Laufer Christin B, Carroll Matthew B
Department of Internal Medicine, Keesler Medical Center, 301 Fisher Street, Biloxi, MS 39534, USA.
Department of Internal Medicine, Keesler Medical Center, 301 Fisher Street, Biloxi, MS 39534, USA ; Department of Rheumatology, Keesler Medical Center, 301 Fisher Street, Biloxi, MS 39534, USA.
J Clin Med Res. 2015 Oct;7(10):757-61. doi: 10.14740/jocmr2233w. Epub 2015 Aug 23.
In 2012, the Centers for Disease Control (CDC) recommended hepatitis C virus (HCV) screening for those born between 1945 and 1965. Prior recommendations endorsed screening based on risk factors (RFs). Because United States (US) military retirees have had at least 20 years of access to free comprehensive health care, mandatory physical fitness tests, periodic health assessments and mandatory drug screening, we hypothesized that the prevalence of HCV amongst military retirees is lower than the national average. Thus the new CDC screening guidelines may not be applicable or cost effective in this particular population.
A quality improvement (QI) initiative implemented the new birth-cohort CDC screening guidelines for the internal medicine (IM) clinic of our hospital (QI group). An age-matched group from the same IM clinic, screened based on RFs for HCV infection, served as the comparator (RF group). The prevalence of the anti-HCV antibody and chronic infection was determined and compared with each other and with the national average.
The prevalence of the HCV antibody was 2.1% and 2.3% in the QI and RF groups, respectively (odds ratio (OR): 1.08, 95% CI: 0.37 - 3.21, P = 1.000). The prevalence of chronic infection was 0.4% and 1.8% in the QI and RF groups, respectively (OR: 4.39, 95% CI: 0.80 - 24.13, P = 0.083). When our data were compared with the national average, there were no statistical differences in the prevalence of the HCV antibody; however, there was statistically more viral clearance, and subsequently less chronic infection, in the QI group versus the national average.
The military retiree population did not have a lower prevalence of the HCV antibody than the American populace whether screened based on age or traditional RFs. Thus, the CDC guidelines are applicable in this population. One interesting finding of this study is the higher rate of viral clearance in military retirees when compared with the national average. It is therefore possible that military retirees may be more likely to have natural viral eradication than the civilian population.
2012年，美国疾病控制中心（CDC）建议对1945年至1965年出生的人群进行丙型肝炎病毒（HCV）筛查。此前的建议是基于风险因素（RFs）进行筛查。由于美国军队退休人员至少有20年可享受免费的全面医疗保健、强制性体能测试、定期健康评估和强制性药物筛查，我们推测军队退休人员中HCV的患病率低于全国平均水平。因此，新的CDC筛查指南可能不适用于这一特定人群，也不具有成本效益。
一项质量改进（QI）倡议在我院内科诊所实施了新的基于出生队列的CDC筛查指南（QI组）。来自同一内科诊所的年龄匹配组，根据HCV感染的风险因素进行筛查，作为对照（RF组）。确定抗HCV抗体的患病率和慢性感染情况，并相互比较以及与全国平均水平进行比较。
QI组和RF组中HCV抗体的患病率分别为2.1%和2.3%（优势比（OR）：1.08，95%置信区间：0.37 - 3.21，P = 1.000）。QI组和RF组中慢性感染的患病率分别为0.4%和1.8%（OR：4.39，95%置信区间：0.80 - 24.13，P = 0.083）。当将我们的数据与全国平均水平进行比较时，HCV抗体的患病率没有统计学差异；然而，与全国平均水平相比，QI组中病毒清除率在统计学上更高，随后慢性感染更少。
无论基于年龄还是传统风险因素进行筛查，军队退休人员中HCV抗体的患病率都不低于美国民众。因此，CDC指南适用于这一人群。本研究的一个有趣发现是，与全国平均水平相比，军队退休人员的病毒清除率更高。因此有可能军队退休人员比平民更有可能自然清除病毒。
