Epidemiological characteristics of incident cases and risk factors of hepatitis C infection in Beijing City from 2004 to 2021 / 中华预防医学杂志

Objective: To analyze the epidemiological characteristics and related factors of hepatitis C in Beijing City from 2004 to 2021. Methods: Descriptive epidemiological method and Joinpoint regression were used to analyze the trend and other epidemiological characteristics of hepatitis C in Beijing City from 2004 to 2021 in National Notifiable Disease Reporting System. According to a 1∶1 matched case-control study design, logistic regression was used to investigate the risk factors of hepatitis C infection in 2021. Results: From 2004 to 2021, the reported incidence of hepatitis C in Beijing City ranged from 2.37/100 000 to 10.46/100 000. The reported cases were mainly aged 30-60 years, and most of them were chronic. The reported incidence of hepatitis C showed an initial increase from 2004 to 2006 (APC=45.37%, 95%CI:-1.56%-114.69%), and declined after 2006 (APC=-9.21%, 95%CI:-10.70%-7.70%). Logistic analysis showed that history of surgery (OR=1.84, 95%CI: 1.08-3.14) and previous blood transfusion (OR=34.22, 95%CI: 8.05-145.41) were risk factors for hepatitis C infection. Conclusion: The reported incidence of hepatitis C in Beijing City increases first and decreases later. It currently remains at a low level. The risk factors of infection are surgery and blood transfusion history. Safe blood supply and preventing iatrogenic transmission should be focused on the prevention of hepatitis C transmission.

Epidemiological characteristics of incident cases and risk factors of hepatitis C infection in Beijing City from 2004 to 2021 / 中华预防医学杂志

Objective: To analyze the epidemiological characteristics and related factors of hepatitis C in Beijing City from 2004 to 2021. Methods: Descriptive epidemiological method and Joinpoint regression were used to analyze the trend and other epidemiological characteristics of hepatitis C in Beijing City from 2004 to 2021 in National Notifiable Disease Reporting System. According to a 1∶1 matched case-control study design, logistic regression was used to investigate the risk factors of hepatitis C infection in 2021. Results: From 2004 to 2021, the reported incidence of hepatitis C in Beijing City ranged from 2.37/100 000 to 10.46/100 000. The reported cases were mainly aged 30-60 years, and most of them were chronic. The reported incidence of hepatitis C showed an initial increase from 2004 to 2006 (APC=45.37%, 95%CI:-1.56%-114.69%), and declined after 2006 (APC=-9.21%, 95%CI:-10.70%-7.70%). Logistic analysis showed that history of surgery (OR=1.84, 95%CI: 1.08-3.14) and previous blood transfusion (OR=34.22, 95%CI: 8.05-145.41) were risk factors for hepatitis C infection. Conclusion: The reported incidence of hepatitis C in Beijing City increases first and decreases later. It currently remains at a low level. The risk factors of infection are surgery and blood transfusion history. Safe blood supply and preventing iatrogenic transmission should be focused on the prevention of hepatitis C transmission.

Interpretation of the important update of the Guideline for the prevention and treatment of hepatitis C (2022 edition) / 中华肝脏病杂志

In the past 20 years, Chinese Medical Association had issued several versions of hepatitis C prevention and treatment guidelines. In the latest guidelines published in 2022, the Chinese Society of Hepatology and the Society of Infectious Diseases for the Chinese Medical Association organized experts to update their recommendations for hepatitis C screening and treatment. The updated key points on prevention, diagnosis, and treatment proposed in the guidelines are now interpreted, aiming to provide reference for more effective clinical application of the guidelines.

Microeliminação da hepatite C na população carcerária: realmente possível? / Micro-elimination of hepatitis c in the incarcerated population: is it really possible?

