The epidemiological situation of hepatitis C in Portugal

Transcrição

1 The epidemiological situation of hepatitis C in Portugal Paula Peixe Serviço de Gastrenterologia Centro Hospitalar de Lisboa Ocidental, EPE Hospital Egas Moniz Director: Dr Leopoldo Matos

2 Summary Estimated prevalence Blood donors Population studies Patient population Genotypes Viremia Liver biopsy and fibrosis

3 Blood donors N ,9% North 0,68% Lisboa 1,0% South 1,59% P<0,05 Marinho R. GE 2000, 7: 72-79

4 Population studies Only one study Coimbra Total: 657 patients Age : 42,7 ±13,1 years Sex: 267 male; 390 female HCV antibody positive 0,46% IV drug use 33,3 % Transfusion 1,8 % Alcohol abuse 1,33 % Previous surgery 1,0 % HBV countries 0,65 % Santos A Acta Med Port 1993,6 567

5 HCV prevalence Hospital de Gaia AcHBs+ isolado 10 (4,9% ) AcVHC+ 3 (1,5% ) AcHBc+ isolado 10 (4,9% ) Total: 205 patients Age : 57,96 ±14,85 years Sex: 114 male; 91 female AcHBs+ AcHBc+ 34 (16,6% ) AgHBs+ 2 (0,98% ) Conclusion The prevalence of HCV infection (1.5%) and HBV (0.98%) in this population was similar to that estimated for the population Portuguese general. AP Silva, 2010

6 Prevalence HCV

7 Prevalence VHC J.I. Esteban et al. / Journal of Hepatology 48 (2008)

8 Reported cases Marinho R. GE 2000, 7: 72-79

9 Reported cases N.º de notificações e taxa de incidência (/10 5 ), 2006 Doenças de Declaração Obrigatória (DDO) CID DDO DGS 2007

10 Nacional surveys Caracterização epidemiológica da Hepatite Crónica C em Portugal. Estudo prospectivo multicêntrico (2001) Jorge Areias et al 7ª Reunião Anual da APEF Virological and Histological Profile of Chronic Hepatitis C Patients Treated with Peginterferon alfa plus Ribavirin in Clinical Practice in Tertiary Centres in Portugal (2009) (Revisão retrospectiva ( ) Doentes seguidos em consulta externa) José Velosa et al (submitted)

11 Centros participantes Centro Hospitalar de Coimbra (Doenças Infecciosas) Centro Hospitalar de Vila Nova de Gaia (Gastrenterologia) Centro Hospitalar de Vila Nova de Gaia (Medicina Interna) Hospitais da Universidade de Coimbra (Infecciosas) Hospitais da Universidade de Coimbra (Medicina III) Hospital Curry Cabral (Unidade de transplatação) Hospital de Braga (Gastrenterologia) Hospital de Castelo Branco Hospital de Faro (Gastrenterologia) Hospital de Leiria (Medicina II) Hospital de S. Teotónio - Viseu (Gastrenterologia) Hospital de S. Teotónio - Viseu (Infecciosas) Hospital de Santa Cruz (Medicina Interna) Hospital de Santarém (Medicina I) Hospital de São João (Gastrenterologia) Hospital de Setúbal (Gastrenterologia) Hospital de Sto. António (Gastrenterologia) Hospital de Sto. António dos Capuchos (Gastrenterologia) Hospital de Vila Real (Gastrenterologia) Hospital de Vila Real (Medicina Interna) Hospital do Barreiro (Medicina I) Hospital do SAMS (Gastrenterologia) Hospital Egas Moniz (Gastrenterologia) Hospital Espírito Santo - Évora Hospital Fernando da Fonseca Hospital Garcia da Orta (Infecciologia) Hospital Infante D. Pedro - Aveiro (Infecciosas) Hospital Infante D. Pedro - Aveiro (Medicina 2) Hospital Pulido Valente (Medicina III) Hospital Santa Maria Hospital Santa Maria (Medicina 2) Hospital São João (Doenças Infecciosas)

12 Patients Evaluable 567 (91,7%) 2001 Total 618 (100%) 2009 Total 1907 north 249 center 157 south 1193 Excluded 51 (8,3%)

13 Demographics Sex (75%) male 142 (25%) female Sex 2009 male 1274 (66,8%) Race Caucasian 537 (94%) African 10 (2%) unknown 20 (4%)

