An hepatologist perspective Hepatitis C in Portugal · An hepatologist perspective Hepatitis C in...

Gastroenterology and Hepatology

President of Hepatology of Portuguese Medical Board

Editor-in-Chief of Acta Médica Portuguesa

Vice-President Portuguese Society of Gastroenterology

President of Scientific Committe of SOS Hepatites (patient NGO)

Infarmed – Consultive panel for hepatitis C

Ministry of Health – National Strategy for hepatitis C

Elected Member of General Assembly of United European Gastroenterology,

Advisory Member of Viral Hepatitis Prevention Board (WHO, CDC, ELPA ECDC)

Rui Tato Marinho (ruitatomarinho@sapo.pt)

An hepatologist perspective

Hepatitis C in Portugal

Abbvie, Merck, BMS, Roche, Janssen, Bayer, Gilead

Conflit of Interests - 1 and 2

President of Hepatology of Portuguese Medical Board

Editor-in-Chief of Acta Médica Portuguesa

Vice-President Portuguese Society of Gastroenterology

President of Scientific Committe of SOS Hepatites (patient NGO)

Infarmed (portuguese FDA) – Consultive panel for hepatitis C

Ministry of Health – National Strategy for hepatitis C

Elected Member of General Assembly of United European Gastroenterology,

Advisory Member of Viral Hepatitis Prevention Board (WHO, CDC, ELPA ECDC)

We have a big problem!!

portugueses with hepatitis C

4 key ideas hepatitis C

Cirrhosis

risk of Cancer

risk of death

Cure

“Core business”

Liver Cirrhosis

Hepatitis C, B, alcohol, obesity

30-40%

Cirrhosis 40%

Cancer 1-4% each year

Chiaramonte et al, Cancer 1999;85:2132-7

Rate of incidence of HCC in patients with

compensated viral cirrhosis

n=66

n=166

n=27

Esteban JI, Sauleda S, Quer J. The changing epidemiology of hepatitis C virus infection in Europe. J Hepatol 2008;48:148-62.

Prevalence of Hepatitis C in Europe

PWID 100 000 (60%) > 60 000

HIV 40 000 (25-30%) > 12 000

Transfusions, sexual, health care workers

30% no risk factor

HCV in Portugal ~1%?

Dying

HCV

HCV-related death rates in countries of

the WHO European region in 2002

Mühlberger N, et al. BMC Public Health 2009;9:34

≤6 6–9 9–12 >12 Death rate

(deaths per 100,000):

HCV ~1000

HIV 561 (2012)

53 62

Needing treatment Dying

Inquiry to State Hospitals

13 000 in outpatient consultations

~5 000 with cirrhosis

Hot Topic

Landmarks – Cure hepatitis C (genotype 1)

Hepatitis C, stigma and cure. Marinho RT, Barreira D, World Journal Gastroenterology 2013

1986 1995 2000 2011 2013/2014

Only now?

2014 1989 1997

WHO Call Attention!

Hepatitis C in media (1997)

Plano Nacional para a Hepatite C. Revista Ordem dos Médicos 2005:53:28-30

2005

Hepatocellular

carcinoma

http://www.vhpb.org/

Hepatitis C 2010

The normal

RM

NR

N 130

2011

No response

cure

Triple

Double

Oral

Peginterferon

weekly

24 or 48 weeks

+ Ribavirine

daily

Double treatment

4 8/8h day (48w) 3 12/12 day (12w)

4032/6500- pills, 1008 times Boceprevir

504 pills, 168 times Telaprevir

Boceprevir Telaprevir

8 000

40m

200

10m

2011 - 2013

Oral

DAA

Approved

36 papers NEJM in 3 years

H. Santa Maria 16 patients cure 100% Portugal 40 patients cure 100%

New era

DAAs Oral

Three (two) months of treatment

No side effects

Cure >90%

€€€€€€€€€€.££££££££.USD.USD.USD

Peginterferon

Treatment Hepatite C

Biopsy

Sofosbuvir

Simeprevir

Daclatasvir

Sofosbuvir + Ledipasvir (((Abbvie, Merck)))

Sofosbuvir

80 000 (USA)

15 000 (16 european countries)

7 (Portugal)

Reduce Risk of Death

• Screen with anti-HCV

• Fibroscan

• Treat and cure

Reduce Risk of Death

• Screen with anti-HCV

• Fibroscan

• Treat and cure for ever

No response

Sustained response cure)