ABSTRACT According to the World Health Organization, 71 million people live with chronic hepatitis C. The treatment of this disease requires assistance from specialized physicians and a highly complex health care system. The prison population has been recognized as being at a high risk of acquiring confinement-related infections, including viral hepatitis. Hepatitis C virus (HCV) infection is a primary cause of death owing to liver disease among liberty-deprived individuals. Generally, prisons do not have adequate isolation wards for persons with communicable diseases, and overcrowding is a risk factor for this population. Besides prison overcrowding, violence, poor sanitary conditions, low socioeconomic status, social isolation, and emotional instability are factors that can lead detainees to adopt unhealthy habits that make them more susceptible to infections, including HCV, and complicate effective treatment. The Criminal Execution Law 7, 210 of July 11, 1984, in Article 14, grants preventive and curative medical, dental, and pharmacological healthcare to detainees. However, adequate hepatitis C treatment is rarely provided at prisons owing to social stigma and lack of knowledge on the severity of this condition or because most detainees are unaware of their condition. Given the multiple limitations imposed by the prison system model, implementing measures to treat diseases effectively is challenging. However, it is possible to eliminate hepatitis C in prisons in the long term through the coordinated action of public health institutions and the prison system.

RESUMO De acordo com a Organização Mundial da Saúde, 71 milhões de pessoas vivem com hepatite C crônica. O tratamento dessa doença requer assistência de médicos especializados e um sistema de saúde de alta complexidade. A população carcerária tem sido reconhecida como sendo de alto risco de adquirir infecções relacionadas às condições de confinamento, incluindo hepatites virais. O vírus da hepatite C (VHC) é uma causa primária de morte por doença hepática em pessoas privadas de liberdade. Geralmente, as prisões não possuem locais adequados para isolamento de pessoas com doenças transmissíveis e a superlotação é um fator de risco para essa população. Além da superlotação das prisões, violência, más condições sanitárias, baixo nível socioeconômico, isolamento social e instabilidade emocional são motivos adicionais que induzem os detidos a praticar hábitos não saudáveis, que os tornam mais suscetíveis a certas infecções (incluindo VHC) e complicam o tratamento específico. A Lei de Execução Penal n. 7.210, de 11 de julho de 1984, em seu artigo 14, garante assistência preventiva e curativa à saúde, incluindo assistência médica, farmacêutica e odontológica aos detidos. No entanto, o tratamento adequado da hepatite C é raramente fornecido nas prisões devido estigma social ou falta de conhecimento de sua condição ou porque a maioria dos detidos não tem conhecimento de sua condição. Devido a múltiplas limitações impostas pelo modelo prisional, a implementação de medidas para o tratamento eficaz de doenças é desafiadora. No entanto, é possível eliminar a hepatite C em um ambiente prisional de longa permanência através de ações coordenadas de instituições de saúde pública e o sistema prisional.

Brazilian protocol for sexually transmitted infections 2020: viral hepatitis

Abstract This article discusses viral hepatitis, a theme addressed by the Clinical Protocol and Therapeutic Guidelines to Comprehensive Care for People with Sexually Transmitted Infections and, more precisely, by the Clinical Protocols and Therapeutic Guidelines for Hepatitis B and Hepatitis C and Coinfections, published by the Brazilian Ministry of Health. Besides the broad spectrum of health impairment, hepatitis A, B, and C viruses also present different transmission forms, whether parenteral, sexual, vertical, or fecal-oral. Among the strategies suggested for the control of viral hepatitis, in addition to behavioral measures, are expanded diagnosis, early vaccination against hepatitis A and hepatitis B viruses, and access to available therapeutic resources. Considering vertical transmission of the hepatitis B and hepatitis C viruses, screening for pregnant women with chronic hepatitis B and C is an essential perinatal health strategy, indicating with precision those who can benefit from the prophylactic interventions.

Protocolo Brasileiro para Infecções Sexualmente Transmissíveis 2020: hepatites virais / Brazilian Protocol for Sexually Transmitted Infections 2020: viral hepatitis / Protocolo Brasileño para las Infecciones de Transmisión Sexual 2020: hepatitis virales

