Ignacio de los Santos Gil Hospital Universitario de la Princesa Madrid
2
OMS Guidelines for the screening and treatment of persons with hepatitis C infection. April 2014
Infección VIH y VHC: grave problema de salud mundial con vías de transmisión superpuestas
HIV infection
HCV infection
•
33.3 million people worldwide have HIV1
•
Incidence: 2.6 million/year1
185 million people worldwide have HCV3,4 Incidence: not well known ~150 000/year in US/Western Europe
deaths/year1
•
1.8 million
•
~a third are HCV co-infected in US and Western Europe
~350 000/year in Japan3
350,000 deaths/year globally3 ~5–10% are HIV co-infected5
•
Transmission – Sexual > Parenteral
Transmission ◦ Parenteral > Sexual
1. World Health Organization. Global Summary of the HIV.AIDS Epidemic. Available from: http://www.who.int/hiv/data/en/ 2. Rockstroh JK, et al. Lancet Infect Dis 2004;4:437–44; 3. World Health Organisation. Hepatitis C. Available from: http://www.who.int/csr/disease/hepatitis/whocdscsrlyo2003/en/index.html 4. World Health Organization. Hepatitis C. Weekly Epidemiological Record 1997;72:65–9; 5. Maier I, Wu GY. World J Gastroenterol 2002;8:577–9
Prevalencia de hepatitis C en la población VIH (1960/5957 patients = 33%)
~2.3million million people ~2.3 people living with HIV in Europe1 living with HIV in Europe1 ~25% co-infected with HCV2
•
1. UNAIDS Global Report: UNAIDS report on the Global AIDS Epidemic 2012. 2012 http://www.unaids.org/en/resources/publications/2012/name,76121,en.asp; 2. Rockstroh JK, Bhagani S. BMC Med 2013;11:234.
Disminución de la prevalencia de infección por VHC en pacientes VIH ◦ CoRIS ◦ Gesida Persistencia de la morbimortalidad de coinfectados vs disminución en monoinfectado ◦ CoRIS ◦ Otras cohortes
Cambio del patrón en la vía de infección de VHC
Epidemiología actual coinfección VIH-VHC en España
Clinical Infectious Diseases 2009; 48: 1467-70
•
Factores que tienden a disminuir la prevalencia
35
31,9
Death rate x 1000 py (CI)
30 IRR (95%CI) ref. 97-03*
25 20
HCV-
0.52 (0.32-0.85)
HCV+
1.27 (0.90-1.79)
23,6
22,2
18,7
17,5
15,7
15
12,5
10 5
8,8
6,5 3,3
6,3
4,6
0
97-03 n
32
py
3619.6
HCV -
VHC -
04-08
97-03
n
32
n
126
py
6965.6
py
6752.5
HCV +
VHC +
04-08 n
42
py
1779.2
*crude incidence rate ratio (and 95% CI) of death in period 2004-08 taking death rates in 1997-03 as reference
Clinical Infectious Diseases 2009; 48: 1467-70
Temporal Trends in Liver-Related Mortality in a Prospective Cohort of HIV-Infected Patients in Spain; 1997-2008
