Determinants of successful chronic hepatitis C case finding among patients receiving opioid maintenance treatment in a primary care setting

Hepatitis C virus (HCV) infection remains a pressing public health issue. Our aim is to assess the linkage to care of patients with HCV diagnosis and to support the proactive case-finding of new HCV-infected patients in an Italian primary care setting. This was a retrospective cohort study of 44 general practitioners (GPs) who managed 63,955 inhabitants in the Campania region. Adults with already known HCV diagnosis or those with HCV high-risk profile at June 2019 were identified and reviewed by GPs to identify newly diagnosed of HCV and to assess the linkage to care and treatment for the HCV patients. Overall, 698 HCV patients were identified, 596 with already known HCV diagnosis and 102 identified by testing the high-risk group (2614 subjects). The 38.8% were already treated with direct-acting antivirals, 18.9% were referred to the specialist center and 42.3% were not sent to specialist care for treatment. Similar proportions were found for patients with an already known HCV diagnosis and those newly diagnosed. Given that the HCV infection is often silent, case-finding needs to be proactive and based on risk information. Our findings suggested that there needs to be greater outreach, awareness and education among GPs in order to enhance HCV testing, linkage to care and treatment.

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Diagnostic accuracy of transient elastography (FibroScan) versus the aspartate transaminase to platelet ratio index in assessing liver fibrosis in chronic hepatitis B: The role in primary care setting

Journal of Clinical Pathology ◽

10.1136/jclinpath-2011-200044 ◽

2011 ◽

Vol 64 (10) ◽

pp. 916-920 ◽

Cited By ~ 23

Author(s):

C Rinaldi A Lesmana ◽

Simon Salim ◽

Irsan Hasan ◽

Andri S Sulaiman ◽

Rino A Gani ◽

...

Keyword(s):

Primary Care ◽

Chronic Hepatitis ◽

Liver Fibrosis ◽

Hepatitis B ◽

Diagnostic Accuracy ◽

Chronic Hepatitis B ◽

Care Setting ◽

Primary Care Setting ◽

Transient Elastography ◽

Liver Stiffness

BackgroundA non-invasive method to assess liver fibrosis by measuring liver stiffness with transient elastography (TE) has been recently introduced. The role of TE among chronic hepatitis B (CHB) patients in starting antiviral therapy in the primary care setting is still controversial because of its high cost. The AST to platelet ratio index (APRI) could be a much cheaper alternative.ObjectivesThis study compares the diagnostic accuracy of TE and APRI in assessing liver fibrosis in CHB patients.Patients and MethodsA cross-sectional study in CHB patients intending to start antiviral treatment. Liver fibrosis was staged according to the METAVIR scoring system. Liver stiffness was measured by TE performed on the same day with liver biopsy, while APRI was calculated as follows: APRI=(AST/upper limit of normal)×100/platelet count (109/l). Cutoff levels of liver stiffness and APRI were calculated by using the receiver operating characteristic curve to detect significant liver fibrosis, defined as fibrosis stage F2 or more.Results117 patients were enrolled in the study; their mean age was 40.6±10.97 years. The median liver stiffness was 5.9 kPa (2.5–48 kPa) and the median APRI was 0.239 (0.09–2.73). The cutoff level of liver stiffness was 5.85 kPa for ≥F2 with an AUC of 0.614, 60.3% sensitivity, 63.6% specificity, 73.3% PPV, 49.1% NPV and a LR+ of 1.66. The APRI cutoff level was 0.235 for F≥2 with an AUC of 0.693, 64.4% sensitivity, 70.5% specificity, 78.3% PPV, 54.4% NPV and a LR+ of 2.18. Both methods gave comparable diagnostic accuracy.ConclusionAPRI is a useful marker to screen liver fibrosis in the primary care setting when TE is not available.

