Torrecillas Miriam, Gómez-Muñoz Neus, Ocete María Dolores, Cuevas Purificación Rubio, Madrid Moisés Diago, González Enrique Ortega, Cardona Concepción Gimeno, García-Deltoro Miguel
General University Hospital Consortium of Valencia, Department of Clinical Microbiology, Avenida Tres Cruces, 2. CP, 46014 Valencia, Spain.
General University Hospital Consortium of Valencia, Department of Infectious Disease, Avenida Tres Cruces, 2. CP, 46014 Valencia, Spain.
Ann Hepatol. 2022 Jan-Feb;27(1):100542. doi: 10.1016/j.aohep.2021.100542. Epub 2021 Sep 24.
Implementation of a one-step strategy for diagnosis of active Hepatitis C virus (HCV) infection would encourage the early diagnosis and reduce the time to access antiviral treatments. The aim of this study was to evaluate the impact of a HCV one-step diagnosis compared to the traditional two-step protocol in terms of the time required for patients to be seen by specialists and the time taken to start antiviral treatment.
A comparative study was carried out to assess two diagnostic algorithms (one-step and two-step) for active HCV infection. Serological markers were quantified using the same serum sample to determine both anti-HCV antibodies (HCV-Ab) and HCV core antigen (HCV-cAg) by Architect i2000 SR kit. In this period, a multidisciplinary procedure was started for telematics referral of viremic patients.
One-step approach reduced the time required for patient HCV diagnosis, referral to a specialist, access to treatment, and eliminated the loss of patients to follow-up. Significant differences were observed between one-step and two-step diagnosis methods in the time required for patients to be seen by a specialist (18 days [Interquartile range (IQR) = 14-42] versus 107 days [IQR = 62-148]) and for the initiation of treatment (54 days [IQR = 43-75] versus 200 days [IQR = 116-388]), mainly for patients with advanced fibrosis (35 days [IQR = 116-388] versus 126 days [IQR = 152-366]).
Use of HCV-cAg has proven to be a useful tool for screening patients with active hepatitis C. The development of a multidisciplinary protocol for the communication of results improved the efficiency of the care process.
实施丙型肝炎病毒（HCV）感染的一步诊断策略将有助于早期诊断，并缩短开始抗病毒治疗的时间。本研究旨在评估与传统两步诊断方案相比，HCV一步诊断在患者由专科医生诊治所需时间以及开始抗病毒治疗所需时间方面的影响。
开展一项比较研究，评估用于诊断活动性HCV感染的两种诊断算法（一步法和两步法）。使用同一血清样本对血清学标志物进行定量，通过Architect i2000 SR试剂盒检测抗-HCV抗体（HCV-Ab）和HCV核心抗原（HCV-cAg）。在此期间，启动了一项多学科程序，用于对病毒血症患者进行远程医疗转诊。
一步法缩短了患者HCV诊断、转诊至专科医生、开始治疗所需的时间，并消除了失访患者。一步法和两步法诊断在患者由专科医生诊治所需时间（18天[四分位数间距（IQR）=14-42]对107天[IQR=62-148]）和开始治疗所需时间（54天[IQR=43-75]对200天[IQR=116-388]）方面存在显著差异，主要是对于晚期纤维化患者（35天[IQR=116-388]对126天[IQR=152-366]）。
已证明使用HCV-cAg是筛查活动性丙型肝炎患者的有用工具。制定结果沟通的多学科方案提高了护理流程的效率。
