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Outcome of Screening for Hepatitis C Virus Infection Based on Risk Factors

Mallette, Carol, M.D.1; Flynn, Maura A., M.S.N.2; Promrat, Kittichai, M.D.12

American Journal of Gastroenterology: January 2008 - Volume 103 - Issue 1 - p 131–137
ORIGINAL CONTRIBUTIONS: LIVER AND BILIARY TRACT
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OBJECTIVES Screening for hepatitis C virus (HCV) infection in individuals at increased risk is currently recommended by most, but not all, health authorities. This study identifies outcomes of individuals diagnosed through a screening program targeting high-risk patients.

METHODS Veterans presenting for care in VA facilities are assessed for HCV risk factors by a questionnaire. Those with a risk factor are offered anti-HCV testing. Between October 1998 and May 2004, 25,701 patients were assessed and 8,471 patients had a risk factor for HCV. Patients diagnosed through the screening program were assessed per study protocol.

RESULTS The prevalence of a positive HCV antibody in veterans who identified a risk factor was 7.3% (95% CI 6.6–8.0%). Among those diagnosed through the screening program (N = 260), 47% had chronic hepatitis C. Among patients with chronic HCV, 18% had evidence of advanced liver disease (stage III/IV on biopsy or clinical cirrhosis) while 34% had persistently normal alanine aminotransferase (ALT). Two-thirds of individuals who underwent liver biopsy had minimal or no fibrosis. About half (47%) of the screen-detected patients with chronic HCV were treatment candidates. Forty-four percent were not immediate candidates secondary to medical or psychiatric comorbidities or active substance abuse. Twenty-two patients (8%) had died after a median follow-up of 911 days. Two were liver-related deaths.

CONCLUSION Screening for hepatitis C in persons at high risk can lead to early identification of individuals at risk for progressive liver disease who may benefit from antiviral therapy and counseling to reduce HCV-related liver injury.

1Division of Gastroenterology, Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island; 2Gastroenterology Section, Veterans Affairs Medical Center, Providence, Rhode Island

Reprint requests and correspondence: Kittichai Promrat, M.D., GI Section, Providence VAMC, 830 Chalkstone Avenue, Providence, RI 02908.

Received January 16, 2007; accepted July 23, 2007.

CONFLICT OF INTERESTGuarantor of the article: Kittichai Promrat, M.D.

Specific author contributions: Carol Mallette, M.D.: study design, data collection, data analysis, and manuscript writing; Maura Flynn: data collection and manuscript writing; Kittichai Promrat, M.D.: study design, data collection, data analysis, and manuscript writing.

Financial support: None.

Potential competing interests: None.

© The American College of Gastroenterology 2008. All Rights Reserved.
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