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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 ([email protected])
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)
