Epidemiological and Clinical Characteristics of Hepatitis C Virus Infection in South Korea from 2007 to 2017: A Prospective Multicenter Cohort Study
2
조회
0
다운로드
13
인용
0
참고문헌
키워드
초록
Background/Aims: This study aimed to elucidate the epidemiological and clinical characteristics of chronic hepatitis C (CHC) patients in South Korea from 2007 to 2017 and to compare the treatment patterns between two periods before and after the first approval of direct-acting antivirals (DAA) in South Korea in 2015. Methods: This prospective, multicenter cohort enrolled 2,758 patients with hepatitis C virus (HCV) viremia at seven tertiary centers, and clinical data were prospectively collected with questionnaire surveys focused on lifetime risk factors related to HCV infection. Results: The HCV patients had a mean age of 57.3 years (50.8% male). Among them, 14.3% showed a positive history of transfusion before HCV screening and 5.6% reported intravenous drug use (IVDU), with significant differences in these risk factors between men and women. The proportions of patients with chronic hepatitis, liver cirrhosis and hepatocellular carcinoma (HCC) were 69.5%, 18.9%, and 11.5%, respectively. The mean alanine aminotransaminase level was within the upper normal limit at 49.9%, and the major genotypes were 1b (48.2%) and 2 (46.4%). The overall treatment rate was 53.8%, showing a rapid transition from interferon-based therapy to DAA therapy. In the post-DAA-approval era, the untreated group was older, had a higher prevalence of HCC, and had less education than the treated group. Conclusions: More than 90% of CHC patients were over 40 years old, the major genotypes were 1b and 2, and IVDU was observed in less than 6% of CHC patients. Approximately half of the patients underwent antiviral therapy even in the DAA era, showing an unmet need with regard to HCV elimination.
Abstract
Background/Aims: This study aimed to elucidate the epidemiological and clinical characteristics of chronic hepatitis C (CHC) patients in South Korea from 2007 to 2017 and to compare the treatment patterns between two periods before and after the first approval of direct-acting antivirals (DAA) in South Korea in 2015. Methods: This prospective, multicenter cohort enrolled 2,758 patients with hepatitis C virus (HCV) viremia at seven tertiary centers, and clinical data were prospectively collected with questionnaire surveys focused on lifetime risk factors related to HCV infection. Results: The HCV patients had a mean age of 57.3 years (50.8% male). Among them, 14.3% showed a positive history of transfusion before HCV screening and 5.6% reported intravenous drug use (IVDU), with significant differences in these risk factors between men and women. The proportions of patients with chronic hepatitis, liver cirrhosis and hepatocellular carcinoma (HCC) were 69.5%, 18.9%, and 11.5%, respectively. The mean alanine aminotransaminase level was within the upper normal limit at 49.9%, and the major genotypes were 1b (48.2%) and 2 (46.4%). The overall treatment rate was 53.8%, showing a rapid transition from interferon-based therapy to DAA therapy. In the post-DAA-approval era, the untreated group was older, had a higher prevalence of HCC, and had less education than the treated group. Conclusions: More than 90% of CHC patients were over 40 years old, the major genotypes were 1b and 2, and IVDU was observed in less than 6% of CHC patients. Approximately half of the patients underwent antiviral therapy even in the DAA era, showing an unmet need with regard to HCV elimination.
