Gastroenterology and Nutrition Research Group, Department of Clinical Medicine, UiT The Arctic University of Tromsø, 9037, Tromsø, Norway.
Department of Internal Medicine, Section of Gastroenterology, University Hospital of North Norway, Tromsø, Norway.
BMC Infect Dis. 2019 Feb 26;19(1):189. doi: 10.1186/s12879-019-3832-7.
Chronic hepatitis C virus (HCV) infection can progress to cirrhosis and end-stage liver disease in a substantial proportion of patients. The infection is frequently asymptomatic, leaving many infected individuals unaware of the diagnosis until complications occur. This advocates the screening of healthy individuals. The aim of this study was to estimate the prevalence of HCV infection in the general adult population of the municipality of Tromsø, Norway, and to evaluate the efficiency of such an approach in a presumed low-prevalence area.
The study was part of the seventh survey of the Tromsø Study (Tromsø 7) in 2015-2016. Sera from 20,946 individuals aged 40 years and older were analysed for antibodies to HCV (anti-HCV). A positive anti-HCV test was followed up with a new blood test for HCV RNA, and the result of any previous laboratory HCV data were recorded. Samples positive for anti-HCV and negative for HCV RNA were tested with a recombinant immunoblot assay. All HCV RNA positive individuals were offered clinical evaluation.
Among 20,946 participants, HCV RNA was detected in 33 (0.2%; 95% CI: 0.1-0.3), of whom 13 (39.4%; 95% CI: 22.7-56.1) were unaware of their infection. The anti-HCV test was confirmed positive in 134 individuals (0.6%; 95% CI: 0.5-0.7) with the highest prevalence in the age group 50-59 years. Current or treatment-recovered chronic HCV-infection was found in 85 individuals (0.4%; 95% CI: 0.3-0.5) and was associated with an unfavorable psychosocial profile.
In this population-based study, the prevalence of viraemic HCV infection was 0.2%. A substantial proportion (39%) of persons with viraemic disease was not aware of their infectious status, which suggests that the current screening strategy of individuals with high risk of infection may be an inadequate approach to identify chronic HCV infection hidden in the general population.
慢性丙型肝炎病毒（HCV）感染在很大一部分患者中可进展为肝硬化和终末期肝病。该感染常无症状，导致许多感染者在出现并发症之前都不知道自己的诊断结果。因此，筛查健康人群势在必行。本研究旨在评估挪威特罗姆瑟市成年人群的 HCV 感染流行率，并评估在假定低流行率地区进行此类筛查的效率。
该研究是 2015-2016 年特罗姆瑟研究（Tromsø 7）第七次调查的一部分。对 20946 名年龄在 40 岁及以上的个体进行 HCV 抗体（抗-HCV）检测。对阳性抗-HCV 检测结果进行 HCV RNA 检测，并记录之前任何实验室 HCV 数据的结果。对抗-HCV 阳性且 HCV RNA 阴性的样本进行重组免疫印迹检测。对所有 HCV RNA 阳性的个体提供临床评估。
在 20946 名参与者中，检测到 33 例（0.2%；95%CI：0.1-0.3）HCV RNA，其中 13 例（39.4%；95%CI：22.7-56.1）为无症状感染者。134 例（0.6%；95%CI：0.5-0.7）抗-HCV 检测结果确认为阳性，其中年龄组为 50-59 岁的个体患病率最高。发现 85 例（0.4%；95%CI：0.3-0.5）为现症或治疗后慢性 HCV 感染，且与不良的社会心理状况相关。
在这项基于人群的研究中，HCV 感染的病毒血症患病率为 0.2%。相当一部分（39%）患有病毒血症的患者不知道自己的感染状态，这表明目前对高感染风险人群的筛查策略可能不足以发现隐匿于普通人群中的慢性 HCV 感染。
