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Introduction 15<br />

patients becomes chronic, a much higher rate than after infection with hepatitis B virus<br />

in adults. Symptoms are nonspecifi c, like fatigue and it make take years before patients<br />

discover that they are chronically infected with hepatitis C.<br />

Chronic hepatitis C is a slowly progressive liver disease. It has been estimated that<br />

10-20% of patients develop liver cirrhosis within 10-30 years and for those with cirrhosis<br />

the yearly risk of developing HCC is about 1-5%. 21<br />

Epidemiology<br />

Chronic hepatitis C affects about 170 million people worldwide. 22 The prevalence is<br />

high in Egypt(>10%), Asia(5-10%) and southern Europe (1-2.5%). 23 In the Netherlands<br />

the prevalence is low (

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