Hepatitis virus (HCV) diagnosis and access to treatment in a UK cohort

Emily Adland, Gerald Jesuthasan, Louise Downs, Victoria Wharton, Gemma Wilde, Anna L McNaughton, Jane Collier, Eleanor Barnes, Paul Klenerman, Monique Andersson, Katie Jeffery, Philippa C Matthews

Research output: Contribution to journalArticle (Academic Journal)peer-review

Abstract

BACKGROUND: As direct acting antiviral (DAA) therapy is progressively rolled out for patients with hepatitis C virus (HCV) infection, careful scrutiny of HCV epidemiology, diagnostic testing, and access to care is crucial to underpin improvements in delivery of treatment, with the ultimate goal of elimination.

METHODS: We retrospectively studied microbiology records from a large UK teaching hospital in order to compare the performance of HCV screening and diagnostic tests (antibody, antigen and HCV RNA detection). Having described a local cohort of adults with active HCV infection, we investigated the proportion who attended hospital appointments, were prescribed direct acting antiviral (DAA) therapy, and cleared HCV RNA following treatment.

RESULTS: Over a total time period of 33 months between 2013 and 2016, we tested 38,509 individuals for HCV infection and confirmed a new diagnosis of active HCV infection (HCV-Ag + and/or HCV RNA+) in 353 (positive rate 0.9%). Our in-house HCV-Ab screening test had a positive predictive value of 87% compared to repeat HCV-Ab testing in a reference laboratory, highlighting the potential for false positives to arise using this test. HCV-Ag had 100% positive predictive value compared to detection of HCV RNA. There was a strong correlation between quantitative HCV-Ag and HCV RNA viral load (p < 0.0001). Among the cases of infection, genotype-1 and genotype-3 predominated, the median age was 37 years, 84% were male, and 36% were in prison. Hepatology review was provided in 39%, and 22% received treatment. Among those who received DAA therapy with 12 weeks of follow-up, 93% achieved a sustained virologic response (SVR12).

CONCLUSIONS: HCV-Ag performs well as a diagnostic test compared to PCR for HCV RNA. Active HCV infection is over-represented among men and in the prison population. DAA therapy is successful in those who receive it, but a minority of patients with a diagnosis of HCV infection access clinical care. Enhanced efforts are required to provide linkage to clinical care within high risk populations.

Original languageEnglish
Pages (from-to)461
JournalBMC Infectious Diseases
Volume18
Issue number1
DOIs
Publication statusPublished - 14 Sep 2018

Keywords

  • Adult
  • Antiviral Agents/therapeutic use
  • Cohort Studies
  • Female
  • Genotype
  • Hepacivirus/genetics
  • Hepatitis C/diagnosis
  • Hepatitis C Antibodies/blood
  • Hospitals, Teaching
  • Humans
  • Male
  • Middle Aged
  • RNA, Viral/blood
  • Retrospective Studies
  • Sustained Virologic Response
  • United Kingdom/epidemiology

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