Late presentation of chronic HBV and HCV patients seeking first time specialist care in Spain: a 2-year registry review

Picchio, Camila A; Lens, Sabela; Hernandez-Guerra, Manuel; Arenas, J J; Andrade, Raúl J.; Crespo, Javier; García‐Samaniego, J.; Romero–Gómez, Manuel; Turnés, Juan; Calleja, José Luís; Simón, Miguel Ángel; White, Trenton M; Riveiro‐Barciela, Mar; Pocurull, Anna; Morales-Arráez, Dalia; Gomez, Alexandra; Buti, María; Lazarus, Jeffrey V.

doi:10.1038/s41598-021-01885-0

Cited by 18 publications

(7 citation statements)

References 25 publications

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“…Interestingly, in our experience, 22% of viraemic HCV patients had advanced liver disease (i.e., decompensated cirrhosis or hepatocellular carcinoma), highlighting the need for earlier diagnosis. Our findings confirm other research that underscores late diagnosis and presentation to specialist viral hepatitis care as an important issue within the healthcare system [ 20 ]. Additionally, HCV-related disease inflicts a huge economic and clinical burden, even as a result of HCV-related extrahepatic comorbidities [ 21 ].…”

Section: Discussionsupporting

confidence: 91%

Hepatitis C Virus Micro-Elimination Plan in Southern Italy: The “HCV ICEberg” Project

Coppola¹,

Kondili

Staiano³

et al. 2023

Pathogens

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This study evaluates the feasibility of a local action program for HCV micro-elimination in highly endemic areas. Retrospective analysis: administrative and laboratory data (Local Health Unit, southern Italy) were integrated to quantize the anti-HCV-positive subjects not RNA tested and untreated HCV-infected subjects (2018–2022). Prospective analysis: all subjects admitted to a division of the LHU largest hospital (2021–2022) were tested for HCV, with linkage of active-infected patients to care. Overall, 49287 subjects were HCV-Ab tested: 1071 (2.2%) resulted positive without information for an HCV RNA test and 230 (0.5%) had an active infection not yet cured. Among 856 admitted subjects, 54 (6.3%) were HCV-Ab+ and 27 (3.0%) HCV RNA+. Of HCV-infected patients, 22.2% had advanced liver disease, highlighting the need for earlier diagnosis; 27.7% were unaware of HCV infection; and 20.4% were previously aware but never referred to a clinical center. Of these, 26% died and 74% received treatment. Our study emphasizes the value of an active HCV hospital case-finding program to enhance diagnosis in patients with several comorbidities and to easily link them to care. Our data strongly suggest extending this program to all hospital wards/access as a standard of care, particularly in highly endemic areas, to help HCV disease control and take steps in achieving the elimination goals.

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Section: Discussionsupporting

confidence: 91%

Hepatitis C Virus Micro-Elimination Plan in Southern Italy: The “HCV ICEberg” Project

Coppola¹,

Kondili

Staiano³

et al. 2023

Pathogens

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“…Patients with suboptimal diagnosis, that is, with a positive HCV antibody with unknown RNA, and those with active infection lost to follow-up, were considered a priority group to be linked to care in the microelimination plans 16 mainly because these patients have a high probability of active infection and are at risk of liver fibrosis progression 9 and late presentation. 17 It is important to emphasize that in our cohort of 13 years of testing, nearly one fourth of the patients with positive serology for HCV remained without full evaluation or treatment for a median of 7 years with positive HCV antibodies, which is consistent with other studies. 16 Some might think that these patients are lost to follow-up because they are likely to be difficult to treat; however, this group of patients is characterized as being young male without comorbidity, with a history of drug use, and having abnormal transaminases without previous specialist evaluation.…”

Section: Discussionsupporting

confidence: 90%

Reengagement strategies for hepatitis C patients lost to follow-up: A randomized clinical trial