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Evolving trends in the prevalence of hepatitis C virus antibody positivity among HIV‐infected men in a community‐based primary care setting

Journal of Viral Hepatitis ◽

10.1111/jvh.13354 ◽

2020 ◽

Vol 27 (11) ◽

pp. 1202-1213

Author(s):

Yun‐Chi Chen ◽

Chloe L Thio ◽

Farin Kamangar ◽

Andrea L Cox ◽

Kjell J Wiberg

Keyword(s):

Primary Care ◽

Hepatitis C Virus ◽

Hepatitis C ◽

Care Setting ◽

Primary Care Setting ◽

Virus Antibody ◽

Community Based ◽

Antibody Positivity ◽

Hepatitis C Virus Antibody

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Efficacy of chronic hepatitis C therapy with pegylated interferon and ribavirin in patients on methadone maintenance treatment

European Journal of Clinical Microbiology & Infectious Diseases ◽

10.1007/s10096-011-1433-5 ◽

2011 ◽

Vol 31 (6) ◽

pp. 1225-1232 ◽

Cited By ~ 5

Author(s):

K. Neukam ◽

J. A. Mira ◽

I. Gilabert ◽

E. Claro ◽

M. J. Vázquez ◽

...

Keyword(s):

Chronic Hepatitis ◽

Hepatitis C ◽

Chronic Hepatitis C ◽

Methadone Maintenance Treatment ◽

Maintenance Treatment ◽

Methadone Maintenance ◽

Pegylated Interferon ◽

Hepatitis C Therapy

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Sofosbuvir Based Regimens in the Treatment of Chronic Hepatitis C with Compensated Liver Cirrhosis in Community Care Setting

International Journal of Hepatology ◽

10.1155/2018/4136253 ◽

2018 ◽

Vol 2018 ◽

pp. 1-8 ◽

Cited By ~ 2

Author(s):

Vijay Gayam ◽

Amrendra Kumar Mandal ◽

Mazin Khalid ◽

Osama Mukhtar ◽

Arshpal Gill ◽

...

Keyword(s):

Liver Cirrhosis ◽

Chronic Hepatitis ◽

Hepatitis C ◽

Chronic Hepatitis C ◽

Care Setting ◽

Community Care ◽

Common Adverse Effect ◽

Community Setting ◽

Patient Characteristics ◽

Virologic Response

Background. Direct-acting antiviral (DAA) drugs have been highly effective in the treatment of chronic hepatitis C (CHC) infection. We aim to evaluate the treatment response of Sofosbuvir based DAA in CHC patients with compensated liver cirrhosis as limited data exists in the real-world community setting. Methods. All the CHC patients with compensated liver cirrhosis treated with Sofosbuvir based DAAs between January 2014 and December 2017 in a community clinic setting were retrospectively analyzed. Pretreatment baseline patient characteristics, treatment efficacy with the sustained virologic response at 12 weeks posttreatment (SVR12), and adverse reactions were assessed. Results. One hundred and twelve patients with CHC infection and concurrent compensated cirrhosis were included in the study. Black patients represented the majority of the study population (64%). Eighty-seven patients were treated with Ledipasvir/Sofosbuvir (LDV/SOF) ±Ribavirin and 25 patients were treated with Sofosbuvir/Velpatasvir (SOF/VEL). Overall, SVR 12 after treatment was achieved in 90% in patients who received one of the two DAA regimens (89.7% in LDV/SOF group and 92% in SOF/VEL group). SVR 12 did not vary based on age, sex, body mass index, baseline HCV viral load, HCV/HIV coinfection, type of genotype, and prior treatment status. Apart from a low platelet count, there were no other factors associated with a statistical difference in SVR 12(p=0.002) between the two regimens. Fatigue (35%) was the most common adverse effect and no patients discontinued treatment due to adverse effects. Conclusion. In the community care setting, Sofosbuvir based DAAs are safe, effective with high overall SVR, and well tolerated in patients with CHC patients with compensated liver cirrhosis.

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