ATIP-AVENIR INSERM Unité 995, Lille, France.
Gastroenterology. 2012 Oct;143(4):974-85.e14. doi: 10.1053/j.gastro.2012.05.054. Epub 2012 Aug 2.
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.
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.
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).
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.
丙型肝炎病毒（HCV）感染的动态变化，以及筛查实践和治疗的可及性，在欧洲各国之间存在差异。重要的是要确定这些差异对感染的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、西班牙和英国之间感染、筛查和治疗实践的动态变化。我们还评估了聚乙二醇干扰素治疗的效果以及蛋白酶抑制剂三联疗法的额外效果。
我们根据发表的流行病学数据（关于 HCV 流行率、筛查、基因型、患者饮酒情况和治疗方法）以及 6 个国家的竞争和肝细胞癌死亡率报告，为每个国家创建了一种特定于国家的 HCV 进展的马尔可夫模型。该模型用于预测每个国家 2002 年至 2021 年期间与 HCV 相关的肝硬化的发病率及其死亡率。
从 2002 年到 2011 年，抗病毒治疗总体上降低了 7.1%的肝硬化累积发病率和 3.4%的死亡率。在意大利，发病率和死亡率的降幅分别为 4.0%和 1.9%，在法国，降幅分别为 16.3%和 9.0%。从 2012 年到 2021 年，包括蛋白酶抑制剂三联疗法在内的针对 HCV 基因型 1 感染患者的抗病毒治疗，将降低肝硬化的累积发病率 17.7%，降低死亡率 9.7%。预测意大利的降幅最小（发病率降低 10.1%，死亡率降低 5.4%），法国的降幅最大（分别为 34.3%和 20.7%）。
尽管不同国家使用相同的疗法治疗 HCV 感染，但这些疗法对发病率和死亡率的影响差异很大。除了基于病毒学反应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。
