Significant Improvement in Diagnosis of Hepatitis C Virus Infection by a One-Step Strategy in a Central Laboratory : an Optimal Tool for Hepatitis C Elimination?
López-Martínez, Rosa (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Arias-García, Andrea (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Rodríguez-Algarra, Francisco (Queen Mary University of London)
Castellote, Laura (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Rando-Segura, Ariadna (Hospital Universitari Vall d'Hebron)
Tarraso, Guillermo (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Vargas-Accarino, Elena (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Montserrat-Lloan, Isabel (Hospital Universitari Vall d'Hebron)
Blanco-Grau, Albert (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Caballero, Andrea (Hospital Universitari Vall d'Hebron)
Ferrer Costa, Roser (Hospital Universitari Vall d'Hebron)
Pumarola Suñé, Tomàs (Universitat Autònoma de Barcelona)
Buti, Maria (Hospital Universitari Vall d'Hebron)
Esteban, Rafael (Esteban Mur) (Universitat Autònoma de Barcelona)
Quer, Josep 1963- (Hospital Universitari Vall d'Hebron)
Casis-Saez, Ernesto (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Rodríguez Frías, Francisco (Universitat Autònoma de Barcelona)

Date:	2019
Abstract:	The remarkable effectivity of current antiviral therapies has led to consider the elimination of hepatitis C virus (HCV) infection. However, HCV infection is highly underdiagnosed; therefore, a global strategy for eliminating it requires improving the effectiveness of HCV diagnosis to identify hidden cases. The remarkable effectivity of current antiviral therapies has led to consider the elimination of hepatitis C virus (HCV) infection. However, HCV infection is highly underdiagnosed; therefore, a global strategy for eliminating it requires improving the effectiveness of HCV diagnosis to identify hidden cases. In this study, we assessed the effectiveness of a protocol for HCV diagnosis based on viral load reflex testing of anti-HCV antibody-positive patients (known as one-step diagnosis) by analyzing all diagnostic tests performed by a central laboratory covering an area of 1. 5 million inhabitants in Barcelona, Spain, before (83,786 cases) and after (45,935 cases) the implementation of the reflex testing protocol. After its implementation, the percentage of anti-HCV-positive patients with omitted HCV RNA determination remarkably decreased in most settings, particularly in drug treatment centers and primary care settings, where omitted HCV RNA analyses had absolute reductions of 76. 4 and 20. 2%, respectively. In these two settings, the percentage of HCV RNA-positive patients identified as a result of reflex testing accounted for 55 and 61% of all anti-HCV-positive patients. HCV RNA results were provided in a mean of 2 days. The presence of HCV RNA and age of ≥65 years were significantly associated with advanced fibrosis, assessed using the serological FIB-4 index (odds ratio [OR], 5. 92; 95% confidence interval [CI], 3. 4 to 10. 4). The implementation of viral load reflex testing in a central laboratory is feasible and significantly increases the diagnostic effectiveness of HCV infections, while allowing the identification of underdiagnosed cases.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Hepatitis C virus ; Diagnosis ; Reflex testing ; Viral load ; One-step diagnosis
Published in:	Journal of Clinical Microbiology, Vol. 58 (december 2019) , ISSN 1098-660X

DOI: 10.1128/JCM.01815-19
PMID: 31694971

10 p, 1.0 MB

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