Morales-Arráez

Hernández-Bustabad

Castro

et al. 2023

Hepatology Communications

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Background and Aims: To achieve the World Health Organization’s goal of eliminating HCV by 2030, reengagement of lost to follow-up cases is mandatory. However, there is lack of evidence concerning the best strategy. Our study evaluated the effectiveness, efficiency, predictive factors, and costs of 2 different strategies. Methods: We identified patients positive for HCV antibodies without RNA requests from 2005 to 2018. Patients fulfilling trial criteria (NCT04153708) were randomized to (1) phone call or (2) letter of invitation to schedule an appointment, followed by switching strategy. Results: Three hundred forty-five patients among 1167 lost to follow-up were identified. An analysis of the first 270 randomized patients (72% male, 51±13 y) showed a higher contact rate in the mail than in the phone call strategy (84.5% vs. 50.3%). In the intention-to-treat analysis, no differences were found related to appointment attendance (26.5% vs. 28.5%). Regarding efficiency, 3.1 letters and 8 phone calls were needed to successfully link 1 patient (p<0.001) but dropped down to 2.3 phone calls if we only considered the first call attempt (p=0.008). Prior specialist’s evaluation and HCV testing in the predirect-acting antiviral era were the only factors associated with no showing up for the appointment. The cost per patient was €621.3 (2.5 quality-adjusted life-years) in the phone call strategy and €611.8 (2.4 quality-adjusted life-years) in the mail letter strategy. Conclusions: Reengagement of patients with HCV is feasible, and equally effective with similar costs in both strategies. The mail letter was more efficient, except when only 1 phone call was considered. Prior specialist’s evaluation and testing in the predirect-acting antiviral era were factors associated with nonattendance to the appointment.

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“…Our study found a higher risk of LP clearly associated with increasing age, male gender, a history of alcohol overuse and lack of postprimary education. Overall, our findings echo the results of several studies for higher age and male gender and a history of alcohol overuse as risk factors for LP [18,[24][25][26][27]. Further risk factors found in other studies are being diagnosed longer than 2 years before referral, genotype 3, MSM [25] and suffering from diabetes [26].…”

Section: Discussionsupporting

confidence: 90%

Late presentation for hepatitis C treatment: prevalence and risk factors in the Swiss Hepatitis C Cohort

Brunner,

Grischott,

Bruggmann

2024

European Journal of Gastroenterology &Amp; Hepatology

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Objective Patients with ‘late presentation’ (LP) of chronic hepatitis C infection (HCV) have already developed advanced liver disease before receiving direct-acting antiviral (DAA) treatment. Even after successful treatment, the risk of morbidity and premature death remains elevated, leading to an unnecessary disease burden. This study aimed to assess the prevalence of LP within the prospective observational Swiss Hepatitis C Cohort (SCCS) and evaluate risk factors as determinants of LP. Methods Treatment-naïve participants of SCCS who received DAA treatment between 2014 and 2019 were included. Demographic, clinical and behavioural data were compared between the LP and non-LP strata. LP prevalence was calculated over time and by year. LASSO regression was used to identify potential risk factors for LP, and odds ratios were calculated by refitting logistic regression models. Results In this explorative, retrospective case–control study using data of n = 5829 SCCS members, a total of 21.3% received their first HCV treatment. The cumulative LP prevalence decreased from mid-2015 and stabilised at 46.5% (n = 579) by the end of 2019. Male gender, higher age and a history of alcohol overuse were associated with a higher risk of LP. Conclusion Despite the study’s limitations, LP prevalence was higher than anticipated, considering Switzerland’s availability period and universal access to DAAs. Therefore, any HCV LP should be viewed as a healthcare system failure, primarily in high-income economies. As LP is directly linked to the disease burden, it must be included as a mandatory parameter in surveillance response systems of HCV elimination programs.

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Late presentation of chronic HBV and HCV patients seeking first time specialist care in Spain: a 2-year registry review

Cited by 18 publications

References 25 publications

Hepatitis C Virus Micro-Elimination Plan in Southern Italy: The “HCV ICEberg” Project

Hepatitis C Virus Micro-Elimination Plan in Southern Italy: The “HCV ICEberg” Project

Reengagement strategies for hepatitis C patients lost to follow-up: A randomized clinical trial

Late presentation for hepatitis C treatment: prevalence and risk factors in the Swiss Hepatitis C Cohort

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