The importance of HCV on the burden of chronic liver disease in Italy: a multicenter prevalence study of 9,997 cases.
Knowledge of the current epidemiology of chronic liver disease in Italy is mostly obsolete and fragmentary for the lack of up-to-date consistent data. In 2001, a 6-month prevalence study was undertaken in 79 hospitals to assess the characteristics of chronic liver disease in Italy. Both prevalent and incident cases were enrolled. A total of 9,997 patients were recruited, of whom 939 (9.4%) had normal liver biochemistry, 6,210 (62.1%) had chronic hepatitis, 1,940 (19.4%) had liver cirrhosis, and 341 (3.4%) had hepatocellular carcinoma (HCC). In 567 patients (5.7%) the diagnosis was not established. Hepatitis C virus (HCV) was found in 69.9% of the patients and was the only etiological factor in 56.3% of all the patients. Hepatitis B surface antigen (HBsAg) was present in the serum of 13.4% of the cases (in 10% it was the only etiological factor). A history of alcohol abuse was found in 23% of the cases (9.4% without viral infection). The prevalence of HCV-related cases was significantly lower in incident than in prevalent cases (44.9% vs. 59.9%, P < 0.0001), while the proportion of patients with alcohol abuse was much higher in incident than in prevalent cases (18.1% vs. 6.6%, P < 0.0001). These findings indicate that nearly one quarter of patients with chronic liver diseases in Italy have a severe disease such as liver cirrhosis and HCC represents a not negligible burden for the national health system. Hepatitis B fell in importance as an etiological factor. Hepatitis C is the important pathogenic factor for chronic liver disease in Italy. However, a comparison between the prevalent and incident cases suggests that in future HCV infection will also play a progressively decreasing role, in part as a consequence of treatment.
Sagnelli
Evangelista
E
Infectious Disease Unit, Department of Public Medicine, 2nd University of Naples, c/o Ospedale Gesù e Maria, via D. Cotugno 1, 80135 Naples, Italy. Evangelista.sagnelli@unina2.it
Stroffolini
Tommaso
T
Mele
Alfonso
A
Almasio
Piero
P
Coppola
Nicola
N
Ferrigno
Luigina
L
Scolastico
Carlo
C
Onofrio
Mirella
M
Imparato
Michele
M
Filippini
Pietro
P
D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000150:complications; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology / Q000209:etiology; D002908:Chronic Disease / Q000453:epidemiology; D005260:Female; D016174:Hepacivirus; D006509:Hepatitis B / Q000150:complications / Q000453:epidemiology; D006515:Hepatitis B virus; D006526:Hepatitis C / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008103:Liver Cirrhosis / Q000453:epidemiology / Q000209:etiology; D008107:Liver Diseases / Q000453:epidemiology* / Q000209:etiology*; D008113:Liver Neoplasms / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors