the local specialist.  

Due to the high prevalence specifically in drug users, a crucial role to achieve HCV elimination by screening and linking patients to care lies within the community and addiction centers (e.g. needle exchange services, MSOCs, maisons médicales, MASSs and other ASBL/VZW etc.). Gilead has actively supported and currently also supports several screening projects initiated in Belgium to improve care and cure for vulnerable populations.

For more information on Belgian projects visit HCV elimination in Belgium and the Video Hub.

For more information visit the What GPs need to know – HCV section or for materials like posters, presentations specifically for the drug user population visit the Hepatitis C toolkit.

Expert opinion

Several Belgian experts have given their opinion on HCV management in Belgium during the Belgian Week of Gastroenterology 2019:

HCV, Hepatitis C virus; PWUDs, people who use drugs; PWIDs, people who inject drugs; MSM, Men having sex with men; DAA, directly-acting antivirals; GP, general practitioner; MSOC, medisch-sociaal opvangcentrum, MASS, maison d’accueuil socio-sanitaire; ASBL, association sans but lucratif; VZW, vereniging zonder winstoogmerk.

Related content

Hepatitis C toolkit

HCV

Find materials (posters, presentations, etc.) and resources in the Hepatitis C toolkit.                 

HCV elimination in Belgium

HCV

Find out more about local projects in Belgium.

Key facts for GPs

GPs

All GPs should know in short about HCV.

Disclaimer:

While this information is considered to be true and correct at the date of publication (May 2020), changes in circumstances after the time of publication may impact the accuracy of the information.

This page will be updated regularly.

References

  1. Muyldermans G et al. Hepatitis C virus (HCV) prevalence estimation in the adult general population in Belgium: a meta-analysis. Acta Gastroenterol Belg. 2019 Oct-Dec;82(4):479-485.
  2. Opstaele L et al. Who to screen for hepatitis C? A cost-effectiveness study in Belgium of comprehensive hepatitis C screening in four target groups. Acta Gastroenterol Belg. 2019 Jul-Sep;82(3):379-387.
  3. Litzroth A et al. Low hepatitis C prevalence in Belgium: implications for treatment reimbursement and scale up. BMC Public Health. 2019 Jan 8;19(1):39.
  4. Mathei et al. Acta Gastroenterol. , 2016, 79(2) : 227-32
  5. Geert Robaeys, BeNHSU conference 2019 (see report in Hepatitis C toolkit)
  6. Christian Brixko, BeNHSU conference 2019 (see report in Hepatitis C toolkit)
  7. Falla AM et al. Estimating the scale of chronic hepatitis C virus infection in the EU/EEA: a focus on migrants from anti-HCV endemic countries. BMC Infect Dis. 2018 Jan 16;18(1):42.
  8. Busschots D et al. Eliminating viral hepatitis C in Belgium: the micro-elimination approach. BMC Infect Dis. 2020 Feb 27;20(1):181.
  9. Wim Verlinden, oral communication (see video in section elimination in Belgium)
  10. Sievert W et Enhanced antiviral treatment efficacy and uptake in preventing the rising burden of hepatitis C­ related liver disease and costs in Australia. J Gastroenterol Hepatol 2014;29 Suppl1:1-9.
  11. Hepatitis C Virus Infection Consensus Statement Working Group. Australian recommendations for the management of hepatitis C virus infection: a consensus statement (September 2018). Melbourne: Gastroenterological Society of Australia 2018.
  12. American Association for the Study of liver Diseases (AASLD). HCV Guidance: recommendations for testing, managing, and treating hepatitis C. Sept 21,2017. Available at: https://www.hcvguidelines.org/ (accessed May 2020).
  13. European Association for the Study of the Liver (EASL). EASL recommendations on treatment of hepatitis C 2018. J Hepatol 2018;69:461-511.
  14. British Association for Sexual Health and HIV (BASHHJ. National Guidelines for the Management for Viral Hepatitides. 2017 interim update. Available at: https://www.bashhguidelines.org/media/1161/viral-hepatitides-2017-update-18-12-17.pdf (accessed May 2020).
  15. World Health Organization (WHO). Guidelines for the care and treatment of persons diagnosed with chronic hepatitis C virus infection. July 2018. Available at https://www.who.int/hepatitis/publications/hepatitis-c-guidelines-2018/en/ (accessed May 2020)