Resumo Este artigo aborda as hepatites virais, tema tratado no Protocolo Clínico e Diretrizes Terapêuticas para Atenção Integral às Pessoas com Infecções Sexualmente Transmissíveis e, mais precisamente, nos Protocolos Clínicos e Diretrizes Terapêuticas para Hepatite B e para Hepatite C e Coinfecções, publicados pelo Ministério da Saúde do Brasil. Além do espectro ampliado de acometimento da saúde, os vírus das hepatites A, B e C também apresentam diferentes formas de transmissão, seja parenteral, sexual, vertical ou oral. Entre as estratégias sugeridas para o controle das hepatites virais, além das medidas comportamentais, estão o diagnóstico ampliado, a vacinação precoce contra os vírus da hepatite A e hepatite B e o acesso aos recursos terapêuticos disponíveis. Considerando a transmissão vertical dos vírus da hepatite B e hepatite C, a triagem das gestantes portadoras crônicas desses vírus é uma importante estratégia de saúde perinatal, indicando com precisão quem pode se beneficiar das intervenções profiláticas disponíveis.

Abstract This article discusses viral hepatitis, a theme addressed by the Clinical Protocol and Therapeutic Guidelines to Comprehensive Care for People with Sexually Transmitted Infections and, more precisely, by the Clinical Protocols and Therapeutic Guidelines for Hepatitis B and Hepatitis C and Coinfections, published by the Brazilian Ministry of Health. Besides the broad spectrum of health impairment, hepatitis A, B and C viruses also present different forms of transmission, whether parenteral, sexual, vertical or oral. Among the strategies suggested for the control of viral hepatitis, in addition to behavioral measures, are expanded diagnosis, early vaccination against hepatitis A and hepatitis B viruses, and access to available therapeutic resources. Considering vertical transmission of the hepatitis B and hepatitis C viruses, screening for pregnant women with chronic hepatitis B and C is an important perinatal health strategy, indicating with precision those who can benefit from the prophylactic interventions.

Resumen Este artículo aborda las hepatitis virales, tema que hace parte del Protocolo Clínico y Directrices Terapéuticas para la Atención Integral a Personas con Infecciones de Transmisión Sexual y más precisamente de los Protocolos Clínicos y Guías Terapéuticas para Hepatitis B, Hepatitis C y Coinfecciones, publicados por el Ministerio de Salud. Además del amplio espectro de deterioro de la salud, los virus de las hepatitis A, B y C presentan diferentes formas de transmisión, como parenteral, sexual, vertical u oral. Entre las estrategias sugeridas para el control de las hepatitis virales, están las medidas conductuales, el diagnóstico ampliado, la vacunación precoz contra los virus de las hepatitis A y B y el acceso facilitado a los recursos terapéuticos disponibles. Considerando la transmisión vertical de los virus de la hepatitis B y C, la identificación de embarazadas portadoras crónicas de estos virus es importante estrategia de salud perinatal, indicando quiénes pueden beneficiarse de las intervenciones profilácticas.

Hepatitis C disease burden and strategies for elimination by 2030 in Brazil. A mathematical modeling approach

ABSTRACT Introduction and aim: Hepatitis C is a key challenge to public health in Brazil. The objective of this paper was to describe the Brazilian strategy for hepatitis C to meet the 2030 elimination goal proposed by World Health Organization (WHO). Methods: A mathematical modeling approach was used to estimate the current HCV-infected Brazilian population, and to evaluate the relative costs of two different scenarios to address HCV disease burden in Brazil: (1) if no further changes are made to the HCV treatment program in Brazil; (2) where the WHO targets for 2030 elimination are met through diagnosis and treatment efforts peaking before 2024. Results: An anti-HCV prevalence of 0.53% was calculated for the total population. It was estimated that the number of HCV-RNA+ individuals in Brazil in 2017 was 632,000 (0.31% of the population). Scale-up of treatment and diagnosis over time will be necessary in order to achieve WHO targets beginning in 2018. Direct costs (diagnostic, treatment and healthcare costs) are projected to increase significantly during the scale-up of treatment and diagnosis in the initial years of the intervention scenario, but then fall below the base case on an annual basis by 2025-2036, once HCV is eliminated, due to health sectors savings from the prevention of HCV liver-related morbidity and mortality. Conclusion: Achieving the WHO targets is technically feasible in Brazil with a scale-up of treatment and diagnosis over time, beginning in 2018. However, elimination of hepatitis C requires policy changes to substantially scale-up prevention, screening and treatment of HCV, together with public health advocacy to raise awareness among affected populations and healthcare providers.

