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Estudio de prevalencia de infección por los virus hepatitis B y C en Cataluña
... According to recent studies, the Spanish Liver Research Association (AEEH) estimates that the prevalence of CHB amongst the Spanish population stands at 0.5% to 0.8%, although this prevalence may have been negatively affected in recent years by the arrival of an immigrant population from countries with high levels of endemicity 9 , since almost half of the persons currently infected with HBV in Catalonia are immigrants 10 . ...
Background: The epidemiology of chronic hepatitis B (CHB) in Spain has changed due to migratory movements and the implementation of vaccination programs. The objective is to determine if prevalence has also changed amongst in Catalonia and the potential predictive variables of the infection. Material and method: Observational cross-sectional multi-centre study of CHB prevalence. Epidemiological and clinical variables were included, and their predictive capacity is analysed by means of a multivariable logistic regression model. Results: A total of 6508 prisoners were studied. CHB prevalence was 1.7%, much less than in studies carried out in previous years. In inmates from North Africa, Asia, Eastern Europe, and Sub-Saharan Africa the CHB rate was 2.8, 4.2, 4.9 and 16.2 times higher, respectively, than amongst those born in Spain, which was 0.6%, the same as in the general population. CHB was associated with: a) being an immigrant [2.6%; OR: 4.18 (CI: 2.50-6.90; P <0.001); b) being unvaccinated (3.1%; OR: 0.13; CI: 0.06-0.26; P <0.001); and c) being infected by the human immunodeficiency virus (HIV) [3.9%; OR: 3.23; CI: 1.24-8.40; P = 0.016]. Conclusion: Vaccination against HBV (hepatitis B virus) has greatly reduced CHB prevalence in inmates over the past 30 years but remains high in immigrants and those with HIV. We recommend: a) maintaining HBV screening amongst inmates; b) continuing with vaccination programmes; and c) referring CHB cases to specialized programs for further study and treatment if needed.
... Según los últimos datos publicados, afecta a más de 70 millones de personas, lo que supone el 1% de la población mundial (1,2). Estudios recientes efectuados en España durante los últimos 3 años estiman que la seroprevalencia de anti-virus de la hepatitis C (VHC) oscila entre el 0,8 y el 1,2% de la población adulta, mientras que entre el 0,2 y el 0,4% muestran una infección activa por el VHC y, por lo tanto, están en riesgo de desarrollar a medio-largo plazo una cirrosis hepática y las complicaciones asociadas a ella (3)(4)(5)(6). Una parte importante de estos sujetos ya han sido diagnosticados y tratados, aunque existe un número relativamente elevado de pacientes que desconocen que tienen una hepatitis C, sobre todo en pacientes mayores de 50 años, como nos muestra el estudio de seroprevalencia del Ministerio (7). En resumen, los resultados definitivos de la encuesta efectuada por el Ministerio de Sanidad (7), en una muestra de 9.103 sujetos de población general, es el siguiente: 9.002 fueron negativas y se detectaron 66 muestras anti-VHC positivas (0,69%). ...
The Spanish Association for the Study of the Liver (AEEH) is convinced that the
elimination of hepatitis C virus (HCV) in Spain is possible as long as we are able to use the
resources and tools necessary for it. This document reflects the position of the AEEH regarding
the elimination of HCV, establishing a wide range of recommendations that can be grouped into
five categories: 1) Screening of HCV according to age, of the existence of classic acquisition risk
factors of infection, active search of previously diagnosed patients and development of microelimination
strategies in vulnerable populations; 2) Simplification of HCV diagnosis (one-step
diagnosis and diagnosis at the point of patient care); 3) Simplification of patient treatment and
improvement of care circuits; 4) Health policy measures, and, finally, 5) Establishment of HCV
elimination indicators.
... Según los últimos datos publicados, afecta a más de 70 millones de personas, lo que supone el 1% de la población mundial 1,2 . Estudios recientes efectuados en España durante los últimos 3 años estiman que la seroprevalencia de anti-virus de la hepatitis C (VHC) oscila entre el 0,8 y el 1,2% de la población adulta, mientras que entre el 0,2 y el 0,4% muestran una infección activa por el VHC y, por lo tanto, están en riesgo de desarrollar a medio-largo plazo una cirrosis hepática y las complicaciones asociadas a ella [3][4][5][6] . Una parte importante de estos sujetos ya han sido diagnosticados y tratados, aunque existe un número relativamente elevado de pacientes que desconocen que tienen una hepatitis C, sobre todo en pacientes mayores de 50 años, como nos muestra el estudio de seroprevalencia del Ministerio 7 . ...
The Spanish Association for the Study of the Liver (AEEH) is convinced that the elimination of hepatitisC virus (HCV) in Spain is possible as long as we are able to use the resources and tools necessary for it. This document reflects the position of the AEEH regarding the elimination of HCV, establishing a wide range of recommendations that can be grouped into five categories: 1)Screening of HCV according to age, of the existence of classic acquisition risk factors of infection, active search of previously diagnosed patients and development of micro-elimination strategies in vulnerable populations; 2)Simplification of HCV diagnosis (one-step diagnosis and diagnosis at the point of patient care); 3)Simplification of patient treatment and improvement of care circuits; 4)Health policy measures, and, finally, 5)Establishment of HCV elimination indicators.
