Lazarus Jeffrey V, Villota-Rivas Marcela, Fernández Inmaculada, Gea Francisco, Ryan Pablo, López Sonia Alonso, Guy Danielle, Calleja José Luis, García-Samaniego Javier
Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain.
Faculty of Medicine, University of Barcelona, Barcelona, Spain.
Commun Med (Lond). 2022 Feb 24;2:20. doi: 10.1038/s43856-022-00077-9. eCollection 2022.
Direct-acting antivirals can cure ≥95% of hepatitis C virus (HCV) cases, but do not reach everyone in need. This cross-sectional study analyses the HCV cascade of care (CoC) in Madrid, Spain, in high-risk patients, to inform micro-elimination measures.
From September 2019 to May 2021, data from medical records were collected and analysed from six public hospitals in Madrid, including seven adult, high-risk patient groups: patients in haemodialysis or pre-dialysis programmes, co-infected with HIV, with advanced liver disease (ALD), with hereditary haematological diseases, with transplants and people who inject drugs (PWID).
Here we present an analysis of 3994 patients (68.8% male), 91.2% were tested for anti-HCV and 28.9% were positive. Of the total, 34.5% were tested for HCV-RNA and 62.4% of these were positive. Of those HCV-RNA positive, 98.0% were treatment-eligible: in 7.4%, treatment is ongoing and in 89.3% completed. Of the latter, 92.2% obtained a sustained virological response 12 weeks post treatment (SVR12). Of those with ongoing or completed treatment, 9.8% experienced loss to follow-up (LTFU) or had unknown SVR12, 50.3% developed hepatic and 20.3% extrahepatic complications. ALD patients had the highest proportion of HCV-RNA positives (32.5%). The lowest proportion of patients treated were PWID (85.2%).
Almost one in ten high-risk patients in six of Madrid's public hospitals remains untested for HCV antibodies. An almost equal percentage of those untested have experienced LTFU, with the highest proportion in PWID. This approach to monitoring the HCV CoC is vital to inform measures to eliminate HCV in hospitals.
直接抗病毒药物可治愈≥95%的丙型肝炎病毒（HCV）病例，但并未惠及所有有需要的人。这项横断面研究分析了西班牙马德里高危患者的HCV照护流程（CoC），以为微观消除措施提供信息。
2019年9月至2021年5月，收集并分析了马德里六家公立医院的病历数据，包括七个成人高危患者群体：血液透析或透析前项目患者、合并感染HIV患者、患有晚期肝病（ALD）患者、患有遗传性血液疾病患者、接受移植患者以及注射毒品者（PWID）。
我们在此呈现对3994例患者（68.8%为男性）的分析，91.2%的患者接受了抗HCV检测，其中28.9%呈阳性。在所有患者中，34.5%接受了HCV-RNA检测，其中62.4%呈阳性。在那些HCV-RNA阳性患者中，98.0%符合治疗条件：7.4%正在接受治疗，89.3%已完成治疗。在已完成治疗的患者中，92.2%在治疗后12周获得了持续病毒学应答（SVR12）。在正在接受治疗或已完成治疗的患者中，9.8%失访（LTFU）或SVR12情况不明，50.3%出现肝脏并发症，20.3%出现肝外并发症。ALD患者中HCV-RNA阳性比例最高（32.5%）。接受治疗的患者比例最低的是PWID（85.2%）。
马德里六家公立医院中，近十分之一的高危患者未接受HCV抗体检测。未接受检测的患者中，失访比例几乎相同，其中PWID的比例最高。这种监测HCV CoC的方法对于为医院消除HCV的措施提供信息至关重要。
