Elimination of hepatitis C. Positioning document of the Spanish Association for the Study of the Liver (AEEH)

Hepatitis C diagnosis slowdown in high-prevalence groups and using decentralised diagnostic strategies during the COVID-19 pandemic

INTRODUCTION

The COVID-19 pandemic has had a major impact on hepatitis C virus (HCV) diagnosis by hindering the path to elimination, although probably in an uneven manner depending on the risk group and diagnostic strategy.

METHODS

We recorded the requests of antibodies/RNA by venipuncture at the hospital and primary care centres (centralised), as well as the requests via venipuncture or dried blood spot test at prison and drug treatment centres referred for central processing (integrated decentralised), for one year before and after the onset of the COVID-19 health alarm.

RESULTS

A total of 20,600 tests (51% male, 47.9±15.8 years) were recorded. Among them, 96.5% of the cases came from centralised and 3.5% from decentralised settings, with an active infection rate of 0.2% and 2.3% (p<0.001), respectively. There was a 31.3% decrease in the number of requests during the pandemic compared to the pre-pandemic period, which was more pronounced in decentralised diagnosis than centralised (60 vs. 30%, p<0.001). In addition, there was a 31.5% decline in screening and an 18.2% decrease in the diagnosis of new cases of active infection, showing a statistically significant decrease in decentralised compared to centralised diagnosis.

CONCLUSIONS

During the COVID-19 pandemic, a decline in HCV diagnostic effort has been observed, especially in decentralised strategies with a higher prevalence of infection. Our results suggest a diagnostic delay that will prevent Spain from reaching the elimination target in 2023, and therefore the reactivation of strategies particularly targeting the priority groups is urgently required.

Active search for hepatitis C patients in Primary Care

INTRODUCTION

Undiagnosed hepatitis C virus (HCV) active infections pose a problem to achieve the WHO (World Health Organization) hepatitis C elimination goal in 2030. One of the possible strategies to identify these patients is the active search for patients in Primary Care (PC).

METHODS

We reviewed patient´s medical record in PC with a "hepatitis C" open case in the last five years. We included those with uncompleted diagnostic study - due to the absence of active infection confirmation -, or those who did not start or finish treatment. A blood analysis was recommended to prove the existence of the active infection. The one-step diagnosis (OSD) was implemented to assess the viremia in all patients with a new serologic diagnosis.

RESULTS

Of 253 cases with a "hepatitis C" open case in their medical records, 24.1% (61) did not finished the diagnostic study or did not follow the treatment. Four of them were not suitable candidates to finish the study. Of the other 57, 92.9% accepted diagnostic test. Active infections were confirmed in 40 patients (75.4%) and the treatment was completed in all of them.

CONCLUSIONS

Active search for patients with hepatitis C in PC together with the OSD are effective measures to detect hidden infections and to increase the number of treatments, contributing to the elimination of hepatitis C.

Hepatitis C and beta-thalassemia major in children: experience with glecaprevir/pibrentasvir

Hepatitis C virus (HCV) is estimated to affect 3.26 million children worldwide, with the highest number of cases registered in Pakistan and China. Vertical transmission is the principal route in industrialized countries. However, iatrogenic transmission is relevant in low-income settings. We present the case of a 12-year-old Pakistani child who suffered from beta-thalassemia major and hepatitis C, successfully treated with glecaprevir/pibrentasvir.

Prevalence of hepatitis C in patients with non-affective psychotic disorders

INTRODUCTION

the goal of this study was to determine the prevalence of hepatitis C virus (HCV) infection in patients with non-affective psychotic disorders and to compare it with population-based data.

MATERIAL AND METHODS

an observational study was performed that measured anti-HCV antibodies (HCV-RNA in case of seropositivity) in 425 serum samples from patients with non-affective psychosis. Eight patients were positive for anti-HCV (1.9 %) and five had detectable HCV-RNA (1.2 %). The prevalence of viremia was significantly higher than in the general population (OR: 5.4; 95 % CI: 1.9-14.6).

CONCLUSIONS

patients with non-affective psychotic disorder have a higher prevalence of active infection than that of the general population and should undergo systematic screening.

Recapture of patients with an incomplete diagnosis of hepatitis C virus infection

BACKGROUND

hepatitis C virus (HCV) antibody tests have been performed since the 90s, although HCV-RNA (viral load) determination was not always performed. Some of these patients may be actively infected and not be aware of it. Here, we describe a procedure to capture these subjects and complete their diagnosis.

METHODS

the historical laboratory results of Navarra were reviewed and individuals who were positive for antibodies against HCV (anti-HCV) and had not undergone HCV-RNA testing were identified. In September 2018, each general practitioner (GP) was informed about their patients and given precise instructions for completing the diagnosis. The procedure was assessed until December 2019.

RESULTS

two hundred and eighty-nine anti-HCV positive patients were detected for whom active infection had not been discarded. Two were HIV-positive and six had already died. GPs were asked to assess the remaining 281 subjects. By the end of 2019, a new blood test had been performed in 187 (67 %) patients, 5 % decided not to do it, 4 % were living outside of Navarra, 3 % could not be contacted and the GP considered that it was not justified in 2 % of cases. Thus, 19 % remained to be contacted. From the 187 assessed patients, active infection was confirmed in 52 (28 %) individuals, 40 % were false positives and HCV-RNA was undetectable in 31 %. Regarding the 52 actively infected subjects, 34 had already initiated antiviral therapy and three were hospitalized due to decompensated cirrhosis, from which one patient died.

CONCLUSIONS

the strategy to recapture individuals with an incomplete HCV infection diagnosis was effective to detect active infections and subsequent initiation of antiviral therapy.