Transcript Slide 1
A population-based surveillance study on the prevalence and treatment of hepatitis C in Estonia Kairi Mansberg PhD student University of Tartu, Department of Internal Medicine
background
• hepatitis C infection is a significant public health problem and a leading cause of chronic liver disease in Estonia • Estonian Society of Gastroenterology • multi-center, open-label study • study cohort of consecutive patients with acute hepatitis C, chronic hepatitis C, C-related cirrhosis, C-related hepatocellular carcinoma represents of the real-life situation
aim
• characterize the patients with hepatitis C • analyse a real-life hepatitis C cohort of patients • describe the risk factors of hepatitis C • analyse antiviral treatment in real-life situation
material and methods (1)
• patients consecutively referred as in-patients and out patients were recruited in 7 divisions of 5 hospitals by 37 gastroenterologists / infectious disease doctors • patients were required to meet the criteria of acute hepatitis C, chronic hepatitis C, C-related cirrhosis or C-related hepatocellular carcinoma • patients were included during a one-year recruitment period, 01.02.09-31.01.10 and followed till 31.07.11
• informed consent was obtained from all patients • Ethics Review Committee on Human Research of the University of Tartu approval was obtained
material and methods (2)
• web-based eCase Report Form is used for data registration • data are entered into an eCRF by doctor • in the course of the study, the study monitor make site visits to verify eCRFs against source documentation • monitoring is conducted in each study center 4 times per year • data were analysed using descriptive statistics program Stata 10,0
results : 518 patients were included
47% 53% male(n=271) female(n=247)
results
:
distribution by gender and age
80 70 60 50 40 30 20 10 0 -29 30-39 40-49 50-59 60-69 70 male female
results: distribution of risk factors
IVDU; 12% Risk due to a profession; 3% unknown cause of infection; 40% blood transfusion before 1994 ; 28% haemodialysis; 0% Piercing; 2% Acupuncture; 0% Tattoo; 8% Sexual contact with HCV pt; 4% blood transfusion after 1994 ; 3%
results: age and risk factors
25 20 15 10 5 0 45 40 35 30 -29 30-39 IVDU blood transfusion after 1994 acupuncture 40-49 50-59 Risk due to a profession Sexual contact with HCV pt Piercing 60-60 blood transfusion before 1994 Tattoo haemodialysis 70-
results
:
distribution of diagnosis
hepatocellular carcinoma 1% acute hepatitis C 1% C-chirrosis 12% chronic hepatitis C 86%
results: distribution of diagnosis
results: c-chirrosis
34% of patsients visit a doctor at the stage of cirrhosis .
34% 66%
results: distribution by genotypes
G2 6% G3 25% G1 69%
HCV genotypes in Estonia
results
:
age and genotypes
60 50 40 30 100 90 80 70 20 10 0 -29 30-39 40-49 50-59 60-69 70 G1 starts from the age of 40, but in younger age groups the increasing importance G3 GT 1 GT 2 GT 3
160 140 120 40 20 0 100 80 60
results: genotypes and risk factors
IVDU Risk due to a profession blood transfusion before 1994 blood transfusion after 1994 Sexual contact with HCV pt Tattoo Acupuncture Piercing haemodialysis G1 G2 G3
results
:
gender, age and genotypes
70 60 50 40 30 20 10 0 -29 30-39 40-49 50-59 60-69 70 -29 30-39 40-49 50-59 60-69 male female G1 is most prevalent among male pt aged 40-49 and female pt aged 50-59. G3 is common in younger age groups of men and women 70 GT 1 GT 2 GT 3
conclusions (1)
• study cohort of consecutive 518 patients is representative of the real-life situation • prevailing genotype in Estonia is 1B, but our data indicate the increasing importance of genotype 3 • in many patients HCV liver disease is diagnosed too late – in HCV-related cirrhosis stage
conclusions (2)
• 265 patients started antiviral treatment during the study period, which makes up 79% of all Estonian patients in whom treatment was started during the same period
Plans for the future
• to analyse antiviral treatment results in real-life situation – RVR, pEVR, cEVR, SVR – relapsers, nonresponders • to analyse adverse events during antiviral treatment in real-life situation • potential cooperation with Department of Microbiology of University of Tartu
Acknowledgements Estonian Society of Gastroenterology Roche Estonia OÜ Tartu University Hospital
Riina Salupere, Karin Kull, Katrin Labotkin, Hele Remmel, Seren Kivi, Leana Sits, Tiina Prükk, Rita Pihlak, Svetlana Proškina, Külliki Ainsalu
West Tallinn Central Hospital
Külliki Suurmaa, Vadim Brjalin, Anu Mäelt, Marina Levitševa, Kristi Ott, Nele Rasmann,Tiiu Aug, Dagmar Mägi
East Talinn Central Hospital
Triin Remmel, Maie Aua, Asta Kolde, Ene Halling, Benno Margus, Toomas Kariis, Peeter Kõiva
Pärnu Hospital
Krista Jaago, Kadi Kenk, Urve Mardna
East Viru Central Hospital
Jelena Šmidt, Svetlana Semjonova