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Risk Factors of Hepatitis B Virus Infection in Mongolia
( Dashchirev Munkh-orshikh ),( Badamnachin Batsukh ),( Ganbold Sarangua ),( Oidov Baatarkhuu ) 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1
Aims: To study risk factors of HBV transmission. Background: Mongolia introduced HBV vaccination into routine immunization schedules for newborns and children under1 year of age in 1991, which substantially decreased the incidence of HBV infection. Methods: The study was conducted 200 patients with acute HBV infection, treated in Mongolia from 2015-2017. Results: The mean age of the patients were 26±6.4, of those 57.5% were males and 42.5% were females and 41% were married. 17(8.5%) were vaccinated, 116 were unvaccinated and 67(33.5%) they don’t know whether they were vaccinated or not. 99(49.5%) survey participants were born before 1991, 87(43.5%) were bornbetween 1992-1997 and 14(7%) were born since 1997. A specially developed questionnaire was used to determine the risk factors for HBV infection (last six months): In the serology test, 178(89%) were HBsAg and anti-HBcIgM-both positive and 22(11%) were HBsAg positive and anti-HBcIgM negative. Conclusions: HBV vaccination is effective method for preventing HBV infection. Most common risk factors of HBV infection are household and sexual contacts of people with HBV and having multiple sexual partners.
Efficacy and Safety of Ledipasvir/Sofosbuvir Treatment of HCV Genotype 1b in Mongolia
( O. Baatarkuu ),( B. Enkhtuvshin ),( N. Lkhaasuren ),( B. Batsukh ),( G. Sarangua ),( D. Enkhtuya ),( N. Choijamts ),( J. Amarsanaa ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1
Aims: The incident of liver cancer in Mongolia generally caused by HBV and HCV, and it is 7 times higher than that of world average. HCV, the most prevalent cause of HCC in Mongolia, is number one public health issue. Mongolia is one of the first countries that registered ledipasvir/sofosbuvir (LDV/SOF) regimen from developing countries. By the support of Access program run by Gilead Sciences, USA, we started HCV treatment program from January 2016. Methods: We followed and evaluated treatment outcome of patients with HCV infection using combination of 90 mg ledispavir/400 mg sofosbuvir (manufactured by Gilead Science) in 937 treatment naive and 83 treatment experienced patients. All patients were treated with LDV/SOF for 12 weeks and, their treatment was evaluated by quantitative HCV-RNA assays prior and W (week) 4 and W12 of treatment. Sustained virological response (SVR) after 12 weeks treatment was assessed. Virus genotype analysis using cDNA microarray, liver enzymes, CBC and drug related adverse events were assessed in every patient. The laboratory tests were conducted at National Center of Communicable Diseases and Happy Veritas Laboratories. Results: We conducted largest ever (415/1020) HCV genotype (GT) distribution study in Mongolian chronic HCV patients. 96.6% (n = 401) of assessed patients were GT1b; 0.7% (n = 3) were GT2; 0.2% (n = 1) were GT1a and b; 0.9% (n = 4) were GT1b and 2; 0.5% (n = 2) were GT1b and 6; 0.2% (n = 1) were GT5 and 0.2% (n = 1) were GT1b and 80 k mutants respectively. 992/1020 (97.3%) patients achieved SVR12W, 28 (2.7%) patients who did not achieve SVR12 W were all genotype 1b. Median ALT level significantly dropped during treatment from 95.5 ± 84.1 IU/L to 27.2 ± 18.6 IU/L and slightly increased by the end of treatment 42.9 ± 17.4 IU/L. Total of 39 adverse events were observed in 595/1020 patients (58.3%). Single adverse events were observed in 401/1020 (39.3%) whereas 2 and more events were observed in 194 (19%) patients respectively. Unreported adverse events such as partial facial palsy, AFP (alpha-fetoprotein) increase, melasma were observed. Conclusions: Treatment of HCV in Mongolia using all-oral dual DAA was divided in 3 phases due to shortness of drugs and logistics arrangements. We were able to include only stage-one patients in this study. We achieved 97.3% SVR12W for 3 months treatment with LDV/SOF this time. But viral relapse has to be determined repeatedly at weeks 24 and 48 post treatment. All viral relapses (n = 14) and non-responders (n = 14) were GT1 in our study. According to HCV genotype assessment, there was no difference in treatment outcomes between patients who had different genotypes. HCV RNA clearance during treatment was no different than clinical trials, but the slight increase of ALT by the end of treatment was commonly observed. It might have happened due to rebound of immune reaction after clearance of HCV or a drug induced effect.
( O. Baatarkhuu ),( B. Davaakhuu ),( N. Naranzul ),( Ch. Gantuul ),( Ch. Bolormaa ),( P. Delgermaa ),( S. Ariunaa ),( G. Sarangua ),( G. Khishigjargal ),( D. Javzmaa ),( D. Ouyntuya ),( S. Nyamaa ),( 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1
Aims: In Mongolia, previous studies shown HCV prevalence is over 10% and 97-98% of people with HCV infection have infected with genotype 1b. In addition, Mongolia is on first place of HCC mortality rate per 100.000 population and this is eighth times higher than globally average rate. HCV prevalence among primary hepatic carcinoma patients is 35%-45%. Therefore activities on reducing chronic infection prevalence of hepatitis viruses and preventing complications of hepatitis viral infections have been conducted in the country. One of them is availability of Harvoni treatment for HCV patients since December 2015. To evaluate data on the antiviral efficacy and safety of direct acting antiviral (DAA) treatment with respect to sustained virological response (SVR) 12 weeks after completion of treatment. Methods: We retrospectively analyzed patient monitoring records and patient registration forms for HCV patients who received Harvoni treatment at NCCD, MNUMS, provinces and districts hospitals. Quantitative methods were applied in that retrospective study. Six hundred and forty-seven patients diagnosed as HCV and treated by Harvoni(ledipasvir/sofosbuvir) were attended the study. Results: There were totally 647 patients received Harvoni for HCV infection by September 2016. People who received treatment for less than 3 months there 31% and for longer than 3 months were 8%. Among them 91.9% have chronic hepatitis and first stage of liver cirrhosis and 8% have liver cirrhosis and carcinoma. After 1 month of treatment, HCV RNA tests result was negative for 98.8% of all Harvoni patients and for the rest 1.1% resulted in decrease of HCV RNA.After 3 month of trerapy, blood test result showed 100% recovery on transaminase level. 453/465, 10/465 and 2/465 of them were respectively genotype 1b, 2 and 1a. APRI score were pre-treatment 1.3±0.58 and post treatment 0.443±0.148. FIB4 score were pre-treatment 3.8±1.2 and post treatment 1.65±0.59. Occurrences of side effects were mild. 1.2%, 5.8% and 4.6% of them were respectively with CTP C, CTP B and CTP A scores. 88.2% of the participants were chronic hepatitis C and 1.7% of them were pre-treated by interferon. Conclusions: After treatment by Harvoni tablets, excellent SVR12 results were shown among the study participants’ and the favorable side-effect profile were observed for the Mongolian context.
Awareness of Immunization against HBV among the Health Care Workers in Mongolia
( Naranzul N ),( Enkhjargal A ),( Burmaajav B ),( Nandintsetseg T ),( Munkh-orshikh D ),( Enkhtuvshin B ),( Sarangua G ),( Azzaya O ),( Jargalmaa B ),( Khurelbaatar N ),( Batzaya M ),( Baatarkhuu O ) 대한간학회 2021 춘·추계 학술대회 (KASL) Vol.2021 No.1