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标题: 美国肝脏学会年度会议召开：丙型肝炎流行趋势不容乐观 [打印本页]

作者: 屈泰龙 时间: 2015-11-23 21:05
标题: 美国肝脏学会年度会议召开：丙型肝炎流行趋势不容乐观

美国肝脏学会2015年会议中指出：尽管有着先进的医疗设施，但由于缺乏筛选与治疗的方法，目前想要完全消除HCV的感染十分困难。

根据目前的形势，到2020年，将会有50万名不知情的HCV携带者。来自麻省医院，哈佛大学医学院的教授Jagpreet Chhatwal说到。 “我们需要更严格的筛选与治疗政策，从而降低HCV的感染”。

在过去的五年内，HCV的感染趋势发生了显著的变化。由于抗病毒领域的发展，针对HCV的治疗结果出现了显著的提升。病毒复发控制率从2011年之前的不到50%上升到2015年的95%以上。同时，“平价医疗法案”的通过使得能够接受治疗的人群数量也显著扩大。

为了严格监控HCV感染的进程，Chhatwal博士等人检测了患者的人口统计学特征、疾病特征、治疗方法、筛选措施、医疗保险以及治疗覆盖率等等。

根据Chhatwal博士的汇报，新型的治疗方法，包括抗病毒靶向治疗手段，能够降低未来35年内HCV引发的死亡率。反之，如果任由目前的形势发展，在同样阶段内将会有31万余人因此死亡。另外，15万以上的HCV携带者将会引发肝癌，19万将会患代偿失调性肝硬化，3万人将被迫接受肝脏移植手术。

研究者们预期，仅今年一年就有2百万非机构患者感染HCV，其中有110万知晓自身的感染情况，也具有相应的医疗保险，然而其中很多人仍未接受治疗。根据药物的售价，研究者们估计2014年仅有14万人选择接受治疗，今年可能会有18万人。

综合感染速率与治疗率，如果要使HCV的感染数量降低到5万人以下，需要花费10年的时间。

“其实我们能够治疗的患者不止18万”，Chhatwal博士说到：“我们希望大家明白这样一个事实：如果我们使更多的人得到治疗，就能够有效避免疾病的爆发”。另外，他还提及美国境内HCV的传播形势比报告中估计的要严重的多，因为报告中并没有统计生活在大型机构中的人群。

报告会结束后，来自辛辛那提大学的教授Kenneth Sherman博士称：他的研究发现食用海洛因能够增加被HCV感染的几率。该会议主持人，来自宾西法尼亚大学的Rajender Reddy博士认为，移民中HCV的高感染率也会影响这一趋势。Chhatwal博士称，他将会把移民与海洛因使用纳入未来的统计影响因子中，这些都是可能会增加感染几率的因素。

作者: 屈泰龙 时间: 2015-11-23 21:06
The Liver Meeting 2015: American Association for the Study of Liver Diseases (AASLD)
SAN FRANCISCO — Despite powerful new medications, the lack of screening and treatment capacity will make it difficult to eliminate the hepatitis C virus in the United States, according to projections presented here at the Liver Meeting 2015.

Current trends show that even after 2020, more than 500,000 people will be unaware that they are infected with hepatitis C, said Jagpreet Chhatwal, PhD, from the Massachusetts General Hospital and Harvard Medical School in Boston.

"We need aggressive screening and treatment policies to further reduce the burden of hepatitis C," he said.

The landscape of hepatitis C has changed rapidly in the past 5 years.

Treatment outcomes have advanced with the advent of direct-acting antiviral, from a sustained virologic response rate of less than 50% before 2011 to better than 95% in 2015. At the same time, the Affordable Care Act has expanded the number of people with healthcare coverage.

To project the course of the disease, Dr Chhatwal and his colleagues assessed patient demographics, disease characteristics, therapeutics, screening policies, insurance coverage, and access to treatment in the United States using the Hepatitis C Disease Burden Simulation model they developed (Ann Intern Med. 2014;161:170-180).

Mortality and Morbidity

Medications, including the new direct-acting antivirals, will reduce the number of hepatitis C deaths by more than half from 2015 to 2050, Dr Chhatwal reported.

But if current trends continue, 317,000 people will still die from the virus during that period.

In addition, 154,000 patients with hepatitis C will develop hepatocellular carcinoma, 198,000 will develop decompensated cirrhosis, and 31,000 will undergo liver transplantation.

This year, there are 2 million noninstitutionalized patients chronically infected with hepatitis C and viremic, the researchers estimate. Of these, 1.1 million are aware of their infection status and have insurance, but it appears that most of them are still not being treated.

On the basis of drug sales, they estimated that only about 140,000 patients were treated in 2014, and this year, about 180,000 will be treated.

At this rate, it will take at least 10 years before the number of treatment candidates is below 50,000, Dr Chhatwal reported.

"We can treat more than 180,000," he told Medscape Medical News. "We want to send a message that if we can increase the number of people getting treated, then we can reduce the disease burden."

He added that the true burden of hepatitis C in the United States was probably underestimated in this study because it doesn't include the many people living in institutions.

After the presentation, Kenneth Sherman, MD, from the University of Cincinnati, said that his own research has shown that the increase in heroin use has led to many people being infected with hepatitis C.

The high rate of infection in immigrants could also affect trends, said session moderator Rajender Reddy, MD, from the Hospital of the University of Pennsylvania in Philadelphia.

Dr Chhatwal said he agrees that it would be worthwhile to include data on heroin users and immigrants in future projections. It is possible that heroin-related infections could increase the incidence of infection, he said.

Cost of Care

In a separate study, Dr Chhatwal and his colleagues estimated that the annual cost of care for patients with hepatitis C grew from $7 billion before the advent of direct-acting antivirals to $21 billion in 2015.

That cost will decrease as the prevalence of the disease declines, likely down to $2 billion by 2020, the researchers report. They estimate, however, that it will cost $106 billion over the next 25 years to make hepatitis C a rare disease.

Primary care providers can help reduce the disease burden by screening more patients, said Gyongyi Szabo, MD, PhD, president of the American Association of the Study of Liver Diseases (AASLD).

Currently, the Centers for Disease Control and Prevention recommends that everyone born from 1945 to 1965 get tested for hepatitis C.

The Institute of Medicine is contemplating a study, supported by the AASLD, to assess strategies for the eradication of the virus in the United States, Dr Szabo told Medscape Medical News.

During a global summit at the Liver Meeting, representatives from hepatology societies around the world and from the World Health Organization set their sights on drastically reducing the burden of the disease, she said.

"We agreed that it is a global potential goal for hepatologists to treat hepatitis C with the vision of not necessarily eradicating it," said Dr Szabo, "but getting to the point where it is a minimal entity."

Dr Chhatwal reports relationships with Merck, Gilead, and HEOR Solutions. Dr Szabo reports relationships with Conatus, GlaxoSmithKline, Bristol-Myers Squibb, Idenix, Ideral Integrated, Therapeutics, Intercept, Johnson & Johnson, Novartis, Novelos, Ocera, Roche, Schering-Plough, Vertex, and Wyeth.

The Liver Meeting 2015: American Association for the Study of Liver Diseases (AASLD). Abstract 104. Presented November 16, 2015.
http://www.medscape.com/viewarti ... ID=892719&faf=1

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