Department of Orthopaedic Surgery, Stanford Hospital and Clinics, Redwood City, CA and Navy Education and Training Command.
Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA.
J Arthroplasty. 2021 Feb;36(2):467-470. doi: 10.1016/j.arth.2020.08.023. Epub 2020 Aug 18.
In 2012, we reported on the prevalence of hepatitis C virus (HCV) infection in Veterans Affairs (VA) patients undergoing total joint arthroplasty (TJA) at our center. In this patient population, 8.4% were antibody positive and 4.5% were viremic with HCV. In 2014, the first all-oral direct-acting antiviral treatment for hepatitis C became available. The Department of Veterans Affairs then underwent an aggressive program to eradicate hepatitis C from the veteran population. The purpose of this report is to provide updated information on the prevalence of HCV viremia among patients undergoing primary TJA at the same center.
A retrospective review was performed of all patients undergoing primary TJA at a single VA medical center in 2019. Anti-HCV antibody and HCV viremia prevalence were calculated. Comparisons were made to data from a previously reported cohort of patients who had undergone TJA at the same center from 2007 to 2009.
Thirty-three (11.6%) of 285 patients screened preoperatively were positive for the hepatitis C antibody. Only one of the 33 anti-HCV-positive patients was viremic at the time of screening for an overall viremic prevalence of 0.4%. We found no statistically significant difference in the birth year, or anti-HCV antibody-positive rate from the prior cohort, but the prevalence of HCV viremia decreased significantly.
Because direct-acting antiviral HCV treatment has become available, HCV viremia among VA patients undergoing TJA has been reduced from 4.5% to 0.4%. Surgeons are still advised to minimize the risk of sharps injury.
2012 年，我们报道了在我们中心接受全关节置换术（TJA）的退伍军人事务部（VA）患者中丙型肝炎病毒（HCV）感染的流行率。在该患者人群中，8.4%的抗体呈阳性，4.5%的 HCV 呈病毒血症。2014 年，首个全口服直接作用抗病毒药物治疗丙型肝炎问世。随后，退伍军人事务部启动了一项积极计划，旨在从退伍军人中消除丙型肝炎。本报告的目的是提供同一中心接受初次 TJA 的患者中 HCV 病毒血症流行率的最新信息。
对 2019 年在单一 VA 医疗中心接受初次 TJA 的所有患者进行了回顾性研究。计算了抗-HCV 抗体和 HCV 病毒血症的流行率。并与先前报道的同一中心 2007 年至 2009 年接受 TJA 的患者队列数据进行了比较。
33 例（11.6%）术前筛查的患者抗-HCV 抗体阳性。在筛查时，33 例抗-HCV 阳性患者中只有 1 例呈病毒血症，总病毒血症流行率为 0.4%。我们发现与之前的队列相比，出生年份或抗-HCV 抗体阳性率没有统计学上的显著差异，但 HCV 病毒血症的患病率显著下降。
由于直接作用抗病毒 HCV 治疗已经可用，接受 TJA 的 VA 患者的 HCV 病毒血症已从 4.5%降至 0.4%。外科医生仍被建议尽量降低锐器伤的风险。
