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Réunion de l’AC 12, ANRS, 28 février 2008

Hépatite C Prise en charge de l’adulte Programme sur l’hépatite C au Sud bilan et perspectives du groupe de travail. Réunion de l’AC 12, ANRS, 28 février 2008. Réunion ANRS, hépatites virales en PED, 17 janvier 2007 Aspects prise en charge. Outils virologiques pour le VHC (J. Izopet)

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Réunion de l’AC 12, ANRS, 28 février 2008

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  1. Hépatite C Prise en charge de l’adulteProgramme sur l’hépatite C au Sud bilan et perspectivesdu groupe de travail Réunion de l’AC 12, ANRS, 28 février 2008

  2. Réunion ANRS, hépatites virales en PED, 17 janvier 2007Aspects prise en charge • Outils virologiques pour le VHC(J. Izopet) • Evaluation et traitement de la fibrose hépatique en Afrique (P. Cales) • Evaluation de la fibrose hépatique au Burkina Faso (P. Bonnard & L. Slama) • Traitement des hépatites B chroniques au Sénégal (P.S. M’Baye & M. Vray) • Etudes sur leVHC au Cameroun • Epidémiologie et études phylogénétiques du VHC au Cameroun (R. Njouom & C. Pasquier) • Histoire médicale du Cameroun et épidémiologie historique du VHC (ANRS 1299) (G. Lachenal) • Traitement du VHC au Cameroun(O. Njoya) • Etudes sur leVHC en Egypte • ANRS viral hepatitis research site in Cairo (M. Mohamed & A. Fontanet) • Immunological markers of HCV clearance (M. Albert & J. Decalf). • Transmission intra-familiale de l'infection par le VHC (L. Abel & S. Plancoulaine)

  3. Cameroun Richard Njouom, Centre Pasteur du Cameroun Oudou Njoya Hépatologue, CHU de Yaoundé

  4. Yokadouma 1994 Pop: 646 (3,3 %) Nditam 1994 Pop: 368 (2,9%) 100 100 80 80 60 60 40 40 20 20 0 0 0 10 20 30 40 50 60 70 0 10 20 30 40 50 60 70 Mekas 1993 Pop: 644 (16,7%) Ntem 1997 Pop: 408 (14,4%) 100 100 80 80 60 60 40 40 20 20 0 0 40 0 10 20 30 40 50 60 70 0 10 20 30 40 50 60 70 HCV sero-prevalence in Cameroun Yaounde 2003 N=1434 6.9% Nerrienet et al. J Med Virol 2005

  5. Hétérogénéité et distribution des génotypes HCV à Yaoundé Richard Njouom, Centre Pasteur du Cameroun Christophe Pasquier, Laboratoire de Virologie, CHU Toulouse • n = 156 • Génotype : 1 70 45% • Génotype : 2 37 24% • Génotype : 4 49 31% • nombreux sous-types (pour 1 et 4) • Nombreux sous-types non classifiés • Concordance parfaite des clusters NS5b et E2 (n=144) • Pasquier, J Med Virol 2005; 77:390-8

  6. HCV genotypes and sub-types n =156

  7. Suivi virologique des patients VHC positifs sous traitement antiviral Résultats : de 2003 à nos jours (résultats au 17/01/2007) O. Njoya Hépatologue, CHU de Yaoundé Richard Njouom, Centre Pasteur du Cameroun 17/01/2007

  8. Egypt

  9. EgyptNetwork participants • In Egypt: • Most of activities are based at the National Hepatology and Tropical Medicine Research Institute (NHTMRI) in Cairo and involve: • Ain Shams University: epidemiology (Prof Mostafa K Mohamed) and immunology (Prof Mona Rafik). • Cairo university: clinical expertise (Prof Gamal Esmat), • Minia University: virology (Prof Mohamed Abdel Hamid), • University of Mansoura: pathology (Prof Khaled Zalata). Under the guidance of the Ministry of Health through the National Committee for the prevention and control of viral hepatitis in Egypt. • In France: • Institut Pasteur, Paris: epidemiology (Dr Arnaud Fontanet); immunology (Dr Matthew Albert), • INSERM U370, Paris: virology (Prof Christian Bréchot, Dr Valérie Thiers), • Necker Hospital, Paris: clinical expertise (Prof Stanislas Pol), • INSERM U707, Paris: mathematical modeling and cost-effectiveness studies (Prof Alain-Jacques Valleron, Dr Bernard Larouzé, Dr Fabrice Carrat, and Dr Michaël Schwarzinger), • INSERM U550, Paris: genetic epidemiology (Dr Laurent Abel), • Beaujon Hospital, Paris: pathology (Prof Pierre Bedossa), • Saint Louis Hospital: virology HBV (François Simon), • Nantes Hospital: virology (Cyrille Féray) • International collaborators: • U.S.A: Prof Stewart Cooper (clinical immunology), Dr Eric Delwart (virology), Dr Chris Loffredo (epidemiology) • U.K.: Prof Nishi Charturvedi (epidemiology)

