The Korean Hepatitis C Virus Care Cascade in a Tertiary Institution: Current Status and Changes in Testing, Link to Care, and Treatment

Abstract

Background/Aims The care cascade for hepatitis C virus (HCV) infection is impeded by multiple barriers, including suboptimal anti-HCV testing, link to care, and diagnosis. We explored the changes in the care cascade of HCV for the past 20 years and its current status in a large cohort from a tertiary referral center. Methods We analyzed 1,144,468 patients who had anti-HCV testing between January 2001 and June 2020. Metrics related to the care cascade of HCV infection and the long-term prognosis of patients were explored. Results The seroprevalence of anti-HCV positivity was 1.8%, with a recent decreasing trend. In all, 69.9% of anti-HCV positive patients performed HCV RNA testing, with a 65.7% positivity. Patients who did not have HCV RNA testing were older and more likely to have a non-hepatocellular carcinoma malignancy, normal alanine aminotransferase level, and good liver function. Linkage times for HCV RNA testing from the anti-HCV positivity and for antiviral treatment from HCV diagnosis decreased, notably after 2015, when highly efficacious oral antiviral treatment was introduced to Korea. The average treatment uptake rate was 35.4%, which increased to 38.9% after 2015. Of the 5,302 patients analyzed for long-term prognosis, the annual incidences of hepatocellular carcinoma were 1.02 or 2.14 per 100 person-years in patients with or without a sustained virological response, respectively. Conclusions The care cascade of HCV infection has been suboptimal for the past 20 years, despite the recent changes. More effort should be made to increase HCV RNA testing and treatment uptake.

Improving the hepatitis C virus care cascade with the in‐hospital Reflex tEsting ALarm‐C (REAL‐C) model

“…In our previous study, the rate of HCV RNA testing among patients with anti‐HCV positivity was approximately 70%, which was higher than the rate observed in the pre‐REAL‐C period (51.0%) in the present study 2 . We speculate that this difference may be due to variations in the exclusion criteria between the present study and our previous study.…”

“…In our previous study, the rate of HCV RNA testing among patients with anti-HCV positivity was approximately 70%, which was higher than the rate observed in the pre-REAL-C period (51.0%) in the present study. 2 We speculate that this difference may be due to variations in the exclusion criteria between the present study and our previous study. Patients with anti-HCV positivity who were tested through health screening centres were not included in the present study, as these patients were not eligible for the REAL-C model due to a difference in the payment systems.…”

“…In a previous study where we investigated the current care cascade for HCV infection in a tertiary Korean hospital, we found that the rate of HCV RNA testing among patients with anti-HCV positivity was only 69.9%, falling short of the 90% target, despite being higher than the rates reported in previous papers. 2,3 This suboptimal diagnosis rate for HCV infection is consistently observed in many studies, underscoring the importance of increased screening and surveillance for unidentified HCV infections. [3][4][5] In this regard, some countries and societies have adopted universal screening for HCV infection, and numerous efforts have been made to raise awareness about HCV infection and reduce barriers impeding access to the HCV care system.…”

The Incidence and Care Cascade of the Hepatitis C Virus in Korea

“…4 Although one of the main challenges of HCV treatment is the difficulty in distributing effective antiviral treatment comprising direct-acting antivirals (DAAs) [5][6][7] owing to its high cost, another large hurdle for HCV elimination is the under-diagnosis and under-reporting of the disease. 8,9 Thus, accurate identification of HCV is a method for assessing how much progress has been made in achieving the World Health Organization 2030 HCV elimination plan, which will accordingly enable the establishment of subsequent plans.…”

How to Optimize the Care Cascade of Hepatitis C Virus Infection

“…In this issue of Gut and liver , Choi et al 8 comprehensively assessed the changes in the HCV care cascade and current status, i.e., HCV test, linkage to care, and treatment and long-term prognosis, in the Republic of Korea, based upon 1,144,468 patients who received anti-HCV test for the past two decades in a single tertiary referral hospital. About 30% of the study population with anti-HCV positivity did not receive the subsequent HCV RNA test.…”