Risk of liver fibrosis progression in patients with suboptimal diagnosis of hepatitis C virus infection. Issue 4 (April 2020)

• Record Type: Journal Article
• Authors: Morales-Arraez, Dalia; Nieto Bujalance, Yolanda; Diaz-Flores, Felicitas; de Vera, Antonia; Jiménez, Alejandro; Garcia Dopico, Jose Antonio; Quintero, Enrique; Hernández-Guerra, Manuel
• Is Part Of: European journal of gastroenterology & hepatology. Volume 32:Issue 4(2020)
• Publication Date: 2020-04
• Subjects: cirrhosis -- fibrosis -- hepatitis C -- late presentation -- link to care; Digestive organs -- Diseases -- Periodicals; Liver -- Diseases -- Periodicals; Digestive organs -- Diseases; Liver -- Diseases; Periodicals; 616.33
• DOI: 10.1097/MEG.0000000000001534
• Languages: English
• ISSNs: 0954-691X

Abstract

Abstract : Objective: Many hepatitis C virus (HCV)-infected patients have a suboptimal diagnosis. Particularly, the characteristics and risk of fibrosis progression of HCV antibody-positive patients without RNA testing are unknown. Methods: Patients with a positive HCV antibody performed during 2005–2007 were classified based on RNA request and result until January 2017. Fibrosis was estimated with serologic scores. Results: Of the 38 246 HCV tests performed, 791 (2.01%) patients tested positive. At the end of the follow-up (median 128.6 months, range 109.8–145.9), 49.43% ( n = 391) of the subjects did not have RNA testing, 13.02% ( n = 103) had undetectable RNA, and 37.55% ( n = 297) had detectable RNA. After excluding patients without data for AST to platelet ratio index calculation ( n = 334), patients without RNA testing ( n = 122) compared with RNA undetectable ( n = 92) were more frequently men (68.9 versus 46.7%), alcohol (52.6 versus 38.2%) and drug (53.0 versus 39.1%) users, lacking social support (50.4 versus 29.3%), and showed higher basal fibrosis. Patients without RNA testing had a significantly higher increase in the percentage of patients with ≥F2 ( P = 0.035) and cirrhosis ( P = 0.022). The relative risk for ≥F2 and cirrhosis in patients without RNA testing was 3.03 [95% confidence interval (CI): 1.54–5.98] and 4.31 (95% CI: 1.42–13.10), respectively. Non-RNA request was an independent predictor factor for progression to cirrhosis. Conclusion: In our cohort, patients with positive HCV antibody without RNA testing were more likely to be people at risk of social exclusion with an increased risk of fibrosis progression, because non-RNA request was a predictor for cirrhosis. Therefore, we urge support measures and strategies to link to care these difficult-to-treat populations. Abstract : Supplemental Digital Content is available in the text.