Declining prevalence in the general population

In 2004, the national prevalence survey of hepatitis B and C conducted among the general adult population in metropolitan France estimated:

• the prevalence of anti-HCV antibodies at 0.84% (95% CI: 0.65–1.10). This corresponded to 367,055 people (95% CI: 269,361–464,750) who had been infected with HCV. Among these individuals, 57% (95% CI: 43–71) were aware of their anti-HCV antibody-positive status,

• with HCV RNA prevalence at 0.53% (95% CI: 0.40–0.70). This corresponded to 232,196 people (95% CI: 167,869–296,523) with chronic infection.

The factors most strongly associated with positive HCV antibody test results were:

• injecting drug use at least once in a lifetime,

• being between 60 and 69 years old,

• being born in a country with high HCV prevalence.

Other factors such as nasal drug use, a history of blood transfusions prior to 1992 or tattoos, being over 29 years of age, and living in precarious circumstances were also associated with positive antibody status.

In 2011, the prevalence of hepatitis C was estimated through modeling in the general metropolitan population aged 18–80:

• 0.75% [95% credibility interval (CI): 0.62–0.92] for anti-HCV antibodies, corresponding to 344,500 [95% CI: 287,373–423,549] people who had been infected with HCV;

• 0.42% [95% CI: 0.33–0.53] for HCV RNA, corresponding to 192,700 [150,935–246,055] people with chronic infection.

In 2016, the “Barotest” virological component of the 2016 Health Barometer estimated the prevalence of HCV RNA in the general adult population (ages 18–75) living in metropolitan France at 0.30% (95% CI: 0.13–0.70), corresponding to 133,466 people (95% CI: 56,880–312,616) with chronic hepatitis C. Among these individuals, 80.6% (95% CI: 44.2–95.6) were aware of their infection.

Due to differences in the methods used, comparisons of these estimates of chronic hepatitis C prevalence should be made with caution. Nevertheless, a decrease in prevalence was observed between 2004 and 2016 (non-significant). This is certainly linked to the decrease in the number of people infected through transfusion prior to 1992, to the direct-acting antivirals available since late 2013, as well as to the decline in HCV incidence.

Finally, the data for 2004 and 2016 are derived from general population surveys, with a likely underrepresentation of certain populations particularly exposed to HCV, leading to a possible underestimation of prevalence at the national level.

Prevalence data in specific populations

Among drug users attending treatment and harm reduction facilities, the 2011 ANRS-Coquelicot survey estimated the prevalence of anti-HCV antibodies at 44% [95% CI: 39–48]. Prevalence was higher in Marseille (56%) and Seine-Saint-Denis (52%) than in Bordeaux (24%) or Lille (28%).
The overall prevalence of chronic hepatitis C was estimated at:

• 30% [95% CI: 26–33] among users who had injected at least once in their lifetime;

• 35% [95% CI: 30–41] among those who had injected in the past month.

Among men who have sex with men who frequent gay social venues, the prevalence of chronic hepatitis C was estimated at 0.7% [95% CI: 0.3–1.5], based on the 2015 Prévagay survey. Among HIV-positive MSM, the estimated prevalence was 3.0% [1.5–5.8].

Among the hospitalized population, an analysis of data from the Program for the Medicalization of Information Systems (PMSI) estimated that 0.33% of hospitalized patients had chronic hepatitis C as their primary, related, or associated diagnosis in 2010 and 2011.