Copyright © 2019 Elsevier España, S.L.U. All rights reserved.
... Hepatitis C virus (HCV) infection is a major health problem affecting more than 71 million people worldwide [1]. In Spain, the latest studies show an HCV infection prevalence in the general population of between 0.87% and 1.19% [2,3]. The serious clinical outcomes of chronic received grant support and consultancy fees from AbbVie, Bayer, Bristol-Myers Squibb, Gilead and Merck, Sharp & Dhome; FGR has served as speaker for AbbVie, Gilead and BMS; MLM has served as a speaker for AbbVie, BMS, Gilead, Janssen, MSD and ViiV; as a consultant for AbbVie, BMS and Janssen and has received research funding from FIPSE 36465/03, FIPSE 36680/07.-NEAT ...
Background and aims:
Limited data are available on the effectiveness and tolerability of direct-acting antivirals (DAAs) therapies in the real world for HCV-infected patients with comorbidities. This study aimed to describe the effectiveness of OBV/PTV/r ± DSV (3D/2D regimen) with or without ribavirin (RBV) in HCV or HCV/HIV co-infected patients with GT1/GT4 and CKD (IIIb-V stages), including those under hemodialysis and peritoneal dialysis in routine clinical practice in Spain in 2015.
Material and methods:
Non-interventional, retrospective, multicenter data collection study in 31 Spanish sites. Socio-demographic, clinical variables, study treatment characteristics, effectiveness and tolerability data were collected from medical records.
Results:
Data from 135 patients with a mean age (SD) of 58.3 (11.4) years were analyzed: 92.6% GT1 (81.6% GT1b and 17.6% GT1a) and 7.4% GT4, 14 (10.4%) HIV/HCV co-infected, 19.0% with fibrosis F3 and 28.1% F4 by FibroScan®, 52.6% were previously treated with pegIFN and RBV. 11.1%, 14.8% and 74.1% of patients had CKD stage IIIb, IV and V respectively. 68.9% of patients were on hemodialysis; 8.9% on peritoneal dialysis and 38.5% had history of renal transplant. A total of 125 (96.2%) of 135 patients were treated with 3D, 10 (7.4%) with 2D and 30.4% received RBV. The overall intention-to-treat (ITT) sustained virologic response at week 12 (SVR12) was 92.6% (125/135) and the overall modified-ITT (mITT) SVR12 was 99.2% (125/126). The SVR12 rates (ITT) per sub-groups were: HCV mono-infected (91.7%), HCV/HIV co-infected (100%), GT1 (92.0%), GT4 (100%), CKD stage IIIb (86.7%), stage IV (95%) and stage V (93%). Among the 10 non-SVR there was only 1 virologic failure (0.7%); 4 patients had missing data due lost to follow up (3.0%) and 5 patients discontinued 3D/2D regimen (3.7%): 4 due to severe adverse events (including 3 deaths) and 1 patient´s decision.
Conclusions:
These results have shown that 3D/2D regimens are effective and tolerable in patients with advanced CKD including those in dialysis with GT 1 or 4 chronic HCV mono-infection and HIV/HCV coinfection in a real-life cohort. The overall SVR12 rates were 92.6% (ITT) and 99.2% (mITT) without clinically relevant changes in eGFR until 12 weeks post-treatment. These results are consistent with those reported in clinical trials.
... (8), Valencia 1.14% (95% CI: 0.73-1.55%) (9), Ethon-cohort (Valencia, Cantabria and Madrid) 1.23% (10) and Catalonia 1.1% (11). According to data published by the Spanish Government (6), more than 117,000 people with HCV have been treated with the new direct acting antiviral (DAA) drugs in Spain as of the end of 2018. ...
Background:
Spain needs to increase the number of new known cases in order to achieve the goal of eliminating hepatitis C virus (HCV) by 2030. The aim of this study was to estimate the number of HCV cases among the migrant population in Spain and propose different scenarios for micro-elimination strategies, targeting the most relevant migrant groups.
Methodology:
this epidemiological and demographic cross-sectional descriptive study employed a systematic approach to estimate the number of migrants infected by HCV in Spain. Estimates are based on demographic data and details the size of the foreign-born population living in every Spanish province and the anti-HVC+ prevalence rates in their respective countries of origin.
Results:
in Spain, there are 100,268 estimated cases of anti-HCV+ among the total adult migrant population who live in the country. The estimated cases of anti-HCV+ among migrants from moderate-high endemic countries with a prevalence of ≥ 2%, > 3%, > 4% and > 5% are 48,979, 48,029, 24,176 and 15,646, respectively. The anti-HCV+ endemic countries (≥ 2%) that contribute to the highest number of estimated cases in Spain are Romania, Italy, Pakistan, Ukraine, Senegal, Russia and Nigeria. The autonomous communities with the highest prevalence and number of estimated anti-HCV+ cases among migrant population are Catalonia, Valencian Community, Madrid and Andalusia, respectively.
