Epidemiology of Hepatitis C Infection. Pablo Barreiro Service of Infectious Diseases Hospital Carlos III, Madrid

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1 Epidemiology of Hepatitis C Infection Pablo Barreiro Service of Infectious Diseases Hospital Carlos III, Madrid

2 Worldwide Prevalence of Hepatitis C <1% 1% 2.4% 2.5% 4.9% 5% 10% >10% No data available WHO. Wkly Epidemiol Rec

3 Hepatitis C in Figures Worldwide prevalence 3% (170 M people) 1 Rate of chronification 75 85% 2 Rate of cirrhosis 10% in 20 years 20% in 30 years 2 Liver mortality (cirrhosis) 1 5% / per year 3 Hepatocarcinoma in cirrhotics 1 4% / per year 2 1. WHO. Hepatitis C. Fact sheet no CDC. MMWR CDC. Hepatitis C slide kit. September 25, 2000.

4 Distribution of Hepatitis C Genotypes 1a, 1b 2a, 2b, 3a 1a, 1b 2a, 2b, 2c, 3a 4 4 1b, 3a 2a 1b, 6 1b 1a, 1b, 2b, 3a 5a 3b 1b, 3a Fang et al. Clin Liver Dis

5 Distribution of HCV Genotype in the US Genotype 2, 3 22% Genotype 4, 5, 6 4% Genotype 1 74% Alter et al. N Engl J Med. 1999; Blatt et al. J Viral Hepatitis

6

7 HCV Prevalence by Selected Groups, US Hemophilia Injecting drug users Hemodialysis STD clients Gen population adults Surgeons, Nurses, PSWs Pregnant women Military personnel Average Percent Anti-HCV Positive Centers for Disease Control and Prevention

8 Prevalence of Hepatitis C by Age & Ethnicity, in the US 7 HCV-Ab positive (%) Blacks Whites =70 Age group (years) Hispanics Adaptado de Alter. N Engl J Med

9 Estimated Incidence of Acute HCV, U.S. New Infections/100, N~240,000/yr Decline in transfusion recipients Decline in injection drug users N~30, Year Centers for Disease Control and Prevention, 2005 Armstrong GL. Hepatology 2000;31: Alter MJ. Hepatology 1997;26:62S-65S

10 Prevalence of Hepatitis C in Spain Area Population (n) Prevalence* Author Year Cataluña General (2,154) 2.6% Sola 2002 La Rioja Urban (890) 2% Sacristán 1996 Galicia General (1,170) 1.6% Riestra 2001 Murcia General (2,203) 1% Gª-Fulgueira 1996 Zamora General (675) 0.7% Chimeno 2001 Alicante Drug addicts (832) 82% Esteban 1997 Madrid Immigrants 8.8% López-Velez 2003 Spain Estimated 2% *according to HCV-Ab positivity Around 70% of HCV-Ab positive are HCV-RNA positive

11 Prevalence of HCV infection in the United States 3,5 Risk factors 3 % 2,5 2 * * * * 1,5 1 0,5 0 Gender Socioeconomic Education Race males / females low-medium / high low / high others / white *p<0,05 Alter M. NEJM 1999

12 Prevalence of HCV infection in the US 6 5 Other risk factors * * Odds Ratio * >2 >50 * 0 *p<0.05 Marijuana Cocaine N sexual partners Early sexual intercourse Alter M. NEJM 1999

13 Exposures not associated with acquiring HCV infection Exposure Cases Controls (previous 6 months) (n=148) (n=200) Medical procedures 30.4% 29.5% Dental work 24.3% 23.5% Health care work (no blood contact) 4.1% 5.0% Ear piercing 2.7% 3.0% Tattooing 0.7% 0.5% Acupuncture 0 1.0% JID 1982;145:886-93; JAMA 1989;262:

14 Overlapping HCV & HIV epidemics HIV Hep C million 175 million million

15 HCV and HIV routes of transmission Percutaneous Injection drug use Transfusion, Transplant Therapeutic Occupational Permucosal Sexual Occupational Vertical Centers for Disease Control and Prevention

