Changing epidemiology of hepatitis C virus infection and liver disease mortality in Taiwan.

Hepatitis C virus (HCV) infection leads to serious sequelae, including hepatocellular carcinoma (HCC) and liver cirrhosis. A national HCV elimination program was launched in 2016 based on comprehensive epidemiological evidence. This review summarizes the changing epidemiology of HCV prior to the national control program. Taiwan represents a unique country with the co-endemicity of hepatitis B virus and HCV. Community surveys, blood donor screenings, and registry-based analyses reveal geographic clustering and birth cohort effect, with individuals born before 1960 carrying the greatest burden resulted from iatrogenic exposures. In contrast, HCV infections in younger generations occur as sporadic cases. Distinctly elevated prevalence was observed in special populations including hemodialysis patients, people who inject drugs (PWID), men who have sex with men (MSM), and people living with HIV (PLWH), underscoring key risk groups for surveillance and intervention. These epidemiological characteristics have translated into important clinical consequences. HCV was the leading cause of HCC in HCV hyperendemic areas. Mortality from HCC substantial despite of recent declines in both HCC incidence and mortality. Sentinel center studies have documented the reduction in HCV-related liver cirrhosis. Consolidating historical and contemporary data, this review provides essential baseline data for the design of HCV Elimination program in Taiwan.