High-risk behaviors for hepatitis B and C infections among female sex workers

Abstract INTRODUCTION: The prevalence of hepatitis B and hepatitis C and risk behaviors among 402 female sex workers in Central Brazil were investigated by respondent-driven sampling. METHODS: Blood samples were tested for hepatitis B and C markers by enzyme-linked immunosorbent assay. Two hepatitis B vaccination schedules were performed. RESULTS: The prevalence of hepatitis B and C infections were 9.3% and 0.5%, respectively. Susceptibility to hepatitis B infection was observed in 61.5% of subjects. There was no significant difference in adherence index (p=0.52) between vaccination schedules and all participants had protective antibody titers. CONCLUSIONS: This hard-to-reach population requires hepatitis B and C surveillance.

Epidemiological features of hepatitis C and its related influencing factors in Shandong province, 2007-2016 / 中华流行病学杂志

Objective: To analyze the epidemiological characteristics, dynamic trend of development and related influencing factors of hepatitis C in Shandong, China, 2007-2016, also to provide epidemiological evidence for prevention and control of HCV. Methods: National surveillance data of hepatitis C from 2007 to 2016 in Shandong was used, with distribution and clustering map of hepatitis C drawn at the county level. Panel Poisson regression was used to explore the influencing factors of hepatitis C at the city level. Results: The incidence of hepatitis C in Shandong increased from 1.49/100 000 in 2007 to 4.72/100 000 in 2016, with the high incidence mainly clustered in the urban regions in Jinan, Zibo, Weihai et al. and surrounding vicinities. Majority of the cases were young adults, with 53.16% (14 711/27 671) of them being farmers. Results from the Multiple panel Poisson regression analysis indicated that factors as: population density (aIRR=1.07, 95%CI: 1.05-1.10), number of hospital per hundred thousand people shared (aIRR=1.16, 95%CI: 1.08-1.24), expenditure of medical fee in rural (aIRR=1.21, 95%CI: 1.08-1.37) and the proportion of the tertiary industry (aIRR=1.08, 95%CI: 1.07-1.09) were all correlated to the incidence of hepatitis C. Conclusions: The incidence of hepatitis C had been increasing rapidly in recent years, in Shandong. Prevention and control of HCV should focus on high risk population. In addition, rural, especially in areas with lower economics provision should be under more attentions, so as to find more concealed cases for early treatment.

Controlling hepatitis C in Rwanda: a framework for a national response

With the introduction of direct-acting antiviral drugs, treatment of hepatitis C is both highly effective and tolerable. Access to treatment for patients, however, remains limited in low- and middle-income countries due to the lack of supportive health infrastructure and the high cost of treatment. Poorer countries are being encouraged by international bodies to organize public health responses that would facilitate the roll-out of care and treatment on a national scale. Yet few countries have documented formal plans and policies. Here, we outline the approach taken in Rwanda to a public health framework for hepatitis C control and care within the World Health Organization hepatitis health sector strategy. This includes the development and implementation of policies and programmes, prevention efforts, screening capacity, treatment services and strategic information systems. We highlight key successes by the national programme for the control and management of hepatitis C: establishment of national governance and planning; development of diagnostic capacity; approval and introduction of direct-acting antiviral treatments; training of key personnel; generation of political will and leadership; and fostering of key strategic partnerships. Existing challenges and next steps for the programme include developing a detailed monitoring and evaluation framework and tools for monitoring of viral hepatitis. The government needs to further decentralize care and integrate hepatitis C management into routine clinical services to provide better access to diagnosis and treatment for patients. Introducing rapid diagnostic tests to public health-care facilities would help to increase case-finding. Increased public and private financing is essential to support care and treatment services

Caracterización del paciente con Hepatitis C bajo control en el Sistema Público de Salud, Chile. Año 2016 -2017- / Characterization of hepatitis C patients under treatment in the Public Health System, Chile-2016

