Ridruejo Ezequiel, Bessone Fernando, Daruich Jorge R, Estes Chris, Gadano Adrián C, Razavi Homie, Villamil Federico G, Silva Marcelo O
Ezequiel Ridruejo, Hepatology Section, Department of Medicine, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, Ciudad Autónoma de Buenos Aires C1425ASG, Argentina.
World J Hepatol. 2016 May 28;8(15):649-58. doi: 10.4254/wjh.v8.i15.649.
To estimate the progression of the hepatitis C virus (HCV) epidemic and measure the burden of HCV-related morbidity and mortality.
Age- and gender-defined cohorts were used to follow the viremic population in Argentina and estimate HCV incidence, prevalence, hepatic complications, and mortality. The relative impact of two scenarios on HCV-related outcomes was assessed: (1) increased sustained virologic response (SVR); and (2) increased SVR and treatment.
Under scenario 1, SVR raised to 85%-95% in 2016. Compared to the base case scenario, there was a 0.3% reduction in prevalent cases and liver-related deaths by 2030. Given low treatment rates, cases of hepatocellular carcinoma and decompensated cirrhosis decreased < 1%, in contrast to the base case in 2030. Under scenario 2, the same increases in SVR were modeled, with gradual increases in the annual diagnosed and treated populations. This scenario decreased prevalent infections 45%, liver-related deaths 55%, liver cancer cases 60%, and decompensated cirrhosis 55%, as compared to the base case by 2030.
In Argentina, cases of end stage liver disease and liver-related deaths due to HCV are still growing, while its prevalence is decreasing. Increasing in SVR rates is not enough, and increasing in the number of patients diagnosed and candidates for treatment is needed to reduce the HCV disease burden. Based on this scenario, strategies to increase diagnosis and treatment uptake must be developed to reduce HCV burden in Argentina.
评估丙型肝炎病毒（HCV）流行的进展情况，并衡量与HCV相关的发病和死亡负担。
使用按年龄和性别划分的队列来跟踪阿根廷的病毒血症人群，并估计HCV的发病率、患病率、肝脏并发症和死亡率。评估了两种情况对与HCV相关结局的相对影响：（1）持续病毒学应答（SVR）增加；（2）SVR增加且治疗增加。
在情况1下，2016年SVR提高到85%-95%。与基础病例情况相比，到2030年，流行病例和肝脏相关死亡减少了0.3%。鉴于治疗率较低，肝细胞癌和失代偿性肝硬化病例减少不到1%，这与2030年的基础病例情况形成对比。在情况2下，模拟了相同的SVR增加情况，同时每年诊断和治疗的人群逐渐增加。与基础病例情况相比，到2030年，这种情况使流行感染减少了45%，肝脏相关死亡减少了55%，肝癌病例减少了60%，失代偿性肝硬化减少了55%。
在阿根廷，由HCV导致的终末期肝病病例和肝脏相关死亡仍在增加，而其患病率正在下降。仅提高SVR率是不够的，需要增加诊断和治疗的患者数量，以减轻HCV疾病负担。基于这种情况，必须制定提高诊断和治疗接受度的策略，以减轻阿根廷的HCV负担。
