Disease burden of chronic hepatitis C in Brazil
Disease burden of chronic hepatitis C in Brazil
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DOI：
10.1016/j.bjid.2015.04.004
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发表时间：
2015-08-01
影响因子：
3.4
通讯作者：
Mendes-Correa, Maria Cássia
中科院分区：
文献类型：
--
作者：
Ferreira, Paulo Roberto Abrão;Brandão-Mello, Carlos Eduardo;Mendes-Correa, Maria Cássia
背景：丙型肝炎病毒感染是肝硬化的主要原因；肝细胞癌;还有肝移植。本研究的目的是从全国的角度估计丙型肝炎病毒疾病的进展和疾病负担。方法：采用建立的模型预测丙型肝炎病毒疾病进展及肝病各阶段病例数；对巴西丙型肝炎病毒感染人群和相关疾病进展进行了量化。比较了两种不同策略的影响：更高的持续病毒学反应和治疗合格率(1)或更高的诊断和治疗率与增加的持续病毒学反应率相关(2)。结果：到2030年，预计感染人数将下降35%（1,255,000人）；代偿性肝硬化（325900例）和失代偿性肝硬化（45000例）；肝细胞癌（n=19,100）；与肝脏相关的死亡（n= 16700）预计将在2028年至2032年间达到峰值。策略2；与2013年（11,740例治疗）相比，2020年治疗病例增加了十倍以上（118,800例治疗）；持续的病毒学应答增加到90%，治疗合格性增加到95%。在这一战略下；2013年至2030年期间，感染人数减少了90%。与基本情况相比；到2030年，肝脏相关死亡减少70%；而丙型肝炎病毒相关的肝癌和失代偿性肝硬化分别下降了75%和80%；分别。结论：虽然巴西丙型肝炎病毒的发病率和流行率正在下降；晚期肝病病例持续上升。此外，更高的持续病毒学应答率；应采取新的战略，重点提高确诊患者的比例和治疗资格，以减轻巴西丙型肝炎病毒感染的负担。(C) 2015 Elsevier Editora ltd .版权所有。
Background: Hepatitis C virus infection is a major cause of cirrhosis; hepatocellular carcinoma; and liver transplantation. The aim of this study was to estimate hepatitis C virus disease progression and the burden of disease from a nationwide perspective.Methods: Using a model developed to forecast hepatitis C virus disease progression and the number of cases at each stage of liver disease; hepatitis C virus-infected population and associated disease progression in Brazil were quantified. The impact of two different strategies was compared: higher sustained virological response and treatment eligibility rates (1) or higher diagnosis and treatment rates associated with increased sustained virological response rates (2).Results: The number of infected individuals is estimated to decline by 35% by 2030 (1,255,000 individuals); while the number of cases of compensated (n =325,900) and decompensated (n=45,000) cirrhosis; hepatocellular carcinoma (n=19,100); and liver-related deaths (n=16,700) is supposed to peak between 2028 and 2032. In strategy 2; treated cases increased over tenfold in 2020 (118,800 treated) as compared to 2013 (11,740 treated); with sustained virological response increased to 90% and treatment eligibility to 95%. Under this strategy; the number of infected individuals decreased by 90% between 2013 and 2030. Compared to the base case; liver-related deaths decreased by 70% by 2030; while hepatitis C virus-related liver cancer and decompensated cirrhosis decreased by 75 and 80%; respectively.Conclusions: While the incidence and prevalence of hepatitis C virus in Brazil are decreasing; cases of advanced liver disease continue to rise. Besides higher sustained virological response rates; new strategies focused on increasing the proportion of diagnosed patients and eligibility to treatment should be adopted in order to reduce the burden of hepatitis C virus infection in Brazil. (C) 2015 Elsevier Editora Ltda. All rights reserved.