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Hépatite C Prise en charge de ladulte Programme sur lhépatite C au Sud bilan et perspectives du groupe de travail Réunion de lAC 12, ANRS, 28 février 2008.

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Présentation au sujet: "Hépatite C Prise en charge de ladulte Programme sur lhépatite C au Sud bilan et perspectives du groupe de travail Réunion de lAC 12, ANRS, 28 février 2008."— Transcription de la présentation:

1 Hépatite C Prise en charge de ladulte Programme sur lhépatite C au Sud bilan et perspectives du groupe de travail Réunion de lAC 12, ANRS, 28 février 2008

2 Réunion ANRS, hépatites virales en PED, 17 janvier 2007 Aspects prise en charge Outils virologiques pour le VHC (J. Izopet) Evaluation et traitement de la fibrose hépatique en Afrique (P. Cales) Evaluation de la fibrose hépatique au Burkina Faso (P. Bonnard & L. Slama) Traitement des hépatites B chroniques au Sénégal (P.S. MBaye & M. Vray) Etudes sur le VHC au Cameroun –Epidémiologie et études phylogénétiques du VHC au Cameroun (R. Njouom & C. Pasquier) –Histoire médicale du Cameroun et épidémiologie historique du VHC (ANRS 1299) (G. Lachenal) –Traitement du VHC au Cameroun (O. Njoya) Etudes sur le VHC en Egypte –ANRS viral hepatitis research site in Cairo (M. Mohamed & A. Fontanet) –Immunological markers of HCV clearance (M. Albert & J. Decalf). –Transmission intra-familiale de l'infection par le VHC (L. Abel & S. Plancoulaine)

3 Cameroun Richard Njouom, Centre Pasteur du Cameroun Oudou Njoya Hépatologue, CHU de Yaoundé

4 Ntem 1997 Pop: 408 (14,4%) Mekas 1993 Pop: 644 (16,7%) Yokadouma 1994 Pop: 646 (3,3 %) Nditam 1994 Pop: 368 (2,9%) HCV sero-prevalence in Cameroun Nerrienet et al. J Med Virol 2005 Yaounde 2003 N= %

5 Hétérogénéité et distribution des génotypes HCV à Yaoundé Richard Njouom, Centre Pasteur du Cameroun Christophe Pasquier, Laboratoire de Virologie, CHU Toulouse n = 156 –Génotype : 17045% –Génotype : 23724% –Génotype : 44931% –nombreux sous-types (pour 1 et 4) –Nombreux sous-types non classifiés –Concordance parfaite des clusters NS5b et E2 (n=144) Pasquier, J Med Virol 2005; 77:390-8

6 HCV genotypes and sub- types n =156

7 Suivi virologique des patients VHC positifs sous traitement antiviral Début TTS12 (RVP)M6-12 (RVFT)M12-18 (RVS) Génotype 13422/34 (64,7%)13/26 (50%)10/23 (43,5%) Génotype 21414/14 (100%)12/13 (92,3%) Génotype 42213/22 (59,1%)9/18 (50%)7/16 (43,8%) Total7049/70 (70%)34/57 (59,6%)29/52 (55,8%) : Résultats : de 2003 à nos jours (résultats au 17/01/2007) O. Njoya Hépatologue, CHU de Yaoundé Richard Njouom, Centre Pasteur du Cameroun 17/01/2007

