Dienstag JL, Mchutchison JG

Idioma: Español
Referencias bibliográficas: 374
Paginas: 198-236
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FRAGMENTO

En los Estados Unidos de América, la infección por virus de la hepatitis C (VHC) es responsable aproximadamente de 40% de todas las enfermedades crónicas del hígado, resultando en 8,000-10,000 muertes anuales y es la indicación más frecuente de trasplante hepático.1-7 La Tercera Encuesta Nacional de Salud y Nutrición, realizada entre 1988 y 1994 entre 21,000 adultos, reveló la presencia de anticuerpos contra VHC (anti-VHC) en 1.8%, tres cuartas partes de los cuales tenían niveles detectables de ARN de VHC en suero.8 Extrapolando esto a la población general de los Estados Unidos de América, estos hallazgos sugieren que aproximadamente cuatro millones de personas han sido infectadas y que tres millones tienen infección crónica por VHC. Entre aquellos sujetos de 40-59 años y entre sujetos de raza negra, la prevalencia de anti-VHC fue aún mayor. Además, los resultados de dichas encuestas serológicas pueden estar ofreciendo en realidad una estimación conservadora de la magnitud del problema, al no incluir a una proporción representativa de sujetos de poblaciones de alto riesgo tales como los usuarios de drogas intravenosas, personas encarceladas e indigentes. Las proyecciones basadas en las cifras actuales de la prevalencia de la infección y las tasas esperadas de progresión son preocupantes por el impacto potencial que tendrá el VHC en las siguientes dos décadas. Una cohorte simulada de la población de los Estados Unidos de América para el decenio 2010-2019 sugiere que la morbilidad y mortalidad asociadas con la hepatitis crónica C incrementará de manera drástica, resultando en 165,900 muertes por enfermedad hepática crónica, 27,700 muertes por carcinoma hepatocelular y $10.7 billones de dólares americanos en gasto médico directo relacionado con VHC.5,9-12 A escala global, con base en las estimaciones actuales de que existen 175 millones de sujetos infectados por VHC, la morbilidad, mortalidad y el gasto en salud actual y proyectado a futuro asociados a infección por VHC son asombrosos.

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