Elimination of Hepatitis C, Iran and International Experiences

سال انتشار: 1397
نوع سند: مقاله کنفرانسی
زبان: انگلیسی
مشاهده: 409

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شناسه ملی سند علمی:

MHC05_007

تاریخ نمایه سازی: 30 دی 1397

چکیده مقاله:

An estimated 186,500 individuals (0.24 of the general population) are currently infected with hepatitis C virus (HCV) in Iran and require treatment. Despite the recent success in introducing new treatment agents that can achieve cure in almost 98% of cases, and reducing HCV treatment costs, the treatment rates has not exceeded 2.5% of the HCV infected population and most of infected patients are undiagnosed yet. This trend in diagnosis and treatment policies can lead to marked and steady increase in number of HCV infections, and HCV related advanced liver disease and mortality in the next decades. HCV as a major public health threat cannot be eliminated unless an active case finding and timely diagnosis and treatment policies be implemented, especially in the priority populations. Recent epidemiologic studies have shown that 75% of HCV infected people have gained infection through injecting drug use (IDU), and that the majority of HCV infected population belong to people who inject drugs (PWID) and people in custodial settings. The problems in these populations are that they are not accessible and that they are not willing to undergo time consuming laboratory testing and treatments, and therefore many of them do not refer for treatment. In order to overcome these problems, the world health organization (WHO) has encouraged the countries to develop and utilize point of care policy for the management of HCV infection. The WHO emphasizes on delivering the healthcare tests, products and services to patients at the time and place of patient care, therefore instead of waiting days for laboratory results and several visits to guide treatment decisions, in a single visit the patient can know his HCV infection status and receive the desired treatment. In order to eliminate hepatitis C virus (HCV) infection in Iran by 2030 it has been calculated that we should treat 24,000 subjects each year for the next 13 years with a treatment modality effective in at least 80% of cases. A large number of these patients are Persons Who Inject Drugs (PWID) who also serves as a major pool for dissemination of the disease. A main prevalent area for hepatitis C infection is prisons where Iranian studies report HCV prevalence between 10 and 80%. Many of these patients are infected in the prison through inmate interactions including unsafe tattooing and needle sharing between PWID. Considering the turnover of prisons in Iran, targeting prisons provides a unique opportunity for both treating patients and preventing disease spread and would be enough to eliminate hepatitis C by 2030. The problem with prisoners is the lack of compliance and follow-up even when all these services are provided for free. The logistics of testing prisoners is also an area of concern.Viral hepatitis is a major infectious disease in patients with hereditary bleeding disorders. Hepatitis C virus (HCV) infection resulted in morbidity and mortality in these patients through the recent decades. The screening for HCV in donated bloods and prescription of virus-inactivated blood products and clotting factors since 1990s resulted in a drop in the rate of transmission of disease. The burden of HCV infection mandates us for screening and start of therapy as soon as possible. Thalassemia patients and patients on hemodialysis are at risk for HCV infection too. One of our programs for control of HCV infection is micro elimination of HCV infection in special group. Fortunately, there are good reports from some provinces in Iran about this goal.

نویسندگان

Seyed-Moayed Alavian

Professor of Baqiyatallah Research Center for Gastroenterology and Liver Disease Tehran, Iran