Sadeghimehr Maryam, Bertisch Barbara, Schaetti Christian, Wandeler Gilles, Richard Jean-Luc, Scheidegger Claude, Keiser Olivia, Estill Janne
Institute of Global Health, University of Geneva, Geneva, Switzerland.
Federal Office of Public Health, Public Health Directorate, Bern, Switzerland.
J Virus Erad. 2019 Nov 4;5(4):191-203. doi: 10.1016/S2055-6640(20)30036-4.
Hepatitis C virus (HCV) infection is a major cause of liver disease. Since symptoms of chronic liver disease usually appear only late in the course of the disease, infected individuals may remain undiagnosed until advanced disease has developed. We aimed to investigate which screening strategies would be most effective to detect individuals unaware of their infection.
We developed a mathematical model for HCV disease progression and compared the current practice of HCV testing in Switzerland with the following screening strategies: intensive screening of active injection drug users (IDU), screening of former IDU, screening of individuals originating from countries with high HCV prevalence, screening of individuals born 1951-1985 (birth-cohort) and universal screening. All screening interventions were considered in addition to a baseline scenario that reflected the current practice of HCV testing.
Within the first 4 years (2018-2021), every year, on average 650 cases were diagnosed in the baseline scenario, 660 with intensified IDU screening, 760 with former IDU screening, 830 with origin-based screening, 1420 with birth-cohort screening and 1940 with universal screening. No difference in liver-related mortality and incidence of end-stage liver disease between the screening scenarios was observed.
Our results suggest that only large-scale screening of the general population could substantially accelerate the rate of HCV diagnosis and treatment in Switzerland and other countries with similar epidemics. However, this implies screening of a large population with low prevalence, and may trigger considerable numbers of false-positive and borderline test results.
丙型肝炎病毒（HCV）感染是肝脏疾病的主要病因。由于慢性肝病症状通常在疾病进程后期才出现，受感染个体可能在疾病发展到晚期之前都未被诊断出来。我们旨在研究哪种筛查策略对于检测未意识到自身感染的个体最为有效。
我们建立了一个HCV疾病进展的数学模型，并将瑞士当前的HCV检测实践与以下筛查策略进行比较：对现用注射毒品者（IDU）进行强化筛查、对既往IDU进行筛查、对来自HCV高流行国家的个体进行筛查、对1951 - 1985年出生人群（出生队列）进行筛查以及普遍筛查。除了反映当前HCV检测实践的基线情况外，所有筛查干预措施都被纳入考虑。
在最初4年（2018 - 2021年），每年在基线情况下平均诊断出650例病例，强化IDU筛查诊断出660例，既往IDU筛查诊断出760例，基于来源地筛查诊断出830例，出生队列筛查诊断出1420例，普遍筛查诊断出1940例。各筛查方案之间在肝脏相关死亡率和终末期肝病发病率方面未观察到差异。
我们的结果表明，只有对普通人群进行大规模筛查才能在瑞士及其他有类似疫情的国家大幅加快HCV诊断和治疗的速度。然而，这意味着要对低患病率的大量人群进行筛查，并且可能引发相当数量的假阳性和临界检测结果。
