Strategy for the Micro-Elimination of Hepatitis C among Patients with Diabetes Mellitus-A Hospital-Based Experience.

Pei-Yuan Su,Yu-Chun Hsu,Yang-Yuan Chen,I-Ling Liu,Fu-Yuan Siao,Ya-Huei Zeng,Hsu-Heng Yen,Siou-Ping Huang

doi:10.3390/jcm10112509

Abstract

Hepatitis C virus (HCV) infection can induce insulin resistance, and patients with diabetes mellitus (DM) have a higher prevalence of HCV infection. Patient outcomes improve after HCV eradication in DM patients. However, HCV micro-elimination targeting this population has not been approached. Little is known about using electronic alert systems for HCV screening among patients with DM in a hospital-based setting. We implemented an electronic reminder system for HCV antibody screening and RNA testing in outpatient departments among patients with DM. The screening rates and treatment rates at different departments before and after system implementation were compared. The results indicated that the total HCV screening rate increased from 49.3% (9505/19,272) to 78.2% (15,073/19,272), and the HCV-RNA testing rate increased from 73.4% to 94.2%. The anti-HCV antibody seropositive rate was 5.7%, and the HCV viremia rate was 62.7% in our patient population. The rate of positive anti-HCV antibodies and HCV viremia increased with patient age. This study demonstrates the feasibility and usefulness of an electronic alert system for HCV screening and treatment among DM patients in a hospital-based setting.

Highlights

Hepatitis C is a leading cause of cirrhosis and hepatocellular carcinoma throughout the world [1,2,3]
The screening rate is defined as the number of patients with test results for anti-Hepatitis C virus (HCV) antibodies (HCV-Abs) of all eligible patients
The positive rates of HCV-Abs and HCV-RNA testing increased among elderly patients

Summary

Introduction

Hepatitis C is a leading cause of cirrhosis and hepatocellular carcinoma throughout the world [1,2,3]. The newly developed direct-acting antiviral agents have revolutionized treatment for hepatitis C virus (HCV) infection compared with what was used in the interferon-based era. Direct-acting antiviral agents have displayed significantly high rates of sustained virologic response (>90%) and good treatment tolerance even in groups that are difficult to treat [2,3,4,5]. A micro-elimination approach targeting specific highrisk populations is less complex and less costly than a universal screening and treatment approach [6,7]. Several specific high-risk populations with bloodstream infections have been identified as the first step toward HCV elimination, including injection drug users [8], HIV-infected patients [2,9], and patients on dialysis [3]

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Conclusion