Pena Danilo Zangirolami, Anadão Murilo Fernandes, Flores Edilson Ferreira, Okada Mayara Namimatsu, Filho Alexandre Martins Portelinha, Ferro Rodrigo Sala, Prestes-Carneiro Luiz Euribel
Infectious Diseases Outpatient Clinic, Oeste Paulista University, Presidente Prudente 19050-920, São Paulo, Brazil.
Statistics Department, School of Sciences and Technology, São Paulo State University, Presidente Prudente 19060-900, São Paulo, Brazil.
Microorganisms. 2020 Oct 13;8(10):1575. doi: 10.3390/microorganisms8101575.
Hepatitis virus infection is a major public health problem worldwide. Currently, Brazil has almost 700,000 cases. The Brazilian Unified Health System (SUS) provides therapeutic regimens for people infected with hepatitis C virus (HCV). We determined the clinical, laboratory, epidemiologic, and geospatial characteristics of patients infected with HCV treated with second-generation direct-action antivirals (DAAs) in a hospital reference center in São Paulo state, Brazil, using data from file records. A map was constructed using a geographic information system. From 2015 to 2018, 197 individuals received second-generation DAAs (mean age, 57.68 ± 1.36 years; interquartile range, 56.22-59.14 years; 58.9% male; 41.1% female). Genotypes 1a and 1b accounted for 75.7% of cases and the prevalent therapeutic regimen was sofosbuvir/simeprevir. Sustained viral response accounted for 98.9% and the METAVIR score F3/F4 for 50.8%. Increased alanine transferase was significantly correlated with an increase in α-fetoproteins ( = 0.01), and severe necro-inflammatory activity ( = 0.001). Associated comorbidities were found in 71.6%, mainly coronary artery and gastrointestinal disorders. The cumulative incidence in the region was 2.6 per 10,000 inhabitants. Our data highlight the role of reference hospitals in Brazil's public health system in the treatment of HCV. Low incidence rates demonstrated the fragility of municipalities in the active search for patients.
肝炎病毒感染是全球主要的公共卫生问题。目前，巴西有近70万例病例。巴西统一卫生系统（SUS）为丙型肝炎病毒（HCV）感染者提供治疗方案。我们利用病历记录数据，确定了巴西圣保罗州一家医院参考中心接受第二代直接作用抗病毒药物（DAA）治疗的HCV感染者的临床、实验室、流行病学和地理空间特征。使用地理信息系统构建了一幅地图。2015年至2018年，197人接受了第二代DAA治疗（平均年龄57.68±1.36岁；四分位间距56.22 - 59.14岁；男性占58.9%；女性占41.1%）。1a型和1b型基因型占病例的75.7%，流行的治疗方案是索磷布韦/西米普明。持续病毒学应答率为98.9%，METAVIR评分F3/F4为50.8%。丙氨酸转氨酶升高与甲胎蛋白升高（=0.01）以及严重坏死性炎症活动（=0.001）显著相关。71.6%的患者存在相关合并症，主要是冠状动脉和胃肠道疾病。该地区的累积发病率为每10000名居民中有2.6例。我们的数据突出了巴西公共卫生系统中参考医院在HCV治疗中的作用。低发病率表明各城市在积极寻找患者方面的脆弱性。
