Abstract
BackgroundDirect-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.MethodsFrom 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).ResultsHere 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%).ConclusionsAlmost 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.
Highlights
Direct-acting antivirals can cure ≥95% of hepatitis C virus (HCV) cases, but do not reach everyone in need
91.2% were tested for anti-HCV Ab and of those tested, 28.9% were positive (Fig. 1, Table 2)
Of those HCV–RNA positive, 71.0% were male, 91.5% of Spanish origin and the mean age was 57.9 years (SD: 11.1). Of those HCV–RNA positive, 61.4% had advanced liver disease (ALD), based on a fibrosis score of ≥F3 (Table 3), and 98.0% were eligible for treatment
Summary
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. 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). 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. 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
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