At the 67° World Health Assembly (WHA67.6), member states are encouraged to undertake measures to ensure and strengthen surveillance, prevention, access to treatment and control of viral hepatitis in all countries. In this context- and although in Chile hepatitis C is considered a low endemic pathology- efforts have been made to improve the lives of people infected by this virus. In the process of inclusion of new direct-action therapies such as Explicit Guarantees in Health (GES), it was necessary to know the real demand, as well as some important variables for decision-making. Methodology: In 2016, the Ministry of Health requested to the centers of hepatitis C of the public health system of the country, to report in Excel spreadsheets the list of patients under control, including variables of clinical-epidemiological interest. Sensitive data from these cases guaranteed throughout the process. Descriptive analysis of the profile of the patient, genotype, comorbidities, as well as liver transplantation, the result of previous treatment and candidates for new therapies according to prioritization criteria, established in GES regulation. In the results the characterization of the patients is described: the age is concentrated between 45 and 69 years old, without greater difference by sex, the most common genotype is 1 with 60% and 18% for genotype 3, 35% has cirrhosis, 21% has esophageal varicose veins, 6% HCV/HIV co-infection, 0.8% HCV/HBV co-infection, 7% with hemophilia.

En la 67ª Asamblea Mundial de la Salud (WHA67.6) se recomienda a los estados miembros emprender medidas para garantizar y fortalecer la vigilancia, prevención, acceso al tratamiento y control de las hepatitis virales en todos los países. En este contexto, y pese a que en Chile se considera la hepatitis C como una patología de baja endemia, se han realizado esfuerzos para mejorar la vida de las personas infectadas por este virus. En el proceso de inclusión de las nuevas terapias de acción directa como garantías explícitas en Salud (GES), se requirió conocer la demanda real, así como algunas variables importantes para la toma de decisiones. Metodología: El año 2016 desde el Ministerio de Salud se solicitó a los centros tratantes de hepatitis C del sistema público de salud del país, informar el listado de pacientes bajo control, incluyendo variables de interés clínico epidemiológico requeridas en planillas Excel. Se garantizó en todo el proceso los datos sensibles de estos casos. Se realizó un análisis descriptivo del perfil del paciente, genotipo, comorbilidades, así como trasplante hepático, resultado de tratamiento anterior y candidatos a nuevas terapias según criterios de priorización, establecidos en la norma GES. En los resultados se describe la caracterización de los pacientes: la edad se concentra entre los 45 y 69 años, sin mayor diferencia por sexo, el genotipo más común es el 1 con 60% y 18% para el genotipo 3, 35% presenta cirrosis, 21% presenta várices esofágicas, 6% coinfección VHC/VIH, 0,8% coinfección VHC/VHB, 7% con hemofilia.

Estudio pre-trasplante hepático: ¿qué buscar y cómo hacerlo? Si algo es positivo: ¿qué hacemos? / Liver transplant pre-study: what to search for and how to do it? what shall we do in case of positive findings?

The process of evaluation of candidate patients for liver transplantation should include the risk of infectious diseases in order to prevent the drop out of the waiting list due to infections or the occurrence of these in the post-transplant period. Cirrhotic patients in the pre-transplant stage are very ill and usually have severe infections. The most common is spontaneous bacterial peritonitis, but they can also present urinary infections and pneumonias. Mortality due to infectious causes has been reported up to 40% in patients on the transplant waiting list. The transplanted patients may have a poor immune response to vaccination, so the optimal immunization period is pre-transplant. In the post-transplant period, Gram-negative bacterial infections are one of the main complications. Invasive fungal infections and cytomegalovirus can also have a high impact on morbidity and mortality. Transplanted patients may also have mycobacterial infections in relation to a latent tuberculosis infection. In the following article we present the pre-transplant evaluations, vaccination schemes and antimicrobial prophylaxis that are used in liver transplantation.

