Epidemiological, demographic and clinical data on chronic viral hepatitis C in Tuscany

Abstract

Background: Recent introduction of direct antiviral agents (DAAs) has completely changed the scenario regarding hepatitis C virus (HCV) treatment. Certain countries’ economic health programs prioritize DAAs according to specific clinical features of HCV-infected patients. The aim of this study was to define epidemiological, demographic and clinical characteristics of HCV-infected patients in the Tuscany region of central Italy.

Methods: We enrolled HCV patients with chronic viral hepatitis who were referred to the outpatient services of 16 hospitals in Tuscany from 1 January 2015 to 31 December 2015. Case report forms contained patient information including main demographic data, blood chemistry data, viral hepatitis markers, instrumental evaluations (liver biopsy or transient elastometry, liver ultrasound), eligibility for DAAs, and liver transplantation or therapy already in progress.

Results: Of all patients considered, 2919 HCV patients were enrolled (mean age: 57.44 ± 15.15; 54% males, 46% females). All routes of transmission were well represented (intravenous drug use in 20.7%; nosocomial/dental care in 20.6%; and coagulation factors/blood transfusions in 13.3%). Diabetes was the highest represented comorbidity (20.8%), followed by metabolic syndrome (15.5%) and ischemic heart disease (6.2%). The most prevalent HCV genotypes were 1b (47.4%) and 2 (16.5%). In the whole cohort of patients, 32.8% were cirrhotic (40 patients were listed for liver transplantation). Signs of portal hypertension were present mostly in the group older than 45 years (92.3%). Extrahepatic HCV-related diseases were present in 13.3% of cases (cryoglobulinemic syndrome in 58.3% and B-cell non-Hodgkin’s lymphoma in 10.5%).

Conclusions: Our study provides evidence of a high prevalence of epidemiological changes in HCV infection with a major prevalence of advanced liver disease, such as portal hypertension, in this elderly cohort of patients.

Keywords:

• Public health
• epidemiology
• hepatitis
• antiviral treatment
• fibrosis

Transparency

Declaration of funding

We certify that no funding has been received for the conduct of this study and/or preparation of this manuscript.

The contents of the paper and the opinions expressed within are those of the authors, and it was the decision of the authors to submit the manuscript for publication.

Author contributions: C.S. participated in study design, wrote the paper, participated in acquisition, interpretation and analysis of the data, and revised the article; Ca.Si. participated in the study design and acquisition and analysis of the data, and revised the article; R.B. and C.O. designed and developed the software for data registration and revised statistical analysis; M.R.B., A.L.Z., S.Mi., L.R., A.D.L., P.B., C.N., D.A., A.B., G.B., S.Ma., F.F., P.Co., P.F., A.G., S.L., S.Ch., A.N., G.C., R.S., P.Ca., A.R., M.G., P.A., A.C., S.Ca. and G.L. participated in study design and acquisition of data and revised the article critically for important intellectual; F.V. and F.C. participated in study design and were the guarantor of the methods used, and revised the article critically for important intellectual content. All authors have reviewed and approved the final manuscript.

Declaration of financial/other relationships

M.R.B. has disclosed that she has served on a speaker’s bureau for: Abbvie, BMS, Gilead, MSD and Janssen; and on an advisory board for: Abbvie, Gilead, MSD and Janssen. A.L.Z. has disclosed that she has served on a speaker’s bureau for: BMS, Gilead, MSD, Janssen and Abbvie; and on an advisory board for: Janssen, Abbvie, Gilead, MSD and BMS. A.D.L. has disclosed that her institution has received research grants from the fellowship program of Gilead Sciences; ViiV Healthcare and Merck Sharp and Dohme; she has received consultation fees from: Gilead Sciences, Abbvie, BMS and Janssen. C.S., Ca.Si., R.B., C.O., S.Mi., L.R., P.B., C.N., D.A., A.B., G.B., S.Ma., F.F., P.Co., P.F., A.G., S.L., S.Ch., A.N., G.C., R.S., P.Ca., A.R., M.G., P.A., A.C., S.Ca., G.L., F.V. and F.C. have disclosed that they have no significant relationships with or financial interests in any commercial companies related to this study or article.

CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgements

We thank Dr. Chiara Spertilli Raffaelli and Dr. Sara Modica for support data collection at the University Hospital of Siena.