Liver Unit, Ospedale Evangelico Betania, 80147 Naples, Italy.
Center for Global Health, Istituto Superiore di Sanità, 00161 Rome, Italy.
Viruses. 2022 May 19;14(5):1096. doi: 10.3390/v14051096.
Free-of-charge HCV screening in some key populations and in 1969-1989 birth cohorts has been funded in Italy as the first step to diagnosing individuals who are infected but asymptomatic. The aim of this study is to evaluate the feasibility of an opportunistic HCV screening and its linkage to care. A hospital-based HCV screening was conducted as a routine test for in-patients admitted to the Evangelical Hospital Betania of Naples from January 2020 to May 2021. All consecutive in-patients were screened for the HCV antibody (HCV-Ab) at the time of their admission to the hospital, and those born prior to year 2000 were included in the study. HCV-RNA testing was required for those not previously treated and without antiviral treatment contraindications. For in-patients with an active infection, treatment started soon after hospital admission. Among 12,665 inpatients consecutively screened, 510 (4%) were HCV-Ab positive. The HCV-Ab positivity rate increased with age, reaching the highest prevalence (9.49%) in those born before 1947. Among patients positive for HCV, 118 (23.1%) had been previously treated, 172 (33.9%) had been discharged before being tested for HCV-RNA, and 26 (5.1%) had not been tested for short life expectancy. Of 194 (38% of HCV-Ab+) patients who were tested for HCV-RNA, 91 (46.2%) were HCV-RNA positive. Of patients with active infection, 33 (36%) were admitted to the liver unit with signs of liver damage either not previously diagnosed or diagnosed but unlinked to care for HCV infection. Of the patients positive for HCV-RNA, 87 (95.6%) started treatment; all achieved sustained virological response. HCV active infection has been frequently found in patients with comorbidities admitted in the hospital in Southern Italy. To achieve HCV elimination in Italy, broader screening strategies are required. In addition to screening of the 1969-1989 birth cohort of individuals unaware of their infection status, diagnosis and linkage to care of patients with known liver damage is strictly required. Hospital screening is feasible, but prompt reflex testing for identifying HCV-active infections is necessary to increase diagnosis and subsequent linkage to care.
意大利为某些重点人群和 1969-1989 年出生队列提供免费 HCV 筛查，作为诊断无症状感染者的第一步。本研究旨在评估机会性 HCV 筛查的可行性及其与护理的关联。
2020 年 1 月至 2021 年 5 月，在那不勒斯贝塔尼亚福音医院进行了一项基于医院的 HCV 筛查，作为常规检测，对入院的住院患者进行 HCV 抗体（抗 HCV）筛查。所有在 2000 年前出生的患者均纳入本研究。对于以前未接受治疗且无抗病毒治疗禁忌证的患者，需要进行 HCV-RNA 检测。对于有活动性感染的住院患者，在入院后不久即开始治疗。
在连续筛查的 12665 名住院患者中，有 510 名（4%）抗 HCV 阳性。抗 HCV 阳性率随年龄增长而增加，在 1947 年前出生的人群中达到最高患病率（9.49%）。在 HCV 阳性患者中，118 名（23.1%）曾接受过治疗，172 名（33.9%）在接受 HCV-RNA 检测之前已出院，26 名（5.1%）因预期寿命较短而未接受检测。在接受 HCV-RNA 检测的 194 名（抗 HCV 阳性的 38%）患者中，91 名（46.2%）HCV-RNA 阳性。在有活动性感染的患者中，33 名（36%）因肝损伤入院，这些损伤或未被诊断，或被诊断但与 HCV 感染的护理未关联。在 HCV-RNA 阳性的患者中，87 名（95.6%）开始治疗；所有患者均获得持续病毒学应答。
在意大利南部医院住院的合并症患者中经常发现 HCV 活动性感染。要在意大利消除 HCV，需要更广泛的筛查策略。除了对不知道自己感染状况的 1969-1989 年出生队列进行筛查外，还需要严格诊断和将已知有肝损伤的患者与护理相联系。医院筛查是可行的，但需要及时进行 HCV 活跃感染的反射检测，以增加诊断并随后与护理相联系。