El proceso de evaluación de pacientes candidatos para trasplante hepático debe incluir el riesgo de enfermedades infecciosas a fin de prevenir la salida de la lista por infecciones o la ocurrencia de éstas en el período post-trasplante. Los pacientes cirróticos en la etapa pre-trasplante están muy enfermos y suelen presentar infecciones graves. La más común es la peritonitis bacteriana espontánea, pero también pueden presentar infecciones urinarias y neumonías. La mortalidad por causa infecciosa se ha reportado hasta en 40% en pacientes en lista de espera de trasplante. Los pacientes trasplantados pueden tener una pobre respuesta inmune a la vacunación, por lo que el momento óptimo de inmunización es en el período pretrasplante. En el período post-trasplante las infecciones bacterianas por Gram negativos son una de las principales complicaciones. Las infecciones por hongos invasores y el citomegalovirus también pueden tener un alto impacto en morbilidad y mortalidad. Los pacientes trasplantados también pueden presentar infecciones por micobacterias en relación a una infección latente por tuberculosis. En el siguiente artículo se presentan las evaluaciones pre-trasplante, esquemas de vacunación y profilaxis antimicrobiana que se utilizan en trasplante hepático.

Protocolo del Sistema Nacional de Vigilancia Epidemiológica de transmisión sexual y VIH/VIH avanzado. No. 07 / Protocol of the National Epidemiological Surveillance System for sexual transmission and advanced HIV / HIV. No. 07

Estos protocolos están dirigido a personal médico, paramédico y otros profesionales que realizan acciones gerenciales y operativas de vigilancia epidemiológica en los servicios de salud del país, y están divididos en varios tomos para dar a conocer y actualizar la identificación y medidas de control para diversos padecimientos a fin de continuar con el mejoramiento de las capacidades técnicas de los trabajadores de salud, que permita planificar la prestación de servicios con decisiones partiendo de un enfoque epidemiológico comprobado, para responder a los cambios de tendencias epidemiológicas y con ello contribuir al fortalecimiento de prácticas asertivas de la salud pública de nuestro país. En el presente protocolo se incluirán tres elementos: La vigilancia en poblaciones clave será centinela Se instituirá la vigilancia para la población general a través de Epiweb La vigilancia de la mujer embarazada para la prevención y eliminación de la transmisión materno infantil de la sífilis congénita, a través de Epiweb

Da saúde internacional à saúde global: trajetórias históricas e geográficas do conceito de medicamentos essenciais / From international health to global health: historical and geographical trajectories of the essential medicines concept

As questões que envolvem o lugar que os medicamentos ocupam no âmbito da saúde pública têm sido foco de importantes debates. A partir dos anos 1970, estados terceiro-mundistas levaram a Organização Mundial de Saúde (OMS) a se debruçar sobre o tema, o que deu origem à primeira lista de medicamentos essenciais, num arranjo de governança em saúde marcadamente estadocêntrico e multilateral. Com a assinatura do Acordo TRIPS e a consolidação da epidemia de HIV como um problema de proporções mundiais, nos anos 1990, o conceito de medicamento essencial assume novos contornos, passando a ser disputado na governança da saúde global, sob a égide do multi-institucionalismo. O objetivo desta tese é estudar as trajetórias históricas e geográficas do conceito de medicamentos essenciais (ME), na transição da saúde internacional para a saúde global. Utilizamos os conceitos de "governança" e "governança em saúde", bem como os estudos do chamado campo da "saúde internacional/global" e a Teoria Crítica das Relações Internacionais para delinear os contextos políticos e econômicos que dão sustentação aos processos de deslocamento do conceito em análise. Partimos de literatura especializada, à qual agregamos o resultado de entrevistas informativas com atores chave, além de pesquisa documental nos arquivos da OMS, em Genebra. No primeiro capítulo, caracterizamos a Saúde Internacional, estudamos o nascimento da lista de medicamentos essenciais da OMS, calcada no multilateralismo e no estadocentrismo e apontamos os sinais que indicam a transição para a Saúde Global. No segundo, descrevemos a ascensão do neoliberalismo, a crise do Estado nacional e da própria OMS para caracterizar a Saúde Global como multi-institucional, formada por uma profusão de "atores". Discutimos os diversos sentidos atribuídos ao conceito de medicamentos essenciais e analisamos a atuação de organizações da sociedade civil, num movimento de repolitização do conceito. O terceiro capítulo estuda o caso do sofosbuvir, medicamento para tratar a Hepatite C, com seus desdobramentos para a governança em saúde e para os medicamentos essenciais. O estudo permitiu concluir que a inclusão do sofosbuvir na lista de ME da OMS, em 2015, tem origem nos processos políticos desencadeados em 2001. Argumentamos que o caso em análise determinou deslocamentos históricos e desencadeou rearranjos geográficos na dinâmica Norte-Sul, afetando de maneira emblemática a questão do acesso a medicamentos

