Late presentation of chronic viral hepatitis for medical care: a consensus definition

Abstract

IntroductionWe present two consensus definitions of advanced and late stage liver disease being used as epidemiological tools. These definitions can be applied to assess the morbidity caused by liver diseases in different health care systems. We focus is on hepatitis B and C virus infections, because effective and well tolerated treatments for both of these infections have greatly improved our ability to successfully treat and prevent advanced and late stage disease, especially if diagnosed early. A consensus definition of late presentation with viral hepatitis is important to create a homogenous, easy-to-use reference for public health authorities in Europe and elsewhere to better assess the clinical situation on a population basis.MethodsA working group including viral hepatitis experts from the European Association for the Study of the Liver, experts from the HIV in Europe Initiative, and relevant stakeholders including patient advocacy groups, health policy-makers, international health organisations and surveillance experts, met in 2014 and 2015 to develop a draft consensus definition of late presentation with viral hepatitis for medical care. This was refined through subsequent consultations among the group.ResultsTwo definitions were agreed upon. Presentation with advanced liver disease caused by chronic viral hepatitis for medical care is defined as a patient with chronic hepatitis B and C and significant fibrosis (≥ F3 assessed by either APRI score > 1.5, FIB-4 > 3.25, Fibrotest > 0.59 or alternatively transient elastography (FibroScan) > 9.5 kPa or liver biopsy ≥ METAVIR stage F3) with no previous antiviral treatment. Late stage liver disease caused by chronic viral hepatitis is clinically defined by the presence of decompensated cirrhosis (at least one symptom of the following: jaundice, hepatic encephalopathy, clinically detectable ascites, variceal bleeding) and/or hepatocellular carcinoma.ConclusionThese consensus definitions will help to improve epidemiological understanding of viral hepatitis and possibly other liver diseases, as well as testing policies and strategies.

Establishing a hepatitis C continuum of care among HIV/hepatitis C virus‐coinfected individuals in EuroSIDA

“… *Calculated as a proportion of those with a liver fibrosis marker; fibrosis stage was missing for 271 (5.24%) overall; 31 (11.4%), 35 (12.9%), 114 (42.1%), 18 (6.6%) and 73 (26.9%) in South, Central‐West, North, Central‐East and Eastern Europe, respectively ( P < 0.0001). † Either a biopsy (≥ METAVIR stage F3), FibroScan (> 9.5 kPa), APRI (score > 1.5) or hyaluronic acid level (> 160 ng/mL) during follow‐up. ‡ Calculated as a proportion of those genotyped; genotype was missing for 2729 (52.8%) overall; 462 (16.9%), 742 (27.2%), 344 (12.6%), 309 (11.3%) and 872 (32.0%) in South, Central‐West, North, Central‐East and Eastern Europe, respectively ( P < 0.0001). …”

Eliminating viral hepatitis C in Belgium: the micro-elimination approach

“…t: number of years. [12] Coinfected with HIV 353 (calculated, 2.4% of HIV-positive population) [13,14] Generational cohorts with high prevalence (born 1945-1965) No data [16] Patients with advanced liver disease 21,875 [17,18] PWID 2970 calculated used benchmark multiplier methodology [19] Prisoners 1777 calculated (15.1% HCV-infected of 11,769 prisoners) [20,21] Transplant recipients 146 (12.6%) out of 1156 liver transplants between 2008 and 2012 [6]; 11 at one site [6] Abbreviations: HCV hepatitis C virus; HD haemodialysis; MSM men who have sex with men; ITM Institute of Tropical Medicine; PWID people who inject drugs…”

Reply to: “Pitfalls in measuring temporal trends for late diagnosis of viral hepatitis”

“…There is a dearth of research measuring late diagnosis of HCV and its complications (DC/HCC) and a lack of standardized approaches/definitions (Table 1). While a consensus definition for late presentation to medical care for HBV/HCV was published in 2017, 1 it did not specifically address late diagnosis and lacked specific guidance for researchers seeking to measure this outcome (e.g. a time window for detection of liver complications).…”

“…Decompensated cirrhosis and late stage liver disease DC is one of the conditions used to define late stage liver disease in late diagnosis studies. In the late presentation consensus definition, 1 DC is defined as one or more of jaundice, hepatic encephalopathy, clinically detectable ascites or variceal bleeding. However, conditions used to define DC and late stage liver disease vary across studies published to date (Table S2), limiting comparability.…”