Predicted Effects of Treatment for HCV Infection Vary Among European Countries
Predicted Effects of Treatment for HCV Infection Vary Among European Countries
复制标题
DOI：
10.1053/j.gastro.2012.05.054
复制
发表时间：
2012-10-01
期刊：
影响因子：
29.4
通讯作者：
Mathurin, Philippe
中科院分区：
文献类型：
--
作者：
Deuffic-Burban, Sylvie;Deltenre, Pierre;Mathurin, Philippe
背景与目的：丙型肝炎病毒（HCV）感染的动态，以及筛查实践和获得治疗的机会，在欧洲国家之间存在差异。重要的是要确定这种差异对感染发病率和死亡率的影响程度。我们比较了比利时、法国、德国、意大利、西班牙和英国的感染动态、筛查和治疗实践。我们还评估了聚乙二醇干扰素治疗的效果和蛋白酶抑制剂三联治疗的额外效果。方法：我们根据已发表的流行病学数据（关于HCV患病率、筛查、基因型、患者饮酒和治疗）以及6个国家的竞争性和肝细胞癌死亡率报告，创建了一个国家特异性HCV进展的马尔可夫模型。该模型用于预测每个国家到2021年的HCV相关肝硬化发病率及其死亡率。结果：从2002年到2011年，抗病毒治疗使肝硬化的累积发病率降低了7.1%，总体死亡率降低了3.4%。发病率和死亡率的下降幅度从意大利的4.0%和1.9%分别降至法国的16.3%和9.0%。从2012年到2021年，HCV基因型1感染患者的抗病毒治疗，包括基于蛋白酶的三联疗法，将使肝硬化的累积发病率降低17.7%，死亡率降低9.7%。预计下降幅度最小的是意大利（发病率下降10.1%，死亡率下降5.4%），下降幅度最大的是法国（分别下降34.3%和20.7%）。结论：尽管不同国家采用相同的疗法治疗HCV感染，但这些疗法对发病率和死亡率的影响差异很大。除了基于病毒学应答指导治疗的共同指南外，还需要基于人群指导治疗的公共卫生政策。
BACKGROUND & AIMS: The dynamics of hepatitis C virus (HCV) infection, as well as screening practices and access to therapy, vary among European countries. It is important to determine the magnitude of the effects of such differences on incidence and mortality of infection. We compared the dynamics of infection and screening and treatment practices among Belgium, France, Germany, Italy, Spain, and the United Kingdom. We also assessed the effects of treatment with pegylated interferon and additional effects of triple therapy with protease inhibitors. METHODS: We created a country-specific Markov model of HCV progression based on published epidemiologic data (on HCV prevalence, screening, genotype, alcohol consumption among patients, and treatments) and reports of competitive and hepatocellular carcinoma mortality for the 6 countries. The model was used to predict the incidence of HCV-related cirrhosis and its mortality until 2021 for each country. RESULTS: From 2002 to 2011, antiviral therapy reduced the cumulative incidence of cirrhosis by 7.1% and deaths by 3.4% overall. Reductions in incidence and mortality values ranged from 4.0% and 1.9%, respectively, in Italy to 16.3% and 9.0%, respectively, in France. From 2012 to 2021, antiviral treatment of patients with HCV genotype 1 infection that includes protease inhibitor-based triple therapy will reduce the cumulative incidence of cirrhosis by 17.7% and mortality by 9.7% overall. The smallest reduction is predicted for Italy (incidence reduced by 10.1% and mortality by 5.4%) and the highest is for France (reductions of 34.3% and 20.7%, respectively). CONCLUSIONS: Although HCV infection is treated with the same therapies in different countries, the effects of the therapies on morbidity and mortality vary significantly. In addition to common guidelines that are based on virologic response-guided therapy, there is a need for public health policies based on population-guided therapy.