Conclusion:
these data show the need to establish HCV screening strategies for the migrant population in Spain and, particularly, in the most affected areas. The strategy should target those migrant communities with a higher prevalence and a higher number of estimated cases, such as people from Eastern Europe, Sub-Saharan Africa and Pakistan.
Resumen
La llegada de los actuales tratamientos antivirales de acción directa ha supuesto un cambio trascendental en el abordaje terapéutico de la hepatitis C, aumentando las tasas de curación por encima del 90% y aportando una importante simplificación del tratamiento que se traduce en beneficios para el paciente, para el clínico y para el sistema de salud. Alcanzar la curación sea cual sea el paciente, con una tolerabilidad similar al placebo y con pocas interacciones farmacológicas con la medicación concomitante, permitiendo una mejoría de la calidad de vida y bienestar del paciente, posibilita además la optimización del abordaje del paciente de forma multidisciplinar; así se reducen los costes tanto a corto como a largo plazo. De esta manera, se facilita la universalidad del tratamiento, con terapias menos condicionadas a determinados factores que permiten obtener mejores resultados en un mayor número de pacientes, y se puede aspirar a la eliminación de la enfermedad.
Información sobre el suplemento: este artículo forma parte del suplemento titulado “El valor de la simplicidad en el tratamiento de la hepatitis C”, que ha sido patrocinado por Gilead.
© 2019 Elsevier España, S.L.U. Todos los derechos reservados.
Background:
hepatitis C, besides health impairment, results in significant loss of productivity and diminished quality of life, and noticeably contributes to health expenditure increases. Because of all this, the Spanish Ministry of Health (Ministerio de Sanidad, Consumo y Bienestar Social - MSCBS) implemented in 2015 a strategic plan for managing hepatitis C (Plan Estratégico para el Abordaje de la Hepatitis C - PEAHC) within the National Health System. However, the PEAHC includes no screening plan. The MSCBS developed a framework document on population screening (Documento Marco sobre Cribado Poblacional) that defines the criteria a disease must meet in order to consider implementing a screening program. Specifically, it defines 4 criteria related to the health issue, 4 related to the screening test, and 3 criteria dealing with diagnosis confirmation and treatment.
Objective:
to identify whether there is scientific evidence to support hepatitis C meeting the criteria to be considered a disease qualifying for a population screening strategy in Spain.
Methods:
a literature search for scientific evidence concerning each required criterion for implementing a population screening plan for hepatitis C in Spain.
Results:
sufficient scientific evidence was found to support hepatitis C meeting the criteria required by the MSCBS for the implementation of a population screening program.
Conclusions:
according to the available scientific evidence, hepatitis C in Spain meets the required criteria to qualify for consideration of population screening plan.
Purpose of Review
In this review, the peculiarities of infection and treatment of HCV in the prison population are detailed. In addition, the barriers to HCV treatment and possible solutions are highlighted.
Recent Findings
Several previous experiences of HCV treatment in prisons have been successful. In this manuscript, we detail the most relevant.
Summary
We think that incarceration should be considered an opportunity to engage this population in health care. Therefore, we should encourage systematic screening of these patients and promote the access to treatment by supporting equity with the general population. Thus, inmates’ care must involve a multidisciplinary team. To solve this matter, we propose telehealth to bring together all these services and overcome the geographical barrier(s) and improve costs. Then, to go further in hepatitis C elimination, harm-reduction programs should be added to treat with direct-acting antivirals.
Background
Reflex testing of antibodies and viral load in the same sample for diagnosing hepatitis C virus infection speeds up access to treatment. However, how hepatitis C is diagnosed in Spanish hospitals is unknown.
Objective
To describe the available resources and procedures for the diagnosis of hepatitis C virus infection in Spain.
Methods
Survey sent to public and private Spanish hospitals with teaching accreditation with at least 200 beds.
Results
Of the 160 hospitals that met the inclusion criteria, 90 centres (response rate 56.3%) completed the survey. Two hospitals (2.2%) have no diagnostic resources, 15 (16.7%) can only test for anti-hepatitis C virus(Ab), 9 (10.0%) for Ab and viral load, 47 (52.2%) for Ab, viral load and genotype, 2 (2.2%) for Ab, viral load and core antigen, and 15 (16.7%) can perform Ab, core antigen, viral load and genotype tests. When an Ab test is positive, 28 (31.1%) hospitals perform reflex testing. When an active infection is diagnosed, some communication strategy is used in 62 (68.9%) hospitals. Approximately 44.2% of the respondents believe that all determinations needed to reach a definitive diagnosis should be done on a single blood sample.
Conclusion
Although 81% of Spanish hospitals have the resources to perform reflex hepatitis C virus infection testing, it is only done in 31%, and less than a half of respondents believe that the definitive diagnosis should be performed on a single sample.
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