Center of Excellence in Clinical Virology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Chumpare Hospital, Chum Phae, Khon Kaen, Thailand.
PLoS One. 2018 Apr 24;13(4):e0196301. doi: 10.1371/journal.pone.0196301. eCollection 2018.
The prevalence of hepatitis C virus (HCV) infection has been decreasing globally, but the growing effects of HCV-related morbidity and mortality remain of concern. Advances in curative medicine, involving direct-acting antivirals (DAAs), have led many countries to aim to eradicate HCV. Information on epidemiology and disease burden is essential for national policy development. Thus, this study aimed to determine the HCV-related hepatic disease burden in areas of Thailand with high and average HCV prevalence in order to extrapolate the viral burden across Thailand. Patients previously diagnosed as positive for anti-HCV antibodies were recruited to assess chronic HCV infection (CHC) status, liver function, HCV-RNA level and hepatic fibrosis. The number of patients eligible for Universal Health Coverage (UC) scheme and the approximately required expenditure on interferon (IFN)-based treatment were estimated. In areas of both high (12%) and average (2%) HCV viremic prevalence, over half of the patients (52.2% to 62.5%) had advanced liver fibrosis (F3 and F4). A striking percentage of patients with F4 (38.9%) were found in the high-prevalence area, while comparable proportions of advanced liver fibrosis presented in the two areas and disease burden peaked at 50-59 years. Under the current UC program treatment scenario, 78-83% of CHC patients with stage F2-F4 fibrosis were eligible for treatment. The estimated expenditure required for overall CHC treatment across the whole country was 1,240 million USD at this current status, but the declining cost of generic DAA-based therapy may reduce the requirement to <90 million USD. This study provides information on the estimated number of CHC patients, liver disease burden and expenditure requirements for Thailand. To eliminate HCV by 2030, proactive government strategies raising public health to minimize transmission and emphasizing targeted screen-and-treatment programs, novel therapeutic guideline development for decentralizing treatment, and effective budget allocation are urgently needed.
丙型肝炎病毒（HCV）感染的流行率在全球范围内呈下降趋势，但与 HCV 相关的发病率和死亡率的增长仍令人担忧。治愈医学的进步，包括直接作用抗病毒药物（DAAs），促使许多国家旨在消灭 HCV。流行病学和疾病负担的信息对于国家政策的制定至关重要。因此，本研究旨在确定泰国高和中 HCV 流行地区与 HCV 相关的肝病负担，以便推断泰国的病毒负担。先前被诊断为抗 HCV 抗体阳性的患者被招募来评估慢性 HCV 感染（CHC）状态、肝功能、HCV-RNA 水平和肝纤维化。估计符合全民健康覆盖（UC）计划条件的患者人数和大约需要用于干扰素（IFN）为基础的治疗的费用。在 HCV 病毒血症流行率高（12%）和平均（2%）的地区，超过一半的患者（52.2%至 62.5%）有晚期肝纤维化（F3 和 F4）。在高流行地区发现了相当比例的 F4 患者（38.9%），而在两个地区都有类似比例的晚期肝纤维化，疾病负担在 50-59 岁时达到峰值。根据当前的 UC 计划治疗方案，78-83%的 F2-F4 纤维化 CHC 患者有资格接受治疗。在当前状态下，全国范围内治疗所有 CHC 所需的估计支出为 12.4 亿美元，但基于通用 DAA 的治疗成本的下降可能会将需求降低到<9000 万美元。本研究提供了泰国 HCV 患者数量、肝病负担和治疗费用需求的信息。为了在 2030 年前消灭 HCV，迫切需要政府采取积极的策略，提高公共卫生水平以尽量减少传播，并强调针对筛查和治疗的方案、为去中心化治疗制定新的治疗指南以及有效分配预算。
