Unit:
Τομέας Παθολογικός - ΝοσηλευτικόςLibrary of the School of Health Sciences
Author:
Evangelidou Eftychia
Dissertation committee:
Ελευσινιώτης Ιωάννης, Αν. Καθηγητής, Νοσηλευτική, ΕΚΠΑ
Φιλντίσης Γεώργιος, Καθηγητής, Νοσηλευτική, ΕΚΠΑ
Τσουμάκας Κωνσταντίνος, Καθηγητής, Νοσηλευτική, ΕΚΠΑ
Λεμονίδου Χρυσούλα, Καθηγήτρια, Νοσηλευτική, ΕΚΠΑ
Μαυρογιάννης Χρήστος, Καθηγητής, Νοσηλευτική, ΕΚΠΑ
Κακλαμάνος Ιωάννης, Αν. Καθηγητής, Νοσηλευτική, ΕΚΠΑ
Μαριόλης Θεόδωρος, Επ. Καθηγητής, Νοσηλευτική, ΕΚΠΑ
Original Title:
Επιδημιολογικά - Ιολογικά χαρακτηριστικά και αποτελεσματικότητα της αγωγής σε χρήστες τοξικών ουσιών με χρόνια ηπατίτιδα C
Translated title:
Epidemiological and virological characteristics and treatment effectiveness among people who inject drugs (PWID) with chronic hepatitis C
Summary:
Introduction: The prevalence of HCV infection is estimated at > 185 million worldwide, and undiagnosed infections can increase this prevalence by 20-30%.
Aim: To evaluate a) HCV genotype distribution in chronic HCV-infected patients and b) the sustained virological response (SVR), at least 24 weeks after the end of treatment of chronic HCV – infected patients treated with Peginterferon/Ribavirin, presenting in a referral center for viral hepatitis of a public hospital in Athens, Greece within the last 6 years, September 2010- October 2016.
Method: This is a non-intervention observational study in patients with chronic hepatitis C (PWID – people who inject drugs or not PWID), with or without HIV coinfection, with or without a history of previous antiviral therapy.
The sample consisted of 660 patients (consequitive patients) with anti-HCV positive / 647 HCV-RNA positive intravenous drug users - IDUs or non-IDUs (transmission via blood transfusion or blood products, or via a cryprescriptional pathway), with or without co-infection of HIV, with or without a history of previous antiviral treatment and who had at least 2 recorded visits and completing an epidemiological report.
The collection of data (epidemiological, somatometric, haematological - biochemical, virological characteristics) for patients who completed the treatment was performed retrospectively, 2000-2010.
The collection of data for patients who were included in the study and whether or not have followed the treatment was prospective, 2010-2016.
Results: 660 anti-HCV(+)/ 647 HCV-RNA(+) (647 patients with chronic HCV infection) (group A: 346 PWID, 67.9% males, mean age 37.5 years, mean BMI 24.2, mean HCV-RNA 286.000 IU/ml and group B: 301 non-PWID, 46.2% males, mean age 48.3 years, mean BMI 25.2, mean HCV-RNA 403.700 IU/ml ) were evaluated for HCV genotype. Among PWID, 108 (33.5%) reported intravenous drug use beginning before 1990 (subgroup A1) and the rest 238 (66.5%) of them after 1990 (subgroup A2). 136 PWID (39.6% of PWID) and 115 non – PWID (38.2%) are treated with Peginterferon/Ribavirin.
From the sample, 98 patients (14.8%) had liver cirrhosis. Genotype 3 was dominant among group A patients (58.3%) followed by genotype 1 (27.1%) and genotype 4 (13.8%) whereas genotype 1 was dominant among group B patients (53.2%) followed by genotype 4 (19.7%) and genotype 3 (17%). The vast majority of genotype 1 infection among PWID (81.8%) presented the subtype 1a whereas subtype 1b was observed in the majority of genotype 1 infections among non-PWID (83.9%, p<0.001). It is important to note that 80% of genotype 3 infections among PWID observed in the subgroup A2 whereas 69% of genotype 4 infections among PWID observed in the subgroup A1. Genotype 1 infections among PWID were almost equally distributed in the subgroup A1 (41.7%) as well as in the subgroup A2 (58.3%). Sustained Virological Response (SVR) was observed in 63.4% (23/36) and 36.4% (20/55) of genotype 1 patients in groups A and B respectively (p <0.001), 54.3% (19/35) of genotype 4 patients and 80.6% (79/98) of genotype 3 patients. In the multivariable analysis, only the absence of cirrhosis (OR = 9.442, p = 0.014) was strongly related to the achievement of SVR in all patients and in addition the subtype 1a relative to 1b (OR = 3.309, p = 0.055) in genotype 1 patients.
Conclusions: The genotype distribution and the dominant subtypes among PWID were determined by the route of transmission of the infection and the period of intravenous drug use beginning among PWID.
Genotype 1 (especially subtype 1b) represent the dominant genotype among non-PWID and genotype 3 the dominant one among PWID in Greece. Genotype 1 (mainly subtype 1a) and genotype 4 infections observed almost exclusively in PWID who reported intravenous drug use beginning before 1990 whereas genotype 3 is responsible for the vast majority of infections among PWID who reported drug use beginning after 1990.
Although PEG / RIBA therapy is used in less than 40% of patients with chronic Hepatitis C, its efficacy is satisfactory in non-cirrhotic genotype 3 patients (80%) and in non-cirrhotic subtype 1a patients (63.4%).
Main subject category:
Health Sciences
Keywords:
Hepatitis C, Prevalence, Genotype, People Who Inject Drugs (PWID)
Number of references:
536
