Prevalence of hepatitis C in the spanish population. The prevhep study (ethon cohort)

Lavin, Arye; Perelló, Christie; Llerena, Susana; Gómez, Martín; Escudero, María Desamparados; Rodríguez, Laudina; Estébanez, Á.; Gámez, Beatriz; Puchades, Laura; Cabezas, Joaquín; Serra, M.Á.; Calleja, José Luís; Crespo, Javier

doi:10.1016/s0168-8278(17)30857-7

Cited by 21 publications

(8 citation statements)

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ArTicle IntroductIonHepatitis C virus (HCV) is a leading cause of liver-related morbidity and mortality worldwide, especially in Mediterranean countries where prevalence rates range from 1 to 3% in the general population [1]. In Spain, the latest population-based data collected during 2016 estimated anti-HCV and viremic (HCV-RNA detectable) prevalences lower than expected (1.2 and 0.4%, respectively) [2,3].The problem is exacerbated in prisons and other closed settings (i.e. jails, pre-trial detention centers, psychiatric institutions, etc.

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mentioning

confidence: 99%

Microenvironment Eradication of Hepatitis C: A Novel Treatment Paradigm

Cuadrado

Llerena

Cobo³

et al. 2018

American Journal of Gastroenterology

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confidence: 99%

Microenvironment Eradication of Hepatitis C: A Novel Treatment Paradigm

Cuadrado

Llerena

Cobo³

et al. 2018

American Journal of Gastroenterology

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“…The seroprevalence of HCV infection in Spain is 1.1% 9 and hepatitis C leads the list of infectious disease related mortality 10 . GT1 accounts for 67% of all HCV infections and GT1a causes 40% of all GT1 infections 11 .…”

Section: Introductionmentioning

confidence: 99%

Epidemic history and baseline resistance to NS5A-specific direct acting drugs of hepatitis C virus in Spain

Palladino

Ezeonwumelu

Maté-Cano

et al. 2020

Sci Rep

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Hepatitis C virus (HCV) infection remains a global health problem. Previously, the prevalence of NS5A resistance-associated substitutions (RASs) to elbasvir, a new direct-acting antiviral (DAA) against the NS5A viral protein was assessed by our group before its introduction into clinical use in Spain. However, the origin, epidemic history, transmission dynamics, diversity and baseline RASs to NS5A direct-acting agents of HCV-GT1a in Spain remain unknown. A nationwide cross-sectional survey of individuals chronically-infected with HCV-G1a and DAAs-naïve was performed. HCV population sequencing, phylogenetic analysis and Bayesian methods were used. GT1a clade II was more prevalent than clade I (82.3% vs. 17.7%; P < 0.001) and older (estimated origin in 1912 vs. 1952). Clade II epidemic is currently declining whereas clade I epidemic has reached equilibrium. A total of 58 single RASs were identified, which account for the moderate level (10%) of baseline resistance observed. When considering the regional data, marked differences were observed, with thirteen regions showing an intermediate level (5-15%) and one a high level (20%) of resistance. Current HCV-GT1a epidemic in Spain is driven by clade I which seem to have different dissemination routes relative to clade II. A moderate level of baseline RASs to NS5A-DAAs with marked differences among regions was observed. Close surveillance of response to treatment with DAAs will be important. Hepatitis C virus (HCV) infection is a global health problem with latest data estimates 71.1 million viraemic chronic infections (1.1% of world population) 1. HCV displays high genetic heterogeneity and is classified into eight major genotypes (1-8) 2 and 86 subtypes 3. Worldwide there are significant differences in epidemic history among the HCV genotypes (GT) which may differ in response to treatment, with GT1 being the most represented 4. Among HCV-infected patients also coinfected with human immunodeficiency virus (HIV) subtype 1a (GT1a) prevails 5-7. Despite the high rates of cure with the new direct-acting antivirals (DAAs), the presence of NS5A resistance-associated substitutions (RASs) may compromise the efficacy of NS5A inhibitors. Recently, Zeuzem and colleagues (2017) observed that pretreatment ledipasvir-specific RASs (identified in 8-16% of patients) may compromise treatment outcome particularly in treatment-experienced patients with GT1a, as they found a sustained virological response (SVR) rate of only 76% in patients with pretreatment RASs 8. The seroprevalence of HCV infection in Spain is 1.1% 9 and hepatitis C leads the list of infectious disease related mortality 10. GT1 accounts for 67% of all HCV infections and GT1a causes 40% of all GT1 infections 11. Until October 2018 117,452 patients had access to DAAs and 95.5% had SVR in the frame of the national plan of universal access to treatment 12 while 1.1% of those cured are reinfected 7 .