8 Egypt

9 Egypt Network participants In Egypt: –Most of activities are based at the National Hepatology and Tropical Medicine Research Institute (NHTMRI) in Cairo and involve: Ain Shams University: epidemiology (Prof Mostafa K Mohamed) and immunology (Prof Mona Rafik). Cairo university: clinical expertise (Prof Gamal Esmat), Minia University: virology (Prof Mohamed Abdel Hamid), University of Mansoura: pathology (Prof Khaled Zalata). Under the guidance of the Ministry of Health through the National Committee for the prevention and control of viral hepatitis in Egypt. In France: –Institut Pasteur, Paris: epidemiology (Dr Arnaud Fontanet); immunology (Dr Matthew Albert), –INSERM U370, Paris: virology (Prof Christian Bréchot, Dr Valérie Thiers), –Necker Hospital, Paris: clinical expertise (Prof Stanislas Pol), –INSERM U707, Paris: mathematical modeling and cost-effectiveness studies (Prof Alain- Jacques Valleron, Dr Bernard Larouzé, Dr Fabrice Carrat, and Dr Michaël Schwarzinger), –INSERM U550, Paris: genetic epidemiology (Dr Laurent Abel), –Beaujon Hospital, Paris: pathology (Prof Pierre Bedossa), –Saint Louis Hospital: virology HBV (François Simon), –Nantes Hospital: virology (Cyrille Féray) International collaborators: –U.S.A: Prof Stewart Cooper (clinical immunology), Dr Eric Delwart (virology), Dr Chris Loffredo (epidemiology) –U.K.: Prof Nishi Charturvedi (epidemiology)

10 Research programme 6 months 1 to 2 months 10 to 30 years INCUBATIONACUTE PHASECHRONIC PHASE Chronic infection 50-85% Cirrhosis 20% Hepatocellular carcinoma 1 to 4 %/year Jaundice 25% Asymptomatic HCV infection Fever Hospitals Village cohort HCV risk factors Factors associated with HCV clearance: -epidemiology -lipids -virology -immunology -co-infection (HBV) Treatment efficacy Treatment efficacy Facteurs associated with transmission & chronicity /morbidity -genetic epidemiology -CV risk factors -virology Mathematical modeling: Prediction, cost-effectiveness

11 HCV antibody prevalence (%) Age group (in years) HCV antibody prevalence (%) by age and sex Zwyat Razin, 2002 (n = 4020) (ANRS 1211). (Arafa et al, J Hepatol, 2005)

12 18,5% 11,7% 4,5% 1,5% HCV-related morbidity among adults (n= 2425, yrs), Zwyat Razin, (Mohamed MK, J Med Virol, 2006) / PBH * * Cirrhose décompensée ou F3/F4 PBH 13 trt indications

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14 Egyptian National Control Strategy for Viral Hepatitis MOHP, National Committee on viral hepatitis –Patient management 9 liver centers where 10,050 patients where currently receiving treatment as of Jan 2008, usually a wing in a MOHP hospital Another 6 more centers in 2008 National headquarter is NHTMRI –Collection of information on patient recruitment and follow-up in the centers Need to be standardized and computerized Development of a web-based data entry system planned To contribute to the evaluation of the network of treatment centers before proceeding further

15 Liver centers open in Egypt as of Jan 2008 SUDAN Asyut Alexandria Tanta Damietta Al Mansurah Cairo Suhag Az Zaqaziq

16 Currently, 48 wks PEG IFN + Ribavirin at a total cost of 3000 euros. 4 categories of patients –Health insurance (HIO) (40%) : PEG-IFN –Contract patients (8%): not covered by HIO. Private-sector employers have agreed to pay for trt in MOHP facilities. PEG-IFN + Riba –Private patients (7%): pay for their own trt in MOHP or private clinics –Patients treated at government expense (45%): no insurance; preliminary evaluation (paid for by MOHP) voucher for trt that covers 12 wks injections but not the cost of ribavirin

17 Liver fibrosis evaluation among HCV genotype 4 infected patients in Egypt P Bonnard, G Esmat To evaluate and compare –diagnostic accuracies of the non-invasive methods for fibrosis assessment for the diagnosis of significant fibrosis Non invasive methods have been validated in western countries In Egypt, –Steatosis is more common, –Elevated BMI may compromise elastometry –Co-infection with S mansoni, HBV 400 patients referred to NHTMRI –Liver biopsy (routinely performed). Gold standard –Elastometry –Blood tests to calculate: APRI, Fib-4, Fibrometre, Fibrotest Expected start of the inclusions : October 2008

18 Key points to be discussed Need of non-invasive markers of fibrosis –Cost-effectiveness Efforts on the cost of treatment including –Antiviral therapy : Generic? –And monitoring : PCR In the context of a National program –Including screening strategies Advanced liver diseases, –Co-factors, –management –Epidemiological tools to follow-up trends?


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