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