O-8 CHARACTERIZATION AND EPIDEMIOLOGICAL CHANGES OF PATIENTS WITH HEPATITIS C VIRUS TREATED IN THE CHILEAN PUBLIC HEALTH SYSTEM FROM 2016 TO 2021.

Introduction and Objectives

International studies have described an epidemiological change in patients with the hepatitis C virus (HCV), with greater involvement of young people and risk groups. The reality in Latin America, particularly in Chile, is unknown. This study aimed to epidemiologically characterize HCV patients treated in the Chilean public health system (period 2016-2021) and compare these characteristics in two periods (2016 - 2019 vs. 2020 - 2021).

Materials and Methods

Historical cohort was constructed based on national data and the Hospital del Salvador registry (Santiago, Chile) (n=410). All patients diagnosed with HCV treated in the Chilean public system (2016-2019) and those treated at Hospital del Salvador (2020-2021 period) were included. It was registered: year of diagnosis, age, sex, presence of cirrhosis, HCV genotype, co-infection with hepatitis B virus (HBV) and/or HIV, need for a liver transplant, or intratreatment dead. Both periods were compared using the Mann-Whitney U test or Fisher's exact test, as appropriate.

Results

61.2% of patients were male, with a median age of 57 years. 73.5% presented genotype 1 and 11.6% genotype 4. There was a 19.3% coinfection with HIV. Only 1.4% had therapy failure at 24 weeks and 5.2% of patients underwent liver transplantation. When comparing the periods 2016 – 2019 vs. 2020 – 2021 a reduction in the median age 59 vs 49 (p<0.001) was observed, with a higher proportion of male gender 79.0% vs 51.7% (p<0.001). There is evidence of change in the proportion of the genotypes, with genotype four being the second most frequent after genotype 1. The presence of co-infection with HIV was 49.7% vs. 3.0% (p<0.001) and HBV/HIV 15.5% vs. 0.8% (p<0.001). There was no difference in the percentage of sustained viral response (Table 1).

Conclusions

There is an epidemiological change in HCV patients, which suggests different routes of transmission and the need to refocus screening.

Table 1: Result and comparison of socio-demographic and clinical variables between the periods 2016-2019 and 2020-2021.

	Total (n = 410)	Period 2016-2019 (n = 267)	Period 2020-2021 (n = 143)	p-value
Age (years), median (p25, p75)	57 (46, 64)	59 (52, 66)	49 (36, 61)	<0.001
Male, n(%)	251 (61.2%)	138 (51.7%)	113 (79.0%)	<0.001
Period years, n(%)
2016	48 (11.7%)	-	-
2017	26 (6.3%)	-	-
2018	183 (44.6%)	-	-
2019	10 (2.4%)	-	-
2020	71 (17.3%)	-	-
2021	72 (17.6%)	-	-
Genotype, n (%)				<0.001
1	285 (73.5%)	209 (78.9%)	76 (61.8%)
2	7 (1.8%)	4 (1.5%)	3 (2.4%)
3	50 (12.9%)	36 (13.6%)	14 (11.4%)
4	45 (11.6%)	15 (5.7%)	30 (24.4%)
3 and 4	1 (0.3%)	1 (0.4%)	0 (0.0%)
HBV co-infection, n (%)	17 (4.1%)	3 (1.1%)	14 (9.8%)	<0.001
HIV co-infection, n (%)	79 (19.3%)	8 (3.0%)	71 (49.7%)	<0.001
HIV-HBV co-infection, n (%)	15 (4.4%)	2 (0.8%)	13 (15.5%)	<0.001
Cirrhosis, n (%)	214 (54.7%)	183 (68.5%)	31 (25.0%)	<0.001
Failure at 12 weeks, n (%)	9 (2.8%)	8 (3.8%)	1 (0.9%)	0.17
Failure at 24 weeks, n (%)	4 (1.4%)	3 (1.5%)	1 (1.3%)	1.00
Use of rescue therapy, n (%)	139 (35.2%)	256 (95.9%)	0 (0.0%)	<0.001
Liver transplant, n (%)	21 (5.2%)	20 (7.5%)	1 (0.7%)	0.002
Kidney transplant, n (%)	1 (0.2%)	1 (0.4%)	0 (0.0%)	>0.999
Other outcomes, n (%)				0.495
Therapy failure	12 (3.4%)	10 (4.3%)	2 (1.6%)
SVR	334 (93.3%)	216 (92.3%)	118 (95.2%)
Discontinues treatment	5 (1.4%)	4 (1.7%)	1 (0.8%)
Deads	7 (2.0%)	4 (1.7%)	3 (2.4%)