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“…Eso es así porque los presos presentan una prevalencia de infección por VHC mucho más alta que la población no encarcelada y porque, además, tratarlos con éxito implica reducir tanto el riesgo de transmisión como la carga de la enfermedad. En concreto, se estima que en España la infección por VHC es 8-14 veces más prevalente en presos que en no presos (8,2-14,8% frente al 0,8-1,2%) [3][4][5][6][7] , a pesar de que los casos incidentes en reclusos se han reducido mucho en los últimos años 8,9 .…”

Section: Introductionunclassified

Cost-effectiveness analysis of chronic hepatitis C treatment in the prison population in Spain

Marco

Domínguez-Hernández

Casado

2020

Rev Esp Sanid Penit

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Evaluar, en presos con hepatitis C crónica (HCc) pendientes de tratamiento, el coste-efectividad de tratarlos con antivirales de acción directa (AAD) frente a no tratarlos, y analizar el impacto clínico y económico del tratamiento sobre las complicaciones hepáticas y la mortalidad. Material y método: Se desarrolló un modelo de Markov para simular el tratamiento y proyectar la progresión de la enfermedad de una cohorte estimada de 4.408 reclusos con HCc tratados con AAD en dos años (el 50% cada año) frente a ningún tratamiento. En los tratados, se asoció una respuesta viral sostenida del 95%. Las características de los pacientes, las probabilidades de transición, las utilidades y los costes (farmacológicos y estados de salud) se obtuvieron de publicaciones científicas. El modelo estimó costes y resultados en salud, la relación coste-utilidad incremental (RCUI), a partir de los costes totales y años de vida ajustados por calidad (AVAC) y los eventos clínicos evitados. La perspectiva fue la del Sistema Nacional de Salud (SNS) y se aplicó una tasa de descuento anual (el 3%) para costes y resultados en salud. La robustez de los resultados se evaluó mediante un análisis de sensibilidad. Resultados: En la población tratada, el modelo estimó una reducción del 92% de los casos de cirrosis descompensada y del 83% de carcinoma hepatocelular, se evitaron 132 trasplantes hepáticos y disminuyó el 88% la mortalidad hepática. El tratamiento consiguió 5,0/AVAC adicionales (21,2 frente al 16,2), con un coste incremental de 3.473 euros (24.088 € frente a 20.615 €) por paciente y una RCUI de 690 €/AVAC ganado. Discusión: Considerando el umbral de disponibilidad a pagar utilizado en España (22.000-30.000 €/AVAC), el tratamiento con AAD en los presos con HCc es una estrategia altamente coste-efectiva, reduce la transmisión, aumenta la supervivencia y reduce las complicaciones hepáticas, así como los costes asociado a su manejo.

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Prevalence of hepatitis C in the spanish population. The prevhep study (ethon cohort)

Cited by 21 publications

References 0 publications

Microenvironment Eradication of Hepatitis C: A Novel Treatment Paradigm

Microenvironment Eradication of Hepatitis C: A Novel Treatment Paradigm

Epidemic history and baseline resistance to NS5A-specific direct acting drugs of hepatitis C virus in Spain

Cost-effectiveness analysis of chronic hepatitis C treatment in the prison population in Spain

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