Abstract
BackgroundMany persons infected with Hepatitis B virus (HBV) and Hepatitis C virus (HCV) in the past are now lost to follow-up. The aim of the Northern Holland Hepatitis Retrieval Project (NHHRP) is to retrieve and re-evaluate persons previously diagnosed with HBV or HCV and bring them back into care. Chronic HBV infection was defined as two positive Hepatitis B surface antigen (HBsAg) tests within 6 months and chronic HCV infection with 2 positive HCV RNA tests by polymerase chain reaction (PCR).MethodsData files of the local public health services and microbiology laboratory were explored to identify all registered HBV and HCV cases in the Alkmaar region, the Netherlands, for the past 15 years. Identified cases were compared with patients currently known in our hospital. Patients without follow-up in primary or hospital care were approached via their primary health care physician and invited for evaluation at our hospitalResultsIn total, 552 cases of HBV were identified. 356 (64.5%) had no follow-up. Only 113/356 (31.7%) were eligible for retrieval and 44.2% were evaluated in our hospital resulting in a change of management in 22/50 (44%) of patients. Four hundred ninety nine cases of HCV were identified, 150/499 (30.1%) were lost to follow-up. Only 20/150 (13.3%) were eligible for retrieval and 4/20 (20%) were evaluated at our clinic. Resulting in a change of management in 3/4 (75%).ConclusionOnly a limited part of HBV and HCV persons lost to follow-up is eligible for retrieval, nonetheless re-evaluation of these persons will lead to a change of management in the majority of persons.
Highlights
Many persons infected with Hepatitis B virus (HBV) and Hepatitis C virus (HCV) in the past are lost to follow-up
It is estimated that 257 million persons worldwide are living with chronic HBV infection and 71 million persons with chronic HCV infection [1]
The World Health Organization (WHO) estimates that viral hepatitis was responsible for 1.34 million deaths in 2015, 96% of these deaths were due to long-term complications of untreated HBV and HCV infection [1]
Summary
Many persons infected with Hepatitis B virus (HBV) and Hepatitis C virus (HCV) in the past are lost to follow-up. Infection with hepatitis B virus (HBV) and hepatitis C virus (HCV) is present worldwide and a leading cause of liver-related morbidity and mortality. The World Health Organization (WHO) estimates that viral hepatitis was responsible for 1.34 million deaths in 2015, 96% of these deaths were due to long-term complications of untreated HBV and HCV infection [1]. .The main goals of antiviral treatment are long-term suppression of HBV replication and hepatic inflammation and thereby preventing progression to cirrhosis and hepatocellular carcinoma. In patients without an direct indication for treatment it is required to check ALT levels and viral load every 6-12 months in order to monitor and prevent progression to cirrhosis and hepatocellular carcinoma [7]
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