14 Demographics Age % 36.8 ± % male 10% 39.4 ± 14.0 female age Age ,1 years (17 years - 91 years)

15 Demographics Weight % 20% 10% omisso weight (kg)

16 Associated diseases % 2% 3% 4% Anemia Renal disease Cardiac disease Diabetes Mellitus Anemia Doença Renal Doença Cardíaca Diabetes Mellitus male female

17 Risk factors 2001 i.v.drugs users Previous surgery Sexual Transfusion Familiar history Hepatitis C Parenteral therapy Stay in risk countries Others Health Care Profissional 10% 20% 30% 40% 50% Risk factors: 485 (86%) Utilizador de substâncis i.v. Cirurgia anterior Sexual Transfusão Familiar c/ história de Hepatite C Terapêutica parentérica Estadia em países de risco Outros Profissional de saúde 87% 82% male female

18 Probable route of infection 2001 Drug user i.v. Transfusion Sexual contact Other Contact with HCV patient Perinatal transmission 10% 20% 30% 40% 50% Identifiable: 461 (81%) Utilizador de substâncias i.v. Transfusão Contacto sexual Outra Contacto com portador VHC 84% 74% Transmissão perinatal male female

19 Infectious disease in drugs users Marinho R. GE 2000, 7: IDT Relatorio anual 2008

20 Time of disease estimated to 9 years 10 to 20 years Less than 5 years More than 20 years unknown 39% Male Female

21 Genotypes % n=542 95,6% 1 53% 3 34% 1% 5% mix 4% 5 0,2% 4 7% 52% 37% 54% 28% homens 3%0% 7% 8% 5% 0% mulheres

22 Genotypes

23 Genotypes ,2% 2 2% 3 24,7% 4 9,4% outros 3,2% J.I. Esteban et al. / Journal of Hepatology 48 (2008)

24 Genotypes 2009 Genotype 1 Genotype 3 Genotype 4 65,1 % 21,5 % 4,4 % 49,6 % 32,4 % 6,3 % 59,5 % 23,7 % 10,3 % N= 1500

25 Immigration 2002 SEF Relatório elaborado pela DeltaConsultores no âmbito do Programa Sócrates,2002

26 Genotype 4

27 Viral load 2001 copies/ml n=314 Genotype 1=186 Genotype 3=125 25% 1M-2M 32% >2M <1M 43% 60% 40% Genotype 1 20% Genotype 3 <1M 1M-2M >2M

28 Table 1. Viremia According to Genotype and Region of the Country Viral load Region Genotype 1 Genotype 2/3 Genotype 4 HCV RNA (UI/mL) HCV RNA (UI/mL) HCV RNA (UI/mL) >800,000 N (%) 400, ,000 N (%) <400,000 N (%) >800,000 N (%) 400, ,000 N (%) <400,000 N (%) >800,000 N (%) 400, ,000 N (%) <400,000 N (%) North 55 (47) 29 (24) 34 (29) 9 (23) 6 (15) 25 (63) 1 (13) 2 (25) 5 (63) Center 35 (49) 13 (18) 23 (32) 24 (44) 6 (11) 24 (44) 3 (30) 2 (20) 5 (50) South 26 (50) 108 (20) 155 (29) 106 (42) 59 (24) 85 (34) 35 (39) 10 (11) 45 (50) Total 35 (50) 150 (21) 212 (29) 139 (40) 71 (21) 134 (39) 39 (36) 14 (13) 55 (51) N= 1213 > (45,4%) < (34,6%) > < (19,9%) Velosa J, 2009 (submetido)

29 VHB and VIH 2001 AgHbs AntiHBs AntiHBc AgHBe AntiHBe AntiD 10% 20% 30% 40% 3% 34,2% 40,4% 1,2% 19,6% 0,2% Hepatitis B: 1,05% HBV carrier: 1,41% HIV positive > 10%

30 Liver biopsy 2001 III 17% IV 4% 0 10% I 36% II 34% fibrose portal N 172

31 Liver biopsy 2009 Liver biopsy 614 patients Metavir classification F1 227 (38,7%) F2 192 (32,7%) F1/F2 440 (71,7%) F3 65 (11,1%) F4 102 (38,%) F3/F4 174 (28,3%) Without genotype association Low prevalence of cirrhosis genotype 3 North genotype 1 Center

32 Hepatocellular carcinoma Marinho R World J Gastroenterol 2007; 13(10): 1522

33 Final comment HCV prevalence 0,9% - 1.5% Genotypes predominance 1, 3 and 4 High viral load in genotype 1 and low in genotype 4 Liver biopsy 71.7% of patients with F1/F2 Hepatocellular carcinoma is increasing