16 HCV and HIV in Figures in the US HCV HIV Incidence ,000 40,000 Prevalence 1, 3, M 0.94 M Deaths/year 1, 2, 5 8,000 10,000 15, CDC. Viral hepatitis C fact sheet. 2. CDC. HIV/AIDS Surveillance Report CDC. Viral hepatitis C fact sheet. 4. UNAIDS/OMS. AIDS epidemic update. 5. CDC. Viral hepatitis B frequently asked questions.

17 Danta M. CROI 2006 (abst 86)

18 Acute hepatitis C outbreaks in HIV+ MSM, UK Median number of different patners (12 months) * 20 Number * Cases (n=59) Controls (n=121) 5 0 Partners One-night stands *p<0.01 Danta M. CROI 2006 (abst 86)

19 Acute hepatitis C outbreaks in HIV+ MSM, UK Group sex risk factors % participating (12 months) * Group sex * Receptive UAI * Insertive UAI Receptive fisting * Insertive fisting * Drugs * Cases (n=52) Controls (n=63) UAI: unprotected anal intercourse; *p<0.01 Danta M. CROI 2006 (abst 86)

20 Prevalence of Chronic Viral Hepatitis in HIV Infected Patients 2,168 patients at the Hospital Carlos III Cohort 59% HCV alone HBV alone HCV+HBV HCV+HBV+Delta None 36% 1% 1% 3% Castellares, et al. J Hepatol (submitted)

21 Mean progression to cirrhosis among HIV+ is 25 years 3-fold faster in HIV pos than in HIV neg Fibrosis Grades (METAVIR Score) HIV+ (n = 122) Controls (n = 122) Duration of HCV Infection (years) Benhamou et al. Hepatology 1999 Soto et al. J Hepatol. 1997;26 :1-5

22 Fibrosis in Patients with Chronic Hepatitis C and Elevated ALT HIV negative (n=476) HIV positive (n=914) by biopsy (n=408) by elastometry F01 F2 F3 F4 Metavir Score 1 Forns et al. Hepatology 2002; 36: Martin-Carbonero et al. CID 2004; 38:

23 Risk of Cirrhosis and ESLD in HIV/HCV vs HCV alone Study N RR of Cirrhosis (95% CI) RR of ESLD (95% CI) Makris et al ( ) 10.8) 4.21 ( ) Soto et al ( ) -- Pol et al ( ) -- Benhamou et al ( ) -- Eyster et al (0.6-17) Telfer et al ( ) Lesens et al ( ) 25.5) Graham et al. 1, ( ) 6.14 ( )

24 Prevalence of Cirrhosis According to Liver Condition in HIV Infected Patients 2,168 patients at the Hospital Carlos III Cohort Cirrhosis (%) [95% CI] No. of patients 8.3 [ ] 19.2 [ ] 6.1 [ ] 41.7 [ ] 66.7 [ ] All HCV HBV HCV+HBV HCV+HBV +Delta 2, [ ] Alcohol 1.1 [ ] None/ Unknown 574 1,055 Castellares, et al. J Hepatol (submitted)

25 Chronic Hepatitis C: Mortality and Cumulative Costs Estimates for in the US Deats related Deaths due to CHC Cost 165,900 27,200 $10,700 M Wong et al. Am J Public Health

26 Impact of Chronic Hepatitis C in Coming Years ( ) Liver transplant 528% Liver decompensation Liver related deaths 223% 279% Hepatocarcinoma 68% Liver cirrhosis 61% Increase in 10 years (%) Davis et al. Hepatology

27 Liver Transplant in the US HCV related Other causes No. of patients Calendar year Kim. Hepatology

28 Chronic Hepatitis C Widely distributed Significantly prevalent in Western countries Frequently associated to HIV infection Source of clinical complications and mortality Impact on the health care system on the rise in coming years

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