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Epidemiology of Hepatitis C in the Moscow Region: Data from the Moscow Regional Registry and Screening for HCV Antibodies

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Epidemiology of Hepatitis C in the Moscow Region: Data from the Moscow Regional Registry and Screening for HCV Antibodies Almanac of Clinical Medicine. 2016 August-September; 44 (6): 689–696. doi: 10.18786/2072-0505-2016-44-6-689-696 Article Epidemiology of hepatitis C in the Moscow Region: data from the Moscow Regional Registry and screening for HCV antibodies P.O. Bogomolov1 • A.O. Bueverov1, 2 • M.V. Matsievich1 • M.Yu. Petrachenkova1 • N.V. Voronkova1 • S.V. Koblov1 • K.Yu. Kokina1 • V.D. Beznosenko1 • E.V. Fedosova1 Pavel O. Bogomolov – MD, PhD, Head of Background: Epidemiological characteristics HCV genotype distribution is concerned, it was Department of Hepatology, Head of the Moscow of chronic hepatitis C virus (HCV) infection pre- as follows: genotype 1, 54.1% (n = 5622) of pa- 1 Regional Hepatology Center sented in the literature are not representative for tients, genotype 2, 7.2% (n = 747), genotype 3, Aleksey O. Bueverov – MD, PhD, Leading Research the real situation with its incidence and preva- 38.4% (n = 3990). According to the results of assess- Fellow, Department of Hepatology1; Professor, lence in the Russian Federation. In the Moscow ment of IL28B genetic polymorphisms (n = 3212), Chair of Medical and Social Expert Assessment Region, which is the second largest population СС rs12979860, which is associated with the most and Out-Patient Therapy of the Postgraduate in the Russian Federation (7.2 million people), favorable sensitivity to interferon α, was found in Medical Training Faculty2; Leading Research Fellow, 27.5% (n = 883), СТ allele, in 58.4% (n = 1876), and Department of Research on Innovative Therapy, the Moscow Regional Registry of patients with Research Center2 hepatic disorders has been continuously main- ТТ in 14,1% (n = 453). Prevalence of HCV infection * 61/2–8 Shchepkina ul., Moscow, 129110, Russian tained since 2010, as well as screening programs in the Moscow Region, assessed by the screening Federation. Tel.: +7 (495) 631 72 90. for anti-HCV positive individuals. Analysis of this program, is 1.38% of adults, or 77 200 anti-HCV Е-mail: [email protected] data allows for generalization of the results ob- positive persons, whereas estimated number of Mariya V. Matsievich – MD, PhD, Senior Research tain to the general population and for description patients with chronic hepatitis C may amount to Fellow, Department of Hepatology; Hepatologist, of the prevalence of the infection among adult 54 000 to 61 700. Conclusion: HCV infection is Hepatology Department, Consultative and population of the Russian Federation. Aim: To an- the most prevalent among other viral hepatites 1 Diagnostics Department alyze the epidemiological situation with chronic in the Moscow Region (80.3%), and the largest Mariya Yu. Petrachenkova – MD, hepatitis C in the Moscow Region. Materials and numbers of infected individuals are of productive Gastroenterologist, Hepatology Department, methods: We analyzed data from the Moscow age. Almost three quarters of these patients are 1 Consultative and Diagnostics Department Regional Registry of patients with hepatic dis- referred for medical care at the stage of minimal Natal'ya V. Voronkova – MD, PhD, Senior Research orders as per April 2016, as well as the results of liver injury, and antiviral therapy can be used on Fellow, Department of Hepatology; Specialist large scale screening of the population of the an elective basis. Knowing the proportion of pa- in Infectious Diseases, Hepatology Department, Moscow Region with oral express test for an- tients with liver cirrhosis (8.4%) allows for plan- Consultative and Diagnostics Department1 ti-HCV antibodies (OraQuick HСV Rapid Antibody ning of the need in emergency treatments. The Sergey V. Koblov – MD, Gastroenterologist, Test). Based on the registry, we assessed the fol- true prevalence of HCV infection estimated from Hepatology Department, Consultative and lowing parameters of the patient cohort with the results of the screening program is at least Diagnostics Department1 chronic HCV infection (n = 17 182): age, gender, 5-fold higher than that in the Registry. This indi- Kseniya Yu. Kokina – MD, Gastroenterologist, HCV genotype, grade of liver fibrosis, allele vari- cates the necessity to upgrade the system of pri- Hepatology Department, Consultative and mary assessments. In particular, it seems reason- Diagnostics Department1 ants of interleukin 28В. Within the large scale screening program among the population of the able to include detection of anti-HCV antibodies Valeriy D. Beznosenko – MD, Specialist in Infectious Moscow Region, 1447 individuals from 6 districts into the list of obligatory screening laboratory Diseases, Hepatology Department, Consultative and tests. Diagnostics Department1 of the region were screened for anti-HCV anti- bodies. Results: As per April 2016, the propor- Ekaterina V. Fedosova – MD, Gastroenterologist, Key words: chronic hepatitis С, prevalence, Hepatology Department, Consultative and tion of patients with chronic viral hepatitis in the Moscow Region, anti-HCV