A pilot sentinel surveillance system to monitor treatment and treatment outcomes of chronic hepatitis B and C infections in clinical centres in three European countries, 2019

Abstract

Background The World Health Organization European Action Plan 2020 targets for the elimination of viral hepatitis are that > 75% of eligible individuals with chronic hepatitis B (HBV) or hepatitis C (HCV) are treated, of whom > 90% achieve viral suppression. Aim To report the results from a pilot sentinel surveillance to monitor chronic HBV and HCV treatment uptake and outcomes in 2019. Methods We undertook retrospective enhanced data collection on patients with a confirmed chronic HBV or HCV infection presenting at one of seven clinics in three countries (Croatia, Romania and Spain) for the first time between 1 January 2019 and 30 June 2019. Clinical records were reviewed from date of first attendance to 31 December 2019 and data on sociodemographics, clinical history, laboratory results, treatment and treatment outcomes were collected. Treatment eligibility, uptake and case outcome were assessed. Results Of 229 individuals with chronic HBV infection, treatment status was reported for 203 (89%). Of the 80 individuals reported as eligible for treatment, 51% (41/80) were treated of whom 89% (33/37) had achieved viral suppression. Of 240 individuals with chronic HCV infection, treatment status was reported for 231 (96%). Of 231 eligible individuals, 77% (179/231) were treated, the majority of whom had received direct acting antivirals (99%, 174/176) and had achieved sustained virological response (98%, 165/169). Conclusion Treatment targets for global elimination were missed for HBV but not for HCV. A wider European implementation of sentinel surveillance with a representative sample of sites could help monitor progress towards achieving hepatitis control targets.

Non-Invasive Prediction Scores for Hepatitis B Virus- and Hepatitis D Virus-Infected Patients—A Cohort from the North-Eastern Part of Romania

“…The prevalence of HDV among HBV infected patients in our study was 16.2%, which was a value found in the range reported by other Romanian cohorts of 9-23.1% [13,[50][51][52],…”

“…The prevalence of HDV among HBV infected patients in our study was 16.2%, which was a value found in the range reported by other Romanian cohorts of 9-23.1% [13,[50][51][52], When assessing the role of therapy in adjusting the predictive value of aMAP for developing HCC, the ROC analysis failed to prove any positive effects (Table 9).…”

“…We retrospectively examined the medical records from all the patients diagnosed with chronic hepatitis B and chronic hepatitis D admitted to university hospitals in Iasi, Romania ("St. Spiridon" Emergency Clinical County Hospital and "St. Parascheva" Clinical Infectious Diseases Hospital from Iasi), from 2012 to 2019. These two hospitals are the most representative from the north-eastern (NE) part of Romania and have the highest addressability of patients with viral hepatitis from this region, as also reported by Nardone et al [13]. Importantly, "St. Spiridon" Emergency Clinical Country Hospital is the university hospital that provides care, according to the internal statistical data, to 67% of patients from Iasi County and 33% of patients from the NE region, characterized by a population exceeding 3.7 million residents (representing more than 17% of the total population of Romania).…”

“…As we stated earlier, Romania has a high prevalence of HDV infections [7,13]. However, there are only a few studies from this area that characterize this type of patient, and none that test whether these non-invasive scores could be used as an accessible tool to monitor and assess the progression of liver disease.…”

“…Patients with chronic hepatitis D (CHD) have a 2-fold higher risk of developing cirrhosis, a 3-fold higher risk of developing HCC, and a 2-fold higher mortality rate compared to chronic hepatitis B (CHB) [12]. A recent large retrospective study, including three European countries (Croatia, Romania, and Spain), reported an overall HBV/HDV co-infection rate of 9% in Romania for samples collected between 1 January 2019 and 30 June 2019, with 3.5% of the tested HBV-infected patients originating from the northern-eastern region [13]. Importantly, the report also indicated that the treatment status was reported only for 89% of the HBV patients, with 51% of patients being treated and 89% achieving viral suppression.…”