26 Age-group of peak prevalence varies by region, and is expected to also vary by country depending on local epidemiology of HCV transmission. For example, in the U.S. cohort effects were seen that were specific to infection stemming from injection drug use in the 1970s.27 Areas with type 1 transmission such as North mTOR inhibitor America exhibit signs of the aging cohort in prevalence, i.e., a shift in age group with highest risk of HCV-sequelae between 1990 and 2005. Regions such as East Asia and Southern Latin America, without previously hypothesized cohort effects, also show signs of type 1 transmission; this suggests that these regions

may have their own cohort effects that are not as well understood or characterized. Further attention should be given to documenting the transmission patterns in different countries, particularly those that have high prevalence (such as Pakistan in South Asia), in order to inform future estimation efforts. The total prevalence estimates in this study are higher compared to those of previous anti-HCV estimates2 and some prominent findings in prevalence patterns of some regions require further discussion. In Australasia,

the estimated peak prevalence at ages 20-24 years may reflect the high incidence of HCV among PWID reported recently.28, 29 Contrary to the literature describing Australia as having very low prevalence and type 1 transmission, our findings may be due to fewer datapoints beyond age 40, resulting in borrowing of strength Miconazole and more influence from younger ages with higher prevalence for the Australasian region. Mother-to-infant Torin 1 research buy transmission is the commonest route of HCV infection in children, with a vertical transmission rate of 5%.30 In West sub-Saharan Africa, the relatively high prevalence in young children may reflect the overlapping human immunodeficiency virus (HIV) epidemic and HIV-HCV coinfection in sub-Saharan Africa, which is known to increase the risk of vertical transmission of HCV and requires further investigation.31 Finally, despite the fact that Central Asia is estimated

to have the highest total prevalence based on very limited data, the high prevalence of immigrants from Uzbekistan (31%) in a study of former Soviet Union immigrants in New York suggests the plausibility of these estimates.32 In conclusion, this analysis highlights the age group with the highest probability for sequelae, i.e., the group with peak prevalence that deserves attention for screening and treatment in each region. Further, it sets the stage for modeling the current and future global burden of HCV-related disease based on seroprevalence and natural history that 5%-20% will go on to develop cirrhosis over a period of 20-30 years and 1%-5% will die from the consequences of chronic infection.33-35 This study also identifies challenges in producing useful “global” and even “regional” estimates for hepatitis C.