Anders Nystedt
Smittskydd Norrbotten
Hepatit B & D
Hepatit C
Hiv
2nd generation DAAs and beyond…
• Daklatasvir (Daklinza®)
• Dasabuvir (Exviera®)
• Elbasvir/grazoprevir (Zepatier®)
• Ombitasvir/paritaprevir(ritonavir) (Viekirax®)
• Simeprevir (Olysio®)
• Sofosbuvir (Sovaldi®)
• Sofosbuvir/ledipasvir (Harvoni®)
• Sofosbuvir/velpatasvir (Epclusa®)
• Glecaprevir + Pibrentasvir (Maviret®)
• Sof + Velpatasvir + Voxialprevir (Vosevi®)
• Grazoprevir + Ruzasvir + Uprifosbuvir (Name??? MK3…)
• ?????
We treat patients with HCV that
• has developed fibrosis stages F2, F3 or F4 verified by liver biopsy or Fibroscan®
• regardless of fibrosis stage, has undergone organ transplantation or suffer from severe extrahepatic
manifestations or is planned for in vitro fertilization (IVF) procedures.
What we do now will not suffice…
Will it suffice if we get the resources to treat all patients with hepatitis C?
We need to reach our patients too… All of them!
Vad vi behöver för att utrota hepatit C
1. The tools
2. The patients
The hidden statistics…
Patients not yet diagnosed
Patients lost to
follow up
Primary and hospital care
Addiction treatment
and psyciatric wards Youth clinics
Social services Police
NGO’s Correctional
services County council,
municipality, general public,
media
How can we find those not yet diagnosed?
Spin a network for risk-based screening
Och här behöver vi er hjälp!
31 patients were contacted for testing
and consultation
On average 3,6 persons per index was followed up and tested during 2010-2011
And perform contact tracing
Swedish Communicable Disease Control Act (2004:168)
Contact tracing…
“…the individual patient is required to provide the information that he or she is able to leave”.
2010
And of cause – we will find our patients where our patients are…
• 44 patients (out of 52) had at some point in the past been given hepatitis C diagnose
• 6 persons where never tested
• 2 persons had negative hep C-serology
• 7 persons had cleared hepatitis B
• 0 patients with Hiv
• Of the 44 patients with known HCV-ab + only six (6!) had a scheduled appointment at the Inf Dis Clinic
The hidden statistics…
Patients lost to
follow up
Review of the diagnosed cases of hepatitis C notified under the Swedish Communicable Diseases act in Norrbotten during 1992-2012
…and those lost to follow up?
…my 207 patients
Och här behöver vi er hjälp!
3. The arenas
…but those that doesn’t show up?
Link between illicit drug abuse and crime
Medical examination and possible treatment of hepatitis C in inmates in Swedish prisons
Prisons!?
Forensic psychiatry hospitals?
n = 114 patients