The issues surrounding the place of medicines in public health have been the focus of important discussions. Since the 1970s, third-world states have led the World Health Organization (WHO) to address the issue, which has given rise to the first list of essential drugs in a markedly state-centric and multilateral health governance arrangement. With the signing of the TRIPs Agreement and the consolidation of the HIV epidemic as a problem of worldwide proportions, in the 1990s the concept of essential medicine takes on new shapes, and is challenged in global health governance under the aegis of multistakeholderism. The objective of this thesis is to study the historical and geographical trajectories of the essential drugs concept, in the transition from international health to global health. We use the concepts of "governance" and "health governance" as well as studies of the so-called "international / global health" field and the Critical Theory of International Relations to delineate the political and economic contexts that underpin the concept under analysis. We started with specialized literature, to which we aggregated the information withdrawn from interviews with key actors, as well as research in the WHO archives Headquarters in Geneva. In the first chapter, we characterize International Health, we study the birth of the essential medicines list of the WHO, based on multilateralism and the state-centric, and point out the signs that indicate the transition to Global Health. In the second chapter, we describe the rise of neoliberalism, the crisis of the State and of the WHO's itself to characterize Global Health as multistakeholder environment, formed by an assemblage of "actors". We discuss the different meanings attributed to the concept of essential drugs and analyze the performance of civil society organizations in re-politicizing the concept. The third chapter looks at the case of sofosbuvir, a drug to treat Hepatitis C, and its implications for health governance and essential medicines. The study allowed us to conclude that the inclusion of sofosbuvir in the WHO essential medicines list in 2015 derives from the political processes initiated in 2001. We argue that the case in question determined historical displacements and triggered geographic rearrangements in the North-South dynamics, regarding the issue of access to medicines

Caracterización de factores asociados a la infección por el virus de la hepatitis C Guatemala 2017 / Characterization of factors associated with infection with the hepatitis C virus Guatemala 2017

Antecedentes: Actualmente se estima que a nivel mundial cerca de 150 millones de personas están infectadas con virus de la hepatitis C (HCV) y se encuentran en riesgo de padecer cirrosis hepática y/o cáncer hepático. De estas, aproximadamente 350,000 mueren cada año por las causas antes mencionadas.(1) En Guatemala, los programas de prevención se han concentrado en el tamizaje y detección de la enfermedad en donantes de sangre, madres embarazadas, pacientes con alcoholismo crónico, usuarios de drogas, entre otros. Objetivo: Caracterizar y describir los principales factores asociados a la infección por el VHC. Materiales y Métodos: Es un estudio ambispectivo, descriptivo y analítico realizado en 138 pacientes con diagnóstico de infección por el HCV que asisten a la Clínica de Enfermedades Infecciosas de Hospital Roosevelt en el período 2007-2016. Se analizaron 29 variables agrupadas en cinco. categorías: características sociodemográficas, características de referencia, factores asociados a la infección por el HCV, características serológicas y virológicas del HCV y criterios para el cumplimiento de tratamiento. Cada una estás fue descrita en base a frecuencias, porcentajes y se calcularon intervalos de confianza al 95% para las variables relacionadas con los factores asociados a la infección por el HCV. También se estudiaron las relaciones entre los factores demográficos y los factores asociados con las pruebas estadísticas Xi cuadrado (a:0.10) y OR. Resultados: 138 pacientes fueron estudiados. 67 hombres y 71 mujeres, con edad promedio de 45 años. El perfil sociodemográfico más común en base a estos pacientes es una persona de 45 años de edad, residente de la ciudad capital, heterosexual, soltero(a), con una profesión u ocupación no relacionada a la salud y con un nivel de escolaridad de diversificado. Los factores asociados a la infección por el VHC que presentaron mayor porcentaje fueron; el antecedente de múltiples parejas sexuales (37%), transfusión de algún hemoderivado (30%) antecedente de alcoholismo (27%) y relaciones sexuales extramaritales sin protección. El 36% de los pacientes cumplió con criterios para inicio de tratamiento. Únicamente el 35% de los pacientes fue referido de otros hospitales nacionales o clínicas particulares. Conclusiones: La hepatitis C en pacientes diagnosticados y en seguimiento en Hospital Roosevelt, corresponden a donantes de sangre referidos, pacientes co-infectados con VIH o de Clínicas privadas u otros centros. Es importante generar programas de detección activa pues con los tratamientos actuales se puede curar a mas del 95% de los pacientes y evitar su progresión a cirrosis o cáncer de hígado...(AU)