antibodies, screening, Diagnostics Department1 Registry was 75.3% (n = 12 938 of 17 182). The vast oral express test, registry majority of them (80.3%, or n = 10 393) had chron- ic hepatitis C, with 84% (n = 8726) of referrals were For citation: Bogomolov PO, Bueverov AO, patients of productive age (from 20 to 50 years). Matsievich MV, Petrachenkova MYu, Voronkova NV, Koblov SV, Kokina KYu, Beznosenko VD, Fedosova EV. 1 Moscow Regional Research and Clinical Institute 8.4% (n = 873) of all HCV infected patients had (MONIKI); 61/2 Shchepkina ul., Moscow, 129110, liver cirrhosis. Although the proportion of pa- Epidemiology of hepatitis C in the Moscow Region: Russian Federation tients with cirrhosis was negligibly low (< 1.5%) data from the Moscow Regional Registry and 2 I.M. Sechenov First Moscow State Medical in patients below 30 years of age, it was progres- screening for HCV antibodies. Almanac of Clinical University; 8/2 Trubetskaya ul., Moscow, 119991, sively increasing with age, with a maximum of Medicine. 2016;44(6):689–96. doi: 10.18786/2072- Russian Federation 23.8% in those above their 50-es. As far as the 0505-2016-44-6-689-696. Almanac of Clinical Medicine. 2016 August-September; 44 (6): 689–696. doi: 10.18786/2072-0505-2016-44-6-689-696 he numbers of hepatitis C virus (HCV) indirect horizontal-flow immune analysis for detec- infected worldwide are estimated as 130 to tion of antibodies to recombinant core antigen, as 200 million; however, true prevalence of well as to non-structural antigens NS3 and NS4 with the disorder has not been established. synthetic viral peptides. The tests were done accord- TSo, among 3.2 million of HCV-carriers in USA, ing to the instruction from the manufacturer. Within from 50 to 70% are unaware of their disease [1– 15 minutes before the saliva sampling, the subjects 3]. According to the World Health Organization, did not eat or drink anything, including drinking wa- annually more than 700,000 people die of HCV- ter. If mouth care products had been used, saliva was associated liver disorders [4]. sampled at least 30 minutes later. Saliva samples were In addition to late liver complications, such as taken by passing with a sampling pad on the external live cirrhosis and hepatocellular carcinomas, which surface of upper and lower gums (it was allowed to are seen in 10 to 25% and 4% of patients, respectively, use both sides of the pad). The testing device was put after 20 years of infection, chronic hepatitis C is asso- into the vial with developer solution. Results were an- ciated with higher rates of cardiovascular disorders, alyzed at 20 to 40 minutes; the reliability of each test B cell lymphoma, type 2 diabetes mellitus and other was confirmed by a built-in control device. If only one disorders of various organs and systems [5–7]. There line in the C zone developed, the result was consid- is emerging data on accelerated progression of other ered negative, if two lines (in the C zone and in the existing disorders, type 1 and type 2 diabetes in par- T zone) were seen, the result was considered positive ticular, in patients with chronic HCV infection [6, 8]. and indicated the presence of anti-HCV antibodies. In Russia, formal registration of HCV infection has been performed since 1994; however, there is no Results accurate statistical data on the prevalence of chronic According to the Registry as per April 2016, total hepatitis C, because patient registries exist only in few number of patients with liver disorders was 17,182, regions. According to some estimations, total num- with 75.3% of them (n = 12,938) having chronic viral ber of cases of chronic hepatitis C exceeds 1.94 mil- hepatic disorders. Of those, 10,392 had been referred lion. As there is no reliable data, this does not include for medical care because of chronic HCV infection; in patients with chronic hepatitis C who with sustained 873 of cases liver cirrhosis was diagnosed (8.4% of all virological response after anti-viral treatment, as well patients with chronic hepatitis C) (Fig. 1). as hepatitis C-related mortality [9]. Age distribution of patients demonstrated obvi- With this in mind, it is interesting to analyze the ous predominance (> 80%, n = 8,726) of those in their epidemiological situation with chronic hepatitis C productive age, namely, from 20 to 50 years (Fig. 2). in the Moscow Region, which is the second largest The highest numbers of HCV infected individuals population in the Russian Federation (7,318,647 peo- were 30 to 39 years of age (n = 4,359). ple) and where the registry of such patients has been There was no significant gender difference in- pa maintained since 2010. tients with chronic hepatitis C in the Registry, with slightly more men (53.5%, n = 5,559). Separate anal- Materials and methods ysis of men and women by age group showed that Analysis of the epidemiological situation was per- the largest number of male patients belonged to the formed based on the data from the Moscow Regional age group from 26 to 39 years, while the largest pro- Registry of patients with liver disorders (hereinafter, the portion of females were above their 40-es (2,878 and Registry) and on the results of the wide-scale program 3,103, respectively).
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