Trends in Hepatitis B, Hepatitis C, and <scp>HIV</scp> Seroprevalence in the Netherlands: Insights From Two Decades of Nationwide <scp>PIENTER</scp> Serosurveys

Hepatitis B (HBV), hepatitis C (HCV), and HIV remain public health challenges despite effective treatments and preventive options. Infections are often asymptomatic, leading to undiagnosed cases, onward transmission, and preventable morbidity and mortality. In the Netherlands, disease burden is concentrated in specific populations, with many undetected infections. We estimated HBV, HCV, and HIV seroprevalence, identified determinants, and assessed trends over 20 years using data from 14,444 participants aged 15-79 years from three nationwide cross-sectional serosurveys (PIENTER: 1995-1996, 2006-2007, and 2016-2017). Participants completed questionnaires on demographics, behaviour, and socio-economic factors, and serum samples were tested for HBV and HCV in all rounds and HIV in 2017. Seroprevalence estimates were weighted to the Dutch population, trends were analysed using weighted Poisson regression, and determinants were evaluated using multivariable Poisson regression. Weighted HBV seroprevalence remained stable across surveys (3%-5% past or present infection; < 0.4% active infection). HBV prevalence was highest among first-generation migrants, with older age, migration background, and STI history as key determinants. HCV seroprevalence remained low (< 0.4%) and was highest among non-Western migrants. HIV prevalence was 0.1% and highest among non-Western migrants and men who have sex with men. Only 9% of active HBV cases were aware of their status. Overall, HBV, HCV, and HIV seroprevalence remain low in the Netherlands but are concentrated in specific groups with limited awareness. These findings support targeted prevention, screening, and linkage-to-care strategies to achieve the 2030 WHO elimination goals and highlight the importance of continued population-based (sero-)monitoring to guide public health policy.