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Comprehensive Program on Hepatitis C in Adults: Insights and Strategies for Effective Management

This program review covers the epidemiology, virological tools, and treatment modalities for Hepatitis C in adults, emphasizing findings and perspectives from collaborative research efforts in Cameroon and Egypt. Explore genetic epidemiology, mathematical modeling, and treatment efficacy insights.

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Comprehensive Program on Hepatitis C in Adults: Insights and Strategies for Effective Management

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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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