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Global epidemiology,detection and acces to

therapy in EuropeIoan Sporea, MD, PhD ,

Dept. of Gastroenterology and Hepatology,"Victor Babe" University of Medicine and Pharmacy,

Timioara, Romania

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Facts Despite the fact that hepatitis C virus (HCV)

was relatively recently discovered, it plays a central

role in the field of hepatology.

This is due to:

the large number of patients infected with this virus

around the world;

to the fact that this infection is curable; to the development of new drugs that ensure a high

curability of this infection.

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Global epidemiology of HCV infection

in the world

HCV infects approximately 170 million peoplearound the world (almost 3% of the entirepopulation) and 3-4 million new subjects becomeinfected each year.

Only in the European Union there are 23 millioninfected persons, and annually 125.000

European citizens die from complications of thischronic infection.

WHO. Hepatitis C. Fact sheet no. 164

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Global epidemiology of HCV infection in the

world (World Health Organization, Estimated global prevalence of hepatitis Cvirus infection)

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Epidemiology of HCV infection in Europe

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Epidemiology in Romania

3,23% = possible 697.680infected persons!

Gheorghe L. et al J Gastrointestin Liver Dis. 2010;19:373-9

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Epidemiology in RomaniaGheorghe L. et al J Gastrointestin Liver Dis. 2010;19(4):373-9

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HCV genotype in Romania

Concerning the HCV genotype in Romania,a previous study showed a high prevalenceof genotype 1b (exceeding 99%)(1).

But, in the last years, other genotypes werefound in Romanian people(in connectionwith a very mobile population) and thus,

specially in young patients, the search ofthe genotype should be mandatory.

1.Grigorescu M: JGLD 2009;18:45-50

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HCV genotype in Western Romania

In a group of 253 patients with C virus chronichepatitis: 52.9% male (134), HCV genotype was

assessed using EDTA-plasma technique

(unpublished recent datas).

In patients with HCV, genotype 1 dominates,

being found in 99% of patients (250/253): 92,4 %

(233/253) genotype 1b, 4,3 %(11/253) genotype1a and 2,3 %(6/253) genotype 1 unspecified.

HCV genotype 3 and 4 were found only in 0.3%

(1case) and 0.7% (2 cases) patients, respectively.

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IL 28B genotype in Romania

Concerning the IL28B genotype in Romanianpopulation, a study from the Western part ofRomaniaon 107 HCV patients showed that 24.3 %were infected with C/C genotype, 62.6% with C/Tand 13.1% with T/T(1)

The same study showed thatthe SVR rate in thiscohort (following standard of care treatment withPegInterferon and Ribavirin) was 50.5% and that it

was directly related to the IL 28B genotype: 73.1%in the C/C genotype vs. 43.7% in non-C/C genotypes(P = 0.0126).

1.Sporea I: Hepat Mon.2011;11(12):975-979

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IL 28B genotype in Romania

Having in mind this facts, in HCV

patients treated with Peg+Riba,evaluation of IL 28B genotype

before the treatment, can be usefull

for the succes of the treatment!

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Detection of HCV chronic infection

Detection of HCV chronic infection is not alwayssufficient, despite a very simple and inexpensiveserological test.

This was demonstrated by the epidemiological study

in the "baby boomers" group or by the fact that incountries such as Germany or the United Kingdom,fewer than 40% of the infected persons aredetected!

A better selection of the subjects suspected to beinfected, can increase the detection rate!

1. Cornberg M et al. A systematic review of hepatitis C virus epidemiology in Europe,Canada and Israel. Liver

International ISSN 1478-3223

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Detection of HCV chronic infection in

Romania

In Romania the detection rate of HCV infected persons isnot high enough (having in mind the high prevalence), andthis is due to the fact that only a specialist physician canprescribe the assessment of serological markers for free,and probably also because media campaigns and publicawareness are not ample enough.

No Free and Anonymous Centers for detection

of infected persons exist in Romania !!. A National strategy for detection of HCV chronically

infected persons is needed, but funded with a sufficientbudget.

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Access to therapy

Concerning the access to therapy in chronic

hepatitis C patients, the world is currently divided

in two types of countries: "rich" and "poor" ones.

In rich countries, in the last approximately 3

years, the standard of care (SOC) was triple

therapy with PegInterferon +Ribavirin + Protease

Inhibitor (PI).

Recently, a second generation PI (Simeprevir) was

approved in these countries.

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