a population-based surveillance study on the prevalence and treatment of hepatitis c in eston ia

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 carcinomarepresents 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

results: distribution by gender and age

results: distribution of risk factors

results: age and risk factors

results: distribution of diagnosis

results: distribution of diagnosis

results: c-chirrosis34% of patsients visit a doctor at the stage of cirrhosis.

results: distribution by genotypes

HCV genotypes in Estonia

results: age and genotypes

G1 starts from the age of 40, but in younger age groups the increasing importance G3

results: genotypes and risk factors

results: gender, age and genotypes

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

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