Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
PLoS One. 2018 Feb 22;13(2):e0193251. doi: 10.1371/journal.pone.0193251. eCollection 2018.
Control of hepatitis C virus infection (HCV) is an increasingly important issue. Enhancing screening coverage is necessary to discover more HCV infected subjects in community. However, a substantial population is unaware of HCV infection that needs more attention.
The aims of this study were to evaluate the status of HCV infected residents in remote villages, to compare characteristics between already known and unaware HCV infection subjects, and to analyze the disease insights.
Screening intervention for liver diseases was conducted in remote villages of Tainan City of southern Taiwan from August 2014 to July 2016. Items of screening examinations included questionnaire, blood sampling for liver tests and viral hepatitis markers (hepatitis B surface antigen and anti-HCV antibody), abdominal sonography survey, and liver stiffness measurement by transient elastography. Quantitation of HCV RNA was measured for residents with positive anti-HCV antibody.
A total of 194 (13.5%) out of 1439 participants showed positive for anti-HCV antibody. HCV viremia was detected in 119 (61.3%) residents. Previously unaware HCV infection by questionnaire record was present in 68 (35.1%) of ant-HCV positive residents. By multivariate logistic analysis, unaware HCV infected residents exhibited significantly mild liver fibrosis (OR 0.876, 95% CI 0.7820.981, p = 0.022), more prevalent of heart diseases (OR 6.082, 95% CI 1.96318.839, p = 0.002), and less cluster of family history of liver diseases (OR 0.291, 95% CI 0.113~0.750, p = 0.011) when comparing with already known HCV infected residents. Among the 126 already know HCV infected residents, only 59 (46.8%) received antiviral treatment or regular follow-up. No concept or no willing to receive medical care was observed in 44 (34.9%) residents.
In HCV endemic villages of Taiwan, residents with unaware HCV infection comprised about one third of HCV infected residents and exhibited obscure characteristics to identify. Less than half of already known HCV infected residents received adequate medical care. To eliminate HCV infection, vigorous efforts on enhancing screening coverage, educating update knowledge of liver diseases, and linking to medical care are urgently needed.
控制丙型肝炎病毒（HCV）感染是一个日益重要的问题。为了在社区中发现更多的 HCV 感染患者，提高筛查覆盖率是必要的。然而，仍有相当一部分人不知道自己感染了 HCV，这需要更多的关注。
本研究旨在评估偏远村庄 HCV 感染居民的现状，比较已发现和未发现 HCV 感染人群的特征，并分析疾病认知。
2014 年 8 月至 2016 年 7 月，在台湾南部台南市的偏远村庄进行了肝脏疾病筛查干预。筛查检查项目包括问卷调查、肝酶和病毒性肝炎标志物（乙肝表面抗原和抗 HCV 抗体）采血、腹部超声检查和瞬时弹性成像检测肝硬度。对抗 HCV 抗体阳性者进行 HCV RNA 定量检测。
在 1439 名参与者中，共有 194 名（13.5%）抗 HCV 抗体阳性。119 名（61.3%）居民检测到 HCV 病毒血症。通过问卷调查记录，在 194 名抗 HCV 抗体阳性居民中，有 68 名（35.1%）为先前未发现的 HCV 感染。多变量 logistic 分析显示，未发现的 HCV 感染居民表现出明显较轻的肝纤维化（OR 0.876，95%CI 0.7820.981，p = 0.022），更常见的心脏病（OR 6.082，95%CI 1.96318.839，p = 0.002）和较少的家族史肝脏疾病（OR 0.291，95%CI 0.113~0.750，p = 0.011），与已发现的 HCV 感染居民相比。在 126 名已知 HCV 感染患者中，只有 59 名（46.8%）接受了抗病毒治疗或定期随访。在 44 名（34.9%）患者中，没有概念或不愿意接受医疗。
在台湾 HCV 流行地区的村庄中，未发现的 HCV 感染居民占 HCV 感染居民的三分之一左右，其特征难以识别。不到一半的已知 HCV 感染患者接受了足够的医疗护理。为了消除 HCV 感染，迫切需要加强筛查覆盖范围、教育更新肝脏疾病知识，并与医疗保健联系起来。
