[Epidemiologic and situational panorama of hepatitis C in Mexico]. / Panorama epidemiológico y situacional de la hepatitis C en México.

OBJECTIVE: To determine the epidemiological situation of Chronic Hepatitis C (CHC) in our country. BACKGROUND DATA: Chronic Hepatitis C affects 170 million people worldwide, and about 0.7% of Mexican population. There is no enough epidemiological information about CHC in our country, and it is very probable that some cases are not even detected. METHODS: An investigation poll was performed. Age, gender, birthday, weight, race, residence and birth place, routes of transmission, ALT levels, histological, serological and molecular diagnosis, evidence of complications and previous treatments were recorded. A data recollection sheet was dispatched to different country provinces; they had 6 months to answer it, in order to recollect all information. RESULTS: 831 patients were analized (58.6% female and 41.4% male) with the following distribution in our country provinces: Aguascalientes 15, Chihuahua 12, Distrito Federal 495, Durango 10, Jalisco 89, Guanajuato 78, Yucatán 8, Querétaro 11, Sonora 40, Tabasco 15, Baja California 5, Veracruz 13, Tamaulipas 2 and 38 patients of Nuevo León. The highest incidence of CHC was found at fifth and sixth decade of life (28.5% y 26.7% respectively. The weight distribution was 36.2% < 65kg, 34.6% 65-75 kg and 29.2% > 75 kg. 86.5% had chronic hepatitis and 13.2% cirrhosis. The risk factors for HCV infection analysis showed that the main route of transmission was via contaminated blood (64.2%); when we excluded the patients that were exposed before 1995, the incidence was lowered to 4.5%. The higher incidence was showed between 1970 and 1990 (68%). The intravenous drug users were predominantly male and on those patients in the provinces near the north border line of our country. The predominant genotype was gen- 1 no matter the province (72.2%), in the intravenous drug users genotype 3 was found in 25%. The viral load was similar in all the provinces. 75% of the patients had have treatment and 22.5% had have two cycles, 50% of cirrhotic patients had have treatment whereas only 28% of the patients with late complications had have it. The most common treatment was pegylated alpha-2a interferon plus ribavirine. CONCLUSIONS: 1. The main route of transmission was blood transfusion. There is a marked decrease in the incidence of post-transfusional hepatitis since the introduction of anti-VHC antibody screening of blood donors (4.5%). 2. The time between the infection and diagnosis was 23 years for chronic hepatitis and 26 years for cirrhosis. 3. Intravenous drugs use was an important route of transmission in the north of our country. 4. The predominant genotype was gen-1. 5. Almost all the patients with chronic hepatitis received treatment, the most common used was pegylated interferon alpha-2a and ribavirin. 6.50% of the patients with CHC have late complications.

[Treatment of chronic hepatitis C in patients coinfected with HIV-HCV/HBV]. / Tratamiento de la hepatitis crónica C en pacientes coinfectados con HIV-HCV/HBV.

In the pre-HAART era, sustained response to single therapy with interferon in patients infected with HCV and HIV without sever immunodeficiency was low (10-23%). The figures were similar to those in HIV-negative people. Results of combination therapy with pegylated interferon (PEG-IFN) and ribavirin in the group of patients infected with HIV and HCV are similar to those observed in the HIV-negative group. The response is > 50%, and the patients who are most benefited are the carriers of genotype 1. Nevertheless, lactic acidosis is reported as a severe side effect, especially in the group who received HAART with nucleosides inhibitors of reverse transcriptase. Several HAART programs include lamivudin for patients infected with HIV and HCV. Molecular hybridation techniques and chain reaction polymerase assays eliminate the hepatitis B virus DNA in 50% of the cases studied. Serological conversion for AgeHB was observed in 35% and AgsHB was eliminated only in 5%. Average period of serological conversion for AgsHB was 8 months; these patients presented high CD4 cell counts and low HIV load. So far, this is the therapy with better results; however, more combinations of lamivudin with tenofovir and adefovir are being studied for patients with resistant viral mutations.