Abstract: Currently it is estimated worldwide that about 150 million people are infected with Hepatitis C Virus (HCV) and are at risk for developing cirrhosis and/or liver cancer. From these, approximately 350,000 people die each year from the conditions described previously (1). In Guatemala, prevention programs have focused on screening persons who donate blood, pregnant women, patients with a history of chronic alcoholism, intravenous drug users, etc. Objective: Characterize and describe the main factors associated with HCV infection. Materials and Methods: This current study is ambispective, descriptive and analytic. It was conducted in 138 patients with a diagnosis of HCV infection attending the Infectious Diseases Clinic, Roosevelt Hospital in 2007-2016. A total of 29 variables were registered and grouped within 5 categories (social and demographic characteristics, characteristics of reference, factors associated with HCV infection, virological and serological characteristics and criteria satisfaction for the initiation of HCV infection treatment). Results: 138 patients were studied: 67 male and 71 female with an average age of 45 years. The most common sociodemographic profile in these patients was a person of 45 years of age, residing within the city, heterosexual, single, with a profession or occupation not related to health services, and with a high school education level. The factors associated with HCV infection with the highest percentage were; history of multiple sexual partners (37%), transfusion of some blood products (30%) alcoholism (27%) and unprotected extramarital sex. Thirty-six percent of the patients met criteria for initiating treatment. Only 35% of the patients were referred from other national hospitals or private clinics. Conclusions: Hepatitis C in patients diagnosed and seconded at Roosevelt Hospital correspond to referred blood donors, patients co-infected with HIV or from private clinics or other centers. It is important to generate active screening programs because with current treatments more than 95% can be cured and therefore prevent their progression to cirrhosis or liver cancer...(AU)

Viral Outcome in Patients with Occult HBV Infection or HCV-Ab Positivity Treated for Lymphoma

ABSTRACT HBV and HCV reactivation has been widely reported in patients undergoing immunosuppressive therapy for oncohaematological diseases. We aimed to evaluate the HBV and HCV reactivation events in patients with non-Hodgkin lymphoma (NHL) or Hodgkin lymphoma (HL) underwent cytotoxic chemotherapy containing or not rituximab. This is a retrospective observational study, including all patients with NHL and HL attending an Italian tertiary referral hospital, the University of Naples "Federico II". A total of 322 patients were enrolled. We evaluated serum HBV and HCV markers. A total of 47 (38%) patients with occult HBV infection were enrolled. Seven/47 were treated with therapeutic cytotoxic schedule containing rituximab. Of them, 6/7 received prophylaxis with lamivudine. HBV reactivation was observed in two patients treated with rituximab. A reactivation was observed in the only patient (HBcAb+/HBsAb+) not receiving lamivudine prophylaxis, and the other one was observed in 1 patient with isolated HBcAb positivity during lamivudine prophylaxis. Moreover, 8 patients with HCV-Ab positivity were enrolled. No viral reactivation was observed in these patients. In conclusion, patients with occult HBV infection receiving chemotherapy containing rituximab for lymphoma without antiviral prophylaxis are at risk of viral reactivation. On the contrary, there is no risk of reactivation in patients undergoing rituximab-free schedule. Our findings suggest that there is also very low risk of HCV reactivation. This preliminary report underlines the concept that HBV reactivation is strongly related to the type of immunosuppressive therapy administered and that antiviral prophylaxis needs to be tailored.