  10. Asymptomatic Treatment efficacy Treatment efficacy Hepatocellular carcinoma 1 to 4 %/year HCV infection Chronic infection 50-85% Cirrhosis 20% Jaundice 25% INCUBATION ACUTE PHASE CHRONIC PHASE 10 to 30 years 1 to 2 months 6 months Research programme Fever Hospitals Village cohort HCV risk factors • Factors associated with HCV clearance: • epidemiology • lipids • virology • immunology • co-infection (HBV) • Facteurs associated with transmission • & chronicity /morbidity • genetic epidemiology • CV risk factors • virology Mathematical modeling: Prediction, cost-effectiveness

  11. HCV antibody prevalence (%) by age and sex Zwyat Razin, 2002 (n = 4020) (ANRS 1211). HCV antibody prevalence (%) Age group (in years) (Arafa et al, J Hepatol, 2005)

  12. HCV-related morbidity among adults (n= 2425, 18-65 yrs), Zwyat Razin, 2002. * 13 trt indications 1,5% 26 PBH 107/266 4,5% 11,7% 284 18,5% 448 * Cirrhose décompensée ou F3/F4 PBH (Mohamed MK, J Med Virol, 2006)

  13. Egyptian National Control Strategy for Viral Hepatitis 2008-2012 • MOHP, National Committee on viral hepatitis • Patient management • 9 liver centers where 10,050 patients where currently receiving treatment as of Jan 2008, usually a wing in a MOHP hospital • Another 6 more centers in 2008 • National headquarter is NHTMRI • Collection of information on patient recruitment and follow-up in the centers • Need to be standardized and computerized • Development of a web-based data entry system planned To contribute to the evaluation of the network of treatment centers before proceeding further

  14. ▲ Damietta Alexandria▲ ▲ Al Mansurah Tanta ▲ ▲ Az Zaqaziq Cairo▲▲ † Asyut▲ Suhag ▲ SUDAN Liver centers open in Egypt as of Jan 2008

  15. Currently, • 48 wks PEG IFN + Ribavirin at a total cost of 3000 euros. • 4 categories of patients • Health insurance (HIO) (40%) : PEG-IFN • Contract patients (8%): • not covered by HIO. • Private-sector employers have agreed to pay for trt in MOHP facilities. PEG-IFN + Riba • Private patients (7%): • pay for their own trt in MOHP or private clinics • Patients treated at government expense (45%): no insurance; • preliminary evaluation (paid for by MOHP) • voucher for trt that covers 12 wks injections but not the cost of ribavirin

  16. Liver fibrosis evaluation among HCV genotype 4 infected patients in EgyptP Bonnard, G Esmat • To evaluate and compare • diagnostic accuracies of the non-invasive methods for fibrosis assessment for the diagnosis of significant fibrosis • Non invasive methods have been validated in western countries • In Egypt, • Steatosis is more common, • Elevated BMI may compromise elastometry • Co-infection with S mansoni, HBV • 400 patients referred to NHTMRI • Liver biopsy (routinely performed). “Gold standard” • Elastometry • Blood tests to calculate: APRI, Fib-4, Fibrometre, Fibrotest • Expected start of the inclusions : October 2008

  17. Key points to be discussed • Need of non-invasive markers of fibrosis • Cost-effectiveness • Efforts on the cost of treatment including • Antiviral therapy : • Generic? • And monitoring : PCR • In the context of a National program • Including screening strategies • Advanced liver diseases, • Co-factors, • management • Epidemiological tools to follow-up trends?

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