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Abstract
Hepatitis virus infection is a major public health problem worldwide. Currently, Brazil has almost 700,000 cases. The Brazilian Unified Health System (SUS) provides therapeutic regimens for people infected with hepatitis C virus (HCV). We determined the clinical, laboratory, epidemiologic, and geospatial characteristics of patients infected with HCV treated with second-generation direct-action antivirals (DAAs) in a hospital reference center in São Paulo state, Brazil, using data from file records. A map was constructed using a geographic information system. From 2015 to 2018, 197 individuals received second-generation DAAs (mean age, 57.68 ± 1.36 years; interquartile range, 56.22–59.14 years; 58.9% male; 41.1% female). Genotypes 1a and 1b accounted for 75.7% of cases and the prevalent therapeutic regimen was sofosbuvir/simeprevir. Sustained viral response accounted for 98.9% and the METAVIR score F3/F4 for 50.8%. Increased alanine transferase was significantly correlated with an increase in α-fetoproteins (p = 0.01), and severe necro-inflammatory activity (p = 0.001). Associated comorbidities were found in 71.6%, mainly coronary artery and gastrointestinal disorders. The cumulative incidence in the region was 2.6 per 10,000 inhabitants. Our data highlight the role of reference hospitals in Brazil’s public health system in the treatment of HCV. Low incidence rates demonstrated the fragility of municipalities in the active search for patients.
Highlights
Viral hepatitis infection is a major public health problem worldwide
Approximately 47% are attributable to hepatitis B virus (HBV) and 48% to hepatitis C virus (HCV) [1]
The first generation of direct-action antivirals (DAAs), boceprevir/telaprevir, both used in combination with alfa-peginterferon plus ribavirin-PEG-IFN + RBV (PR), constituting a triple therapy (PR + IP) increased the sustained viral response (SVR) but were associated with intolerable side effects [5]
Summary
Viral hepatitis infection is a major public health problem worldwide It is responsible for an estimated 1.4 million deaths per year from acute infection and hepatitis-related liver cancer and cirrhosis. With the approval and release of second-generation DAAs free from interferon by the SUS, the use of interferon-based regimens was gradually replaced [6]. Such a strategy is fundamental to the success of the Plan for the Elimination of Hepatitis C in Brazil as a public health problem by 2030 [7]. These goals are in line with the strategy adopted by the World Health Organization, which establishes global strategies, including reduction of the incidence of HCV by 80% and HCV-related mortality by 65% by 2030 [8]
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