C형 간염의 역학
Epidemiology of Hepatitis C Virus Infection in Korea
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초록
우리나라 성인에서 HCV 항체 유병률은 0.8%로 약 29만 명의 감염자가 있을 것으로 추산되는데 나이가 증가할수록 유병률이 높고 여성에서 유병률(0.83%)이 남성(0.78%)보다 약간 높다. 한편 만성 C형 간염 환자군에서 마약남용자가 전체환자군의 10% 미만을 차지하여 서구의 역학과는 상이한 특징을 보이고 있다. 국내 환자군의 HCV 유전자형은 1형과 2 형이 각각 절반을 차지하며 1형 중에는 1b형이 대부분이므로항바이러스 치료의 비용적정성 등을 예상하는 데 중요하게고려되어야 한다. 부산, 경남지역 및 호남권의 유병률이 국내다른 지역보다 유의하게 높은데 호남권은 원인을 알 수 없는과거 감염으로 현재 환자군의 나이가 많고 간질환의 중증도가 심한 경향이 있으므로 진단과 치료가 우선적으로 시행되어야 하고, 부산지역은 관혈적 시술 및 정맥주사 남용과 같은위험인자를 차단하는 예방전략의 수립과 실행이 시급하다. 아직 국내 인구를 대표할 만한 역학 연구가 부족하고 일반인과의료진에서 C형 간염에 대한 인지도가 낮으므로 진단이 늦어져 질병부담을 증가시키는 점을 고려하여 40세 이상 인구에서 생애 한 번 선별검사 시행을 제안하며, 질병의 비용효과 연구에 근거한 치료전략이 수립을 위한 연구가 필요하다.
Abstract
The anti-hepatitis C virus (HCV) prevalence in South Korean adults is estimated to be 0.8%, suggesting that at least 290,000 people are HCV infected. HCV positivity increases with age and is slightly more prevalent in women than men. Among patients with chronic HCV infection, intravenous drug users comprise < 10%, which is a distinct epidemiological feature of Western data. HCV genotype is a critical factor determining treatment regimen and duration. The major HCV genotypes in Korea are genotypes 1 (mostly genotype 1b) and 2. A peculiar intra-national geographic difference in anti-HCV prevalence was seen, as higher prevalence was found in southern coastal areas, such as Busan and Jeonnam. This geographic difference in exposure to risk factors for HCV infection suggests that active recognition and treatment is a priority in the Jeolla area, and that active prevention is an urgent issue in Busan. Considering the low recognition of HCV disease and the high cure rate using current antiviral therapy, the inclusion of a HCV screening test in the national health check examination program for people 40 years of age should be considered. Further studies on the HCV disease burden are warranted in this direct acting antiviral era.
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