Cohort of HBV and HCV Patients

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1 Cohort of HBV and HCV Patients Emanuel K. Manesis, MD Professor of Medicine

2 In 2003 the Hellenic Center for Disease Prevention & Control (HCDPC) started a cohort study of chronic HBV, HDV and HCV infection in Greece. The The study had the financial support of the HCDPC and this will continue up to the year The The project is scientifically directed by the Viral Hepatitis section of the HCDPC. Code named:

3

4 Year 2003

5 30 Participating Hepatology Centers (2003) Area Number % Athens (metropolitan area) 18 60% Piraeus (metropolitan area) 2 7% Thessalonica (northern Greece) 4 14% Alexandroupolis (Thrace) 1 3% Larissa (central Greece) 1 3% Ioannina (western Greece) 1 3% Heraklion (Crete) 1 3% Rodos Island (Aegean sea) 1 3% Rio (Peloponnesus) 1 3%

6 Year 2007

7 30 Participating Hepatology Centers (2003) Area Number % Athens (metropolitan area) 12 60% Piraeus (metropolitan area) 1 5% Thessalonica (northern Greece) 3 15% Alexandroupolis (Thrace) 1 5% Larissa (central Greece) 1 5% Ioannina (western Greece) Heraklion (Crete) Rodos Island (Aegean sea) 1 5% Rio (Peloponnesus) 1 5%

8 20 Hepatology Centers Currently Participating Primary target of the study: To investigate the course and the outcome of chronic hepatitis B, D and C in a large cohort of Greek patients with/without Rx. Secondary targets: Obtain an indirect estimate of the incidence of chronic HBV, HDV & HCV infection in Greece from the number of newly diagnosed patients yearly. Introduce common standards of care in HBV and HCV patients. Improve collaboration between Hepatology Centers in Greece.

9 Methodology Retrospective-prospective prospective study. Started Started in 2003 with the retrospective recording of all patients followed at each participating Center since Data Data included demographic, clinical, biochemical and virological information available in patients records. Since Since 2005, patients already in the study, as well as, all the new cases have been followed semiannually and new data reported centrally.

10 Methodology At the beginning, recording was manual by filling-up a detailed questionnaire at each Center. Data Data were centrally evaluated and sorted by a special team at the Department of Epidemiology, Athens University School of Medicine and transferred to an electronic database. Since Since 2006, data entry and central reporting is being done electronically. Electronic data entry prevents reporting of a case, if a piece of crucial information is missing.

11 Results Cases analyzed by October 2007: HBV: 3480 cases HCV: 2817 cases Not included: 538 cases HBV & HCV coinfection. Analysis pending: HDV cases.

12 Sex HBV Results-Demographics Adults Children Males (N, %) 2,135 (64%) 78 (61%) Females (N, %) 1,218 (36%) 49 (39%) Total 3353 (96%) 127 (4%) 3480

13 HBV Results-Demographics Parameter Adults (Mean ± SD) Children (Mean ± SD) Current Age 45.3± ±4.0 Age (at 1 st diagnosis) 40.3± ± ±4.1

14 HBV Results-Demographics Parameter Adults (Mean ± SD) Children (Mean ± SD) Current Age 45.3± ±4.0 Age (at 1 st diagnosis) 40.3± ± ±4.1 Follow-up (at the time of study entry ) 3.0± ±3.3

15 HBV Results-Immigrants Status Adults (N, %) Children (N, %) Native Greeks 2,558 (83%) 53 (43%) (or 2% of natives) Immigrants 531 (17%) 69 (57%) (or 12% of immigrants)

16 HBV Results-Immigrants Native Greeks Immigrants Parameter Current Age 47.0± ±14.2 Age (at 1 st diagnosis) 41.4± ± ±13.4 Follow-up (at the time of study entry ) 3.3± ±1.9

17 HBV Results-Immigrants Area of Origin N % Albania % Eastern Europe % Asia % Africa % Total %

18 HBV Results-Immigrants Place of Residence in Greece by Nationality Native Greeks Immigrants Urban 662 (25.7%) 39 (7.0%) Semi-urban 272 (10.5%) 39 (7.0%) Rural 1,645 (63.8%) 483 (86.1%)

19 HBV Results-HBeAg Status HBeAg Positive Negative Adults 237 (8%) 2872 (92%) Children 76 (62%) 46 (38%)

20 HBV Results-- --HBeAg Status HBeAg Positive Negative Native Greeks 194 (8%) 2273 (92%) Immigrants 90 (17%) 451 (83%)

21 HBV Results-Immigrants Presence of Cirrhosis & HCC at the 1 st Visit Native Greeks Cirrhosis (N, %) 195/2625 (7.4%) HCC (N, %) 25/2625 (1.0%) Immigrants 20/598 (3.3%) 3/598 (0.5%)

22 HCV Results-Demographics Sex (Males, Males, %)% 1670 (59%) Current Age 43.4±16.3 Age (at 1 st diagnosis) 41.5±16.0 Follow-up (at the time of study entry) 2.6±3.3 years

23 HCV Results-Epidemiological Possible Source of Infection Intravenous drug use 30.7% Transfusion(s) (before 1992) 22.6% Hospital admissions / Operations (without Tx s.. Before 1992) 3.4% Professional exposure 1.1% Other 5.6% Unknown 36.6%

24 HCV Results-Clinical Obese (BMI >30) 12% Normal (BMI 25-30) 50% Overweight (BMI 25-30) 38%

25 Distribution of HCV Genotypes in Greece Gn 4 14% Untypable 3% Gn 1 43% Gn 3 33% Gn 2 7%

26 HCV Genotypes in Greece Overall Gn 4 14% Untypable 3% Gn 1 43% IVDU Gn 4 11% Gn 1 24% Gn 2 2% Gn 3 33% Gn 2 7% Gn 3 63% Transfusions Gn 4 16% Unknown Gn 4 19% Gn 1 52% Gn 3 12% Gn 2 10% Gn 1 62% Gn 3 21% Gn 2 9%

27 Temporal Change in the Distribution of HCV Genotypes in Greece Gn 1 Gn 2 Gn 3 Gn < >1992

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