Estimated prevalence of undiagnosed HCV infected individuals in Italy: A mathematical model by route of transmission and fibrosis progression

Autor: Antonio Craxì, Sergio Babudieri, Alfredo Alberti, Walter Marrocco, Rocco Cosimo Damiano Merolla, Salvatore Lobello, Massimo Andreoni, Antonio Saverio Roscini, Loreta A. Kondili
Přispěvatelé: Kondili L.A., Andreoni M., Alberti A., Lobello S., Babudieri S., Roscini A.S., Merolla R., Marrocco W., Craxi A.
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Liver Cirrhosis
Pediatrics
Blood transfusion
Epidemiology
medicine.medical_treatment
law.invention
0302 clinical medicine
Fibrosis
law
Prevalence
030212 general & internal medicine
Stage (cooking)
Child
Substance Abuse
Intravenous
Monte Carlo
Aged
80 and over
education.field_of_study
Middle Aged
Hepatitis C
Infectious Diseases
Transmission (mechanics)
Italy
Child
Preschool
HCV
medicine.symptom
Models
Theoretical: Young Adult
Human
Adult
medicine.medical_specialty
Sexual transmission
Adolescent
Liver Cirrhosi
030231 tropical medicine
Population
Markov chain
Antiviral Agents
Microbiology
Asymptomatic
lcsh:Infectious and parasitic diseases
Young Adult
03 medical and health sciences
Virology
medicine
Humans
lcsh:RC109-216
Hepatitis C infection
education
Aged
Antiviral Agent
business.industry
Public Health
Environmental and Occupational Health
Infant
Newborn
Undiagnosed
Infant
Models
Theoretical
medicine.disease
Parasitology
business
Zdroj: Epidemics, Vol 34, Iss, Pp 100442-(2021)
Popis: Background The universal treatment of diagnosed patients with chronic HCV infection has been widely conducted in Italy since 2017. However, the pool of individuals diagnosed but yet to be treated in Italy has been estimated to end around 2025, leaving a significant proportion of infected individuals undiagnosed/without care. Estimates of this population are currently unknown. Methods A probabilistic modelling approach was applied to estimate annual historical HCV incident cases by their age-group (0–100 years) distribution from available literature and Italian National database (1952 to October 2019). Viraemic infection rates were modelled on the main infection routes in Italy: people who inject drugs (PWID), tattoos, sexual transmission, glass syringe use, blood transfusion and vertical transmission. Annual liver fibrosis stage transition probabilities were modelled using a Markov model. The number of HCV viraemic asymptomatic (fibrosis stage F0-F3:potentially undiagnosed/unlinked to care) and symptomatic (fibrosis stage F4: potentially linked to care) individuals was estimated. Results By October 2019, total viraemic HCV individuals in Italy (excluding treated patients since 1992) were estimated to be 410,775 (0.68 % of current population of Italy; 95 % CI: 0.64−0.71%, based on the current Italian population), of which 281,809 (0.47 %; 95 % CI:0.35−0.60%) were fibrosis stage F0-F3. Among different high risk groups in stage F0-F3, the following distribution was estimated: PWID; 52.0 % (95 % CI:37.9–66.6 %), tattoo; 28.8 % (95 % CI:23–32.3 %), sexual transmission; 12.0 % (95 % CI:9.6–13.7 %), glass syringe and transfusion; 6.4 % (95 % CI:2.4–17.8 %), and vertical transmission; 0.7 % (95 % CI:0.4–1.2 %). Conclusion Under the assumption that most untreated HCV-infected individuals with stage F0-F3 are undiagnosed, more than 280,000 individuals are undiagnosed and/or unlinked to care in Italy. Marked heterogeneity across the major routes of HCV transmission was estimated. This modelling approach may be a useful tool to characterise the HCV epidemic profile also in other countries, based on country specific epidemiology and HCV main transmission routes.
Databáze: OpenAIRE
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