학술논문
Therapy as prevention toward HCV elimination in maintenance hemodialysis: a multi-center, prospective cohort study
ORIGINAL ARTICLE
ORIGINAL ARTICLE
Document Type
Clinical report
Author
Huang, Chung-Feng; Dai, Chia-Yen; Wang, Chih-Wen; Liang, Po-Cheng; Wei, Yu-Ju; Tsai, Pei-Chien; Jang, Tyng-Yuan; Hsu, Po-Yao; Lee, Jia-Jung; Niu, Sheng-Wen; Huang, Jiun-Chi; Yeh, Ming-Lun; Huang, Ching-I; Hsieh, Ming-Yen; Lin, Yi-Hung; Chen, Szu-Chia; Chiu, Yi-Wen; Huang, Jee-Fu; Chang, Jer-Ming; Hwang, Shang-Jyh; Chuang, Wan-Long; Yu, Ming-Lung
Source
Clinical Kidney Journal. December 2023, Vol. 16 Issue 12, p2429, 8 p.
Subject
Language
English
ISSN
2048-8505
Abstract
INTRODUCTION Hepatitis C virus (HCV) infection is recognized as a major global health burden. Patients on maintenance hemodialysis (HD) are at great risk for HCV infection [1]. The prevalence and [...]
Background. The World Health Organization has established interim guidance for hepatitis C virus (HCV) elimination. We aimed to prove the concept of 'treatment as prevention' by conducting a prospective HCV elimination program for hemodialysis (HD) patients. Methods. A universal HCV screen was launched in 22 HD centers in 2019. HCV-viremic patients were linked to care with direct-acting antivirals (DAAs). The second screen was performed in 2021 to evaluate the effect of link-to-care in lowering the prevalence of HCV viremia and the incidence of HCV new/re-infections. Results. Of 2336 patients enrolled in the first screening in 2019, 320 (13.7%) were seropositive for anti-HCV and 181 (7.7%) were HCV-viremic. Of 152 patients successfully linked to treat with DAA, 140 (92.1%) patients achieved a sustained virological response. Of them, 1733 patients participated in the second surveillance. Five anti-HCV-negative patients experienced anti-HCV seroconversion. Of 119 DAA-cured patients and 102 spontaneous HCV clearance patients, none had HCV reinfection. The annual incidence of HCV new infection was 0.1%. Sixty-one of the 620 (9.8%) newly enrolled patients were anti-HCV-seropositive in the second survey. The overall HCV-viremic rate decreased from 7.7% in 2019 to 0.6% (15/2353) in 2021. At the institutional level, 45.5% (10/22) eradicated HCV and 82% (18/22) of HD units had no HCV new infections or reinfections. Conclusions. The link-to-care project proved the concept of 'treatment as prevention' by which HCV microelimination helps to prevent reinfection and new infections in the HD population. Trial registration: ClinicalTrials.gov identifer: NCT03803410 and NCT03891550. Keywords: DAA, HCV, hemodialysis, hepacivirus, microelimination
Background. The World Health Organization has established interim guidance for hepatitis C virus (HCV) elimination. We aimed to prove the concept of 'treatment as prevention' by conducting a prospective HCV elimination program for hemodialysis (HD) patients. Methods. A universal HCV screen was launched in 22 HD centers in 2019. HCV-viremic patients were linked to care with direct-acting antivirals (DAAs). The second screen was performed in 2021 to evaluate the effect of link-to-care in lowering the prevalence of HCV viremia and the incidence of HCV new/re-infections. Results. Of 2336 patients enrolled in the first screening in 2019, 320 (13.7%) were seropositive for anti-HCV and 181 (7.7%) were HCV-viremic. Of 152 patients successfully linked to treat with DAA, 140 (92.1%) patients achieved a sustained virological response. Of them, 1733 patients participated in the second surveillance. Five anti-HCV-negative patients experienced anti-HCV seroconversion. Of 119 DAA-cured patients and 102 spontaneous HCV clearance patients, none had HCV reinfection. The annual incidence of HCV new infection was 0.1%. Sixty-one of the 620 (9.8%) newly enrolled patients were anti-HCV-seropositive in the second survey. The overall HCV-viremic rate decreased from 7.7% in 2019 to 0.6% (15/2353) in 2021. At the institutional level, 45.5% (10/22) eradicated HCV and 82% (18/22) of HD units had no HCV new infections or reinfections. Conclusions. The link-to-care project proved the concept of 'treatment as prevention' by which HCV microelimination helps to prevent reinfection and new infections in the HD population. Trial registration: ClinicalTrials.gov identifer: NCT03803410 and NCT03891550. Keywords: DAA, HCV, hemodialysis, hepacivirus, microelimination