참고문헌 (30)
- Lavanchy D, "Evolving epidemiology of hepatitis C virus", Clin Microbiol Infect, 17, pp.107~115 (2011)
- El-Serag HB, "Epidemiology of viral hepatitis and hepatocellular carcinoma", Gastroenterology, 142, pp.1264~1273 (2012)
- Wong MCS, "The changing epidemiology of liver diseases in the Asia-Pacific region", Nat Rev Gastroenterol Hepatol, 16, pp.57~73 (2019)
- Hajarizadeh B, "Epidemiology and natural history of HCV infection", Nat Rev Gastroenterol Hepatol, 10, pp.553~562 (2013)
- "Global health sector strategy on viral hepatitis 2016-2021: towards ending viral hepatitis" (2016)[URL]
- "Combating hepatitis B and C to reach elimination by 2030: advocacy brief" (2016)[URL]
- Shin HR, "Epidemiology of hepatitis C virus in Korea", Intervirology, 49, pp.18~22 (2006)
- Mohd Hanafiah K, "Global epidemiology of hepatitis C virus infection : new estimates of age-specific antibody to HCV seroprevalence", Hepatology, 57, pp.1333~1342 (2013)
- Bruix J, "American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma", Hepatology, 42, pp.1208~1236 (2005)
- Bruix J, "Management of hepatocellular carcinoma: an update", Hepatology, 53, pp.1020~1022 (2011)
- Kim DY, "A nationwide seroepidemiology of hepatitis C virus infection in South Korea", Liver Int, 33, pp.586~594 (2013)
- The Korean Association for the Study of the Liver, "2017 KASL clinical practice guidelines management of hepatitis C: Treatment of chronic hepatitis C", Clinical and Molecular Hepatology, 24(3), pp.230~277 (2018), 대한간학회
- Kim KA, "Cost-effectiveness and health-related outcomes of screening for hepatitis C in Korean population", Liver Int, 39, pp.60~69 (2019)
- Richard JL, "The epidemiology of hepatitis C in Switzerland : trends in notifications, 1988-2015", Swiss Med Wkly, 148, pp.w14619~ (2018)
- McLauchlan J, "Cohort profile : the hepatitis C virus(HCV)research UK clinical database and biobank", Int J Epidemiol, 46, pp.1391~1391h (2017)
- Yehia BR, "The treatment cascade for chronic hepatitis C virus infection in the United States : a systematic review and meta-analysis", PLoS One, 9, pp.e101554~ (2014)
- Cornberg M, "A systematic review of hepatitis C virus epidemiology in Europe, Canada and Israel", Liver Int, 31(Suppl 2), pp.30~60 (2011)
- Goolsby Hunter A, "Clinical characteristics, healthcare costs, and resource utilization in hepatitis C vary by genotype", Curr Med Res Opin, 33, pp.829~836 (2017)
- Younossi ZM, "The impact of hepatitis C burden : an evidence-based approach", Aliment Pharmacol Ther, 39, pp.518~531 (2014)
- Poynard T, "A comparison of fibrosis progression in chronic liver diseases", J Hepatol, 38, pp.257~265 (2003)
- Jin YJ, "Clinicobiochemical prediction of biopsy-proven cases of severe hepatic fibrosis in patients with chronic hepatitis C infection", BMJ Open, 4, pp.e006255~ (2014)
- Puoti C, "Serum HCV RNA titer does not predict the severity of liver damage in HCV carriers with normal aminotransferase levels", Liver, 19, pp.104~109 (1999)
- Anand BS, "Assessment of correlation between serum titers of hepatitis C virus and severity of liver disease", World J Gastroenterol, 10, pp.2409~2411 (2004)
- Collier J, "Hepatitis C viral infection in the immunosuppressed patient", Hepatology, 27, pp.2~6 (1998)
- Pol S, "Predictive factors for development of cirrhosis in parenterally acquired chronic hepatitis C : a comparison between immunocompetent and immunocompromised patients", J Hepatol, 29, pp.12~19 (1998)
- Hiroishi K, "Cytotoxic T lymphocyte response and viral load in hepatitis C virus infection", Hepatology, 25, pp.705~712 (1997)
- Ticehurst JR, "Factors affecting serum concentrations of hepatitis C virus(HCV)RNA in HCV genotype 1-infected patients with chronic hepatitis", J Clin Microbiol, 45, pp.2426~2433 (2007)
- "Korean national health and nutrition examination survey" (2018)[URL]
- "Global hepatitis report, 2017" (2017)[URL]
- European Association for the Study of the Liver, "EASL recommendations on treatment of Hepatitis C 2018", J Hepatol, 69, pp.461~511 (2018)