MO829: Hepatitis C Prevalence, Incidence and Treatment in Chinese Hemodialysis Patients: Results From the Dialysis Outcomes and Practice Patterns Study-China (2019–21)

Abstract

Abstract BACKGROUND AND AIMS Prior work from the Dialysis Outcomes and Practice Patterns Study (DOPPS) showed the HCV incidence and prevalence in China in 2012–15 to be the second highest and upper third, respectively, among 15 different countries/regions. With direct-acting antivirals (DAA) approved in 2017 in China, we have utilized the DOPPS-China study to: (1) determine if HCV prevalence and incidence in Chinese HD patients has changed after DAAs became available and (2) to understand how HCV is treated, monitored and managed in Chinese HD facilities and non-dialysis chronic kidney disease (CKD) clinics. METHOD Detailed data for 1700 HD patients were collected from 39 randomly selected HD facilities in Beijing, Shanghai and Guangzhou participating in the DOPPS 7-China study (2019–21). Study site medical directors completed a survey regarding HCV treatment and management practices for HD and ND-CKD patients. HCV prevalence was calculated based on an initial cross-section (n = 1279) of study patients, and HCV incidence was based on 1197 patients who were HCV negative at baseline, had ≥2 HCV antibody measurements during follow-up, and were treated in facilities accepting HCV + patients. The median study follow-up was 1.2 years. RESULTS HCV prevalence in this 2019–21 cohort was 7.4% (Table 1), which was <14.8% and 11.5% HCV prevalences reported in DOPPS-China for the 2009–11 and 2012–5 cohorts, respectively (Jadoul et al. 2019). HCV incidence was also lower in the 2019–21 cohort (1.2 cases/100 pt-years) versus that in the 2012–5 cohort (2.1 cases/100 pt-years). Although nearly all study site medical directors indicated that all or nearly all HCV + patients should be treated for HCV (data not shown), medical directors indicated that relatively few HCV + patients have been treated as yet at most dialysis units (Table 2). The DOPPS 7-China study appeared to have excellent programs in place for frequent monitoring of patients and staff for HCV, education of staff and referral of HCV cases in most HD units to infectious disease, gastroenterology and liver disease specialists. Liver biopsies were not commonly performed in HCV + HD patients. HCV genotyping was also rarely performed. Admittedly, data were not collected from the specialist clinics where genotyping may have occurred. CONCLUSION HCV continues to be prevalent among Chinese HD patients despite the prevalence appearing to be lower now than that seen in the 2009–15 DOPPS-China cohorts. However, most HCV + HD patients remain untreated, which may be due to financial/cost reimbursement barriers and patients’ non-acceptance of HCV treatment. If such barriers can be overcome, then Chinese HD facilities and associated specialists, as described here in DOPPS 7, appear to be well-equipped and organized to successfully treating and managing their HCV + HD and CKD patients in order to achieve the WHO goal of eliminating HCV by 2030.