Epidemiology and Genotype Distribution of HCV in Mongolia

( Sosorbaram Ariunaa ),( D. Munkh-orshikh ),( Ch. Bolormaa ),( B. Gansaikhan ),( Oidov Baatarkhuu ) 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1

Aims: Mongolia is a unique country with high endemicity for three blood borne hepatitis viruses, namely HBV, HCV and HDV. The number of patients with acute hepatitis decreased considerably with an estimated annual number of cases 13,000/ year in 1991 to 1700/year in 2013 in Mongolia.Hepatitis B and C virus infection are one of the major causes of liver cirrhosis and HCC in Mongolia. However, viral hepatitis C is still one of the serious public health concerns in Mongolia. To investigate of HCV infection among apparently healthy populations in Mongolia. Methods: The study population was consisted of 1512 subjects from 13 provinces and Ulaanbaatar city which is the capital city of Mongolia, and the age ranged from 0 to 80 years. Results: According to our study results, the prevalence of anti-HCV was 15.6%, and the HCV RNA was detected in 11 %; therefore, we can say that the prevalence of this infection is very high in Mongolia.The prevalence of anti-HCV and HCV RNA had a tendency to increase with age. The prevalence of anti-HCV and HCV RNA in population aged over 61 years was significantly higher than those aged 31 to 40 year. The history of dental care, surgery, and tattooing was significantly more frequent in anti-HCV positive subjects compared with anti-HCV negative subjects. Interestingly, the most of HCV infection is caused by genotype 1. However, Genotype 2 of HCV is very rare, less than 2 percent in Mongolia. The extreme predominance of HCV genotype 1b in the Mongolian population may be explained by the greater ethnic and genetic homogeneity of current Mongolian population. Conclusions: The epidemiological situation of HCV infection in Mongolia is catastrophic. This infection was evenly distributed in all areas and has endemic characteristics for the country. The rate of positive anti-HCV and HCV-RNA was increasing age-dependently. The predominant genotype of HCV in Mongolia is 1b.

The Development of DAA Treatment for HCV in Mongolia

( O. Baatarkhuu ),( Sosorbaram Ariunaa ),( N. Naranzul ) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1

Aims: During last several years, internationally available diagnostics, treatments and medicines of HCV have changed dramatically. Interferon-based therapy for HCV has comparatively low result of treatment effect, more side effects, long treatment duration, high cost of single dose and limited option of treatment. Since introduction of direct antiviral agents including in 2011 Boceprevir, Telaprevir, in 2013 Simeprevir, Sofosbuvir, in 2014 Harvoni (ledipasvir/sofosbuvir), Daklinza (daclatasvir), Vikera Pack (ombitasvir/paritaprevir/dasabuvir), the new era HCV treatment came up. thanks to those new drugs HCV infection became one of the curable diseases, and entire world is targeting free from HCV /WHO/. Therefore, there is need of to access milestones of diagnostic and treatment development of HCV in our country. Our study aims to determine implementation of global trend for HCV diagnostic and treatment in Mongolia. Methods: This study is qualitative one and we analyzed policy and strategic documents and statistics issued by Mongolian Government, Ministry of Health, National Center for Communicable Disease, Mongolian National University of Medical Sciences and other organizations. Results: Ministry of Health played very large role in introduction of new management of HCV into the country. It provided all the legal ground and support to service providers at all levels of care. New guideline was approved which includes all new schemes of the treatment, diagnostic methods, new drugs were registered, specialist doctors were trained and access of the new drug were widened thanks to joining the Access programme from Gilead Sciences. It can be said that the tentative result of DAA treatment is successful, compare few years ago interferon treatment effect was fewer than 20 percent to the 99 percent effective of current new treatment. Conclusions: All those achievements show that Mongolia has been able to introduce a comprehensive and efficient short-term treatment for HCV and free the population of that disease which may increase the mortality level due to liver cancer.

Acute Viral Hepatitis D in Mongolia

( Badamnachin Batsukh ),( Dashchirev Munkh-orshikh ),( Sosorbaram Ariunaa ),( Oidov Baatarkhuu ) 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1

Aims: To investigate prognosis and risk factors acute viral hepatitis D in Mongolia Introduction: Hepatitis D virus (HDV) infection is considered to cause more severe hepatitis such as liver cirrhosis and HCC. Mongolia has the highest prevalence (> 15%) of HCV, (> 10%) HBV infection and HDV 75-100% of HBsAg carriers. Methods: A total of 86 patients with acute viral hepatitis D were enrolled and their data collected 2016-2017. Results: The mean age of patients was 29.7+-7.17. 52 (60.4%) of them were males and 34 (39.6%) were females. Risk factors were unprotected sexual contact 41 (47.67%), dental care 11 (12.8%), tattooing 8 (9.3%), admit hospital 42 (48.83%), history of surgery 13 (15.1%), acupuncture 12(13.9%), share with nail clipper 74(86%) and family contacts with viral hepatitis B 23(26.7%). Anti-HDV IgM and anti-HD total Ab tests were both positive in 34/86 samples, anti HDV IgM was the only positive delta marker in 65/86 samples and anti-HD total Ab was the only marker in 61/86 samples. During follow-up, three of 5 (4.9%) patients with co D infection showed HBsAg loss and 58 patients with super D infection (100%) showed persistent hepatitis B and D viremia. Conclusions: Risk factors for hepatitis D virus infection were unprotected sexual contact, admitted hospital, share with nail clipper and family contacts with viral hepatitis B. During follow-up, three of 5 (60%) patients with co D infection showed HBsAg loss and 58 patients with super D infection (100%) showed persistent hepatitis B and D viremia.

Acute hepatitis A, B and C but not D is still prevalent in Mongolia: a time trend analysis

( Oidov Baatarkhuu ),( Hye Won Lee ),( Jacob George ),( Dashchirev Munkh-orshikh ),( Baasankhuu Enkhtuvshin ),( Sosorbaram Ariunaa ),( Mohammed Eslam ),( Sang Hoon Ahn ),( Kwang-hyub Han ),( Do Young 대한간학회 2017 Clinical and Molecular Hepatology(대한간학회지) Vol.23 No.2

Background/Aims: Mongolia has one of the highest hepatitis A, C, B and D infection incidences worldwide. We sought to investigate changes in the proportion of acute viral hepatitis types in Mongolia over the last decade. Methods: The cohort comprised 546 consecutive patients clinically diagnosed with acute viral hepatitis from January 2012 to December 2014 in Ulaanbaatar Hospital, Mongolia. A time trend analysis investigating the change in proportion of acute hepatitis A virus, hepatitis C virus (HCV), hepatitis B virus (HBV) and hepatitis delta virus (HDV) infection among the cohort with respect to a previous published study was undertaken. Results: Acute hepatitis A, B and C was diagnosed in 50.9%, 26.2% and 6.0% of the cohort. Notably, 16.8% of the cohort had a dual infection. The etiologies of acute viral hepatitis were varied by age groups. The most common cause of acute viral hepatitis among 2-19 year olds was hepatitis A, HBV and superinfection with HDV among 20-40 year olds, and HCV among 40-49 year olds. Patients with more than one hepatitis virus infection were significantly older, more likely to be male and had a higher prevalence of all risk factors for disease acquisition. These patients also had more severe liver disease at presentation compared to those with mono-infection. Conclusions: Acute viral hepatitis is still prevalent in Mongolia. Thus, the need for proper infection control is increasing in this country. (Clin Mol Hepatol 2017;23:147-153)