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A population-based surveillance study on the prevalence and treatment of hepatitis C in Estonia Kairi Mansberg PhD student University of Tartu, Department of Internal Medicine background • hepatitis C infection is a significant public health problem and a leading cause of chronic liver disease in Estonia • Estonian Society of Gastroenterology • multi-center, open-label study • study cohort of consecutive patients with acute hepatitis C, chronic hepatitis C, C-related cirrhosis, C-related hepatocellular carcinoma represents of the real-life situation aim • characterize the patients with hepatitis C • analyse a real-life hepatitis C cohort of patients • describe the risk factors of hepatitis C • analyse antiviral treatment in real-life situation material and methods (1) • patients consecutively referred as in-patients and outpatients were recruited in 7 divisions of 5 hospitals by 37 gastroenterologists / infectious disease doctors • patients were required to meet the criteria of acute hepatitis C, chronic hepatitis C, C-related cirrhosis or C-related hepatocellular carcinoma • patients were included during a one-year recruitment period, 01.02.09-31.01.10 and followed till 31.07.11 • informed consent was obtained from all patients • Ethics Review Committee on Human Research of the University of Tartu approval was obtained material and methods (2) • web-based eCase Report Form is used for data registration • data are entered into an eCRF by doctor • in the course of the study, the study monitor make site visits to verify eCRFs against source documentation • monitoring is conducted in each study center 4 times per year • data were analysed using descriptive statistics program Stata 10,0 results: 518 patients were included 47% male(n=271) female(n=247) 53% results: distribution by gender and age 80 70 60 50 male 40 female 30 20 10 0 -29 30-39 40-49 50-59 60-69 70- results: distribution of risk factors IVDU, 12% unknown cause of infection, 40% Risk due to a profession, 3% blood transfusion before 1994 , 28% haemodialysis, 0% Piercing, 2% Tattoo, 8% Acupuncture, 0% blood transfusion after 1994 , 3% Sexual contact with HCV pt, 4% results: age and risk factors 45 40 35 30 25 20 15 10 5 0 -29 30-39 40-49 50-59 60-60 IVDU Risk due to a profession blood transfusion before 1994 blood transfusion after 1994 Sexual contact with HCV pt Tattoo acupuncture Piercing haemodialysis 70- results: distribution of diagnosis hepatocellular carcinoma 1% acute hepatitis C 1% C-chirrosis 12% chronic hepatitis C 86% results: distribution of diagnosis results: c-chirrosis 34% of patsients visit a doctor at the stage of cirrhosis 34% 66% . results: distribution by genotypes G3 25% G2 6% G1 69% HCV genotypes in Estonia results: age and genotypes 100 90 80 70 60 GT 1 50 GT 2 GT 3 40 30 20 10 0 -29 30-39 40-49 50-59 60-69 70- G1 starts from the age of 40, but in younger age groups the increasing importance G3 results: genotypes and risk factors 160 IVDU 140 Risk due to a profession 120 blood transfusion before 1994 100 blood transfusion after 1994 80 Sexual contact with HCV pt 60 Tattoo Acupuncture 40 Piercing 20 haemodialysis 0 G1 G2 G3 results: gender, age and genotypes 70 60 50 40 GT 1 GT 2 30 GT 3 20 10 0 -29 30-39 40-49 50-59 male 60-69 70- -29 30-39 40-49 50-59 60-69 female G1 is most prevalent among male pt aged 40-49 and female pt aged 50-59. G3 is common in younger age groups of men and women 70- conclusions (1) • study cohort of consecutive 518 patients is representative of the real-life situation • prevailing genotype in Estonia is 1B, but our data indicate the increasing importance of genotype 3 • in many patients HCV liver disease is diagnosed too late – in HCV-related cirrhosis stage conclusions (2) • 265 patients started antiviral treatment during the study period, which makes up 79% of all Estonian patients in whom treatment was started during the same period Plans for the future • to analyse antiviral treatment results in real-life situation – RVR, pEVR, cEVR, SVR – relapsers, nonresponders • to analyse adverse events during antiviral treatment in real-life situation • potential cooperation with Department of Microbiology of University of Tartu Acknowledgements Estonian Society of Gastroenterology Roche Estonia OÜ Tartu University Hospital Riina Salupere, Karin Kull, Katrin Labotkin, Hele Remmel, Seren Kivi, Leana Sits, Tiina Prükk, Rita Pihlak, Svetlana Proškina, Külliki Ainsalu West Tallinn Central Hospital Külliki Suurmaa, Vadim Brjalin, Anu Mäelt, Marina Levitševa, Kristi Ott, Nele Rasmann,Tiiu Aug, Dagmar Mägi East Talinn Central Hospital Triin Remmel, Maie Aua, Asta Kolde, Ene Halling, Benno Margus, Toomas Kariis, Peeter Kõiva Pärnu Hospital Krista Jaago, Kadi Kenk, Urve Mardna East Viru Central Hospital Jelena Šmidt, Svetlana Semjonova