Hepatitis virus (HCV) diagnosis and access to treatment in a UK cohort.
Hepatitis virus (HCV) diagnosis and access to treatment in a UK cohort.
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DOI：
10.1186/s12879-018-3367-3
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发表时间：
2018-09-14
影响因子：
3.7
通讯作者：
Matthews PC
中科院分区：
文献类型：
--
作者：
Adland E;Jesuthasan G;Downs L;Wharton V;Wilde G;McNaughton AL;Collier J;Barnes E;Klenerman P;Andersson M;Jeffery K;Matthews PC
随着直接作用抗病毒（DAA）治疗逐渐推广到丙型肝炎病毒（HCV）感染患者，对HCV流行病学，诊断检测和获得护理的仔细审查对于支持治疗提供的改善至关重要，最终目标是消除。我们回顾性研究了英国一家大型教学医院的微生物学记录，以比较HCV筛查和诊断试验（抗体、抗原和HCV RNA检测）的性能。在描述了一个当地队列的成人活动性丙型肝炎病毒感染，我们调查了比例谁出席医院预约，规定直接作用抗病毒（DAA）治疗，并清除HCV RNA治疗后。在2013年至2016年的33个月内，我们对38，509名患者进行了HCV感染检测，并在353名患者中确认了活动性HCV感染（HCV-Ag +和/或HCV RNA+）的新诊断（阳性率0.9%）。我们的内部HCV-Ab筛查试验与参考实验室中的重复HCV-Ab检测相比具有87%的阳性预测值，突出了使用该试验出现假阳性的可能性。HCV-Ag与HCVRNA检测相比具有100%的阳性预测值。HCV-Ag定量与HCVRNA病毒载量之间存在强相关性（p < 0.0001）。在感染病例中，基因型1和基因型3占优势，中位年龄为37岁，84%为男性，36%在监狱中。39%的患者接受了肝脏检查，22%的患者接受了治疗。在接受DAA治疗并随访12周的患者中，93%达到了持续病毒学应答（SVR 12）。与HCV RNA的PCR相比，HCV-Ag作为诊断测试表现良好。活动性HCV感染在男性和监狱人口中所占比例过高。DAA疗法在接受它的人中是成功的，但少数诊断为HCV感染的患者可以获得临床护理。需要加强努力，在高危人群中提供与临床护理的联系。
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. 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. 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). 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.
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影响因子：
39.2
作者：
Freiman JM;Tran TM;Schumacher SG;White LF;Ongarello S;Cohn J;Easterbrook PJ;Linas BP;Denkinger CM
通讯作者：
Denkinger CM
影响因子：
3.7
作者：
Lanini S;Scognamiglio P;Mecozzi A;Lombardozzi L;Vullo V;Angelico M;Gasbarrini A;Taliani G;Attili AF;Perno CF;De Santis A;Puro V;Cerqua F;D'Offizi G;Pellicelli A;Armignacco O;Mennini FS;Siciliano M;Girardi E;Panella V;Ippolito G;members of the Lazio Region HCV treatment group
通讯作者：
members of the Lazio Region HCV treatment group
影响因子：
6.7
作者：
Asselah, Tarik;Marcellin, Patrick;Schinazi, Raymond F.
通讯作者：
Schinazi, Raymond F.
DOI：
10.1002/hep.28497
发表时间：
2016-06
期刊：
Hepatology (Baltimore, Md.)
影响因子：
--
作者：
Martin NK;Vickerman P;Brew IF;Williamson J;Miners A;Irving WL;Saksena S;Hutchinson SJ;Mandal S;O'Moore E;Hickman M
通讯作者：
Hickman M
影响因子：
9.4
作者：
Nguyen LT;Dunford L;Freitas I;Holder P;Nguyen LA;O'Gorman J;Connell J;Carr M;Hall W;De Gascun C
通讯作者：
De Gascun C