Comparing the public health burden of chronic hepatitis C and HIV infection in France Sylvie Deuffic-Burban 1, * , John B. Wong 2 , Alain-Jacques Valleron 1 , Dominique Costagliola 3 , Jean-Franc ¸ois Delfraissy 4 , Thierry Poynard 5 1 Unite ´ de Recherche ‘Epide ´miologie et Sciences de l’Information’ INSERM U444, Faculte ´ de Me ´decine Saint-Antoine, 27 rue Chaligny, 75 571 Paris Cedex 12, France 2 Tufts-New England Medical Center, Tufts University School of Medicine, Boston, MA, USA 3 INSERM EMI 0214, Groupe Hospitalier Pitie ´-Salpe ˆtrie `re, Paris, France 4 Ho ˆpital Bice ˆtre, Le Kremlin Bice ˆtre, France 5 Service d’He ´pato Gastroente ´rologie, Groupe Hospitalier Pitie ´-Salpe ˆtrie `re, Paris, France Background/Aims: In France, the prevalence of hepatitis C virus (HCV) exceeds that of HIV, but in the absence of treatment, HIV infection progresses more rapidly than HCV. More HIV-infected patients, however, have received treatment. Using reported public health data in France and natural history models, we applied the back-calculation method to project future mortality from HCV and HIV incorporating current therapies. Methods: The HCV model was based on literature data for the natural history of HCV and reports of hepatocellular carcinoma mortality. The HIV model used estimates from the French Hospital Database on HIV and reported AIDS cases and deaths. Results: Peak annual mortality from HIV at 5000 occurred in 1994 and was 1000 in 1998, but HCV mortality likely increased through the 1990s and reached 3000 in 1998. Considering only HCV infections occurring until 1998 and currently available therapy, our model suggested that annual HCV-related mortality would continue to rise and would reach 4500 deaths in 2022. In contrast, AIDS-related deaths began to decrease in 1997. Conclusions: The public health burden of HCV is likely on the rise, while the burden of HIV, given the fairly widespread use of effective medications, may be on the decline. These results may help health policymakers in planning their responses to these epidemics. q 2003 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved. Keywords: AIDS; Back-calculation; Disease burden; HCV; Hepatocellular carcinoma; Liver disease; Mortality; Predictions 1. Introduction In France, an estimated 600,000 individuals have HCV infection and 110,000 have HIV infection, making them major public health concerns [1]. If untreated, HIV infection confers a poorer prognosis than HCV, but because the majority of HIV-infected individuals have been detected and treated with combination antiretroviral therapy, the incidence and mortality of acquired immune deficiency syndrome (AIDS) have fallen dramatically [2]. For HCV- infected individuals, however, fewer than 20% have been detected and treated with antiviral therapy [3]. Because of its high prevalence and the absence of widespread screening and treatment, HCV morbidity and mortality may increase for many years [4]. Given these differences, projecting future morbidity and mortality from HCV or HIV infection may help health 0168-8278/$30.00 q 2003 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved. doi:10.1016/j.jhep.2003.10.018 Journal of Hepatology 40 (2004) 319–326 www.elsevier.com/locate/jhep Received 21 March 2003; received in revised form 26 September 2003; accepted 22 October 2003 * Corresponding author. Tel.: þ33-1-44-73-84-45; fax: þ 33-1-44-73- 84-62. E-mail address: sylvie.burban@libertysurf.fr (S. Deuffic-Burban).