Theme: Epidemiology & Public Health Research Year: 2024
Background: In Switzerland, direct-acting antivirals (DAAs) are reimbursed without liver fibrosis restriction since 2017. We determined prevalence of HCV late presentation in times of unrestricted DAA access.
Methods: The SAMMSU-cohort is an open cohort with yearly follow-up, enrolling >18-year-old patients with current/previous opioid agonist therapy (OAT) in eight different centers throughout Switzerland since 2014. By 02/01/2024, 1,390 patients have been enrolled. HCV late presentation (LP) was defined as F3/F4-fibrosis (Fibroscan® >9.5kPa) at first HCV therapy and first HCV diagnosis, respectively.
Results: For 90.3% (243/269) first HCV therapies since 2017, Fibroscan® was available prior to treatment: 58.0% had no/mild fibrosis (F0/F1), 14.8% significant fibrosis (F2), 13.2% severe fibrosis (F3) and 14.0% cirrhosis (F4) [LP: 27.2% (66/243)]. LP prevalence was 57.8% (48/83) in 2014-2016, 28.1% (25/89) in 2017, 24.8% (33/133) in 2018-2020 and 38.1% (8/21) in 2021-2023. Risk factors for LP were male sex (OR 1.9, p=0.078) and alcohol (≥49g/d) (OR 3.2, p<0.001), whereas diagnosis of schizophrenia was negatively associated (OR 0.4, p=0.015). Comparing LP versus non-LP at first HCV therapy, median age was 47.1 versus 45.9 years (p=0.250), median time since HCV diagnosis 12.5 versus 11 years (p=0.472) and median time since first intravenous drug use (IDU) 28 versus 25 years (p=0.357).
There were 78 HCV first diagnoses since 2017: median age: 39 years; median time since first IDU: 16 years; 88.5% diagnosed at/before enrolment; for 70.5%, no pretest recorded; 37.9% (22/58) diagnosed with a rapid test. 27.4% (20/73) cleared spontaneously, while 72.6% (53) developed chronic infection (5 unclear/unknown). Treatment-uptake was 86.8% (46/53), mostly within one year. Of the 88.7% (47/53) chronically infected individuals with Fibroscan® available, 23.4% (11/47) already had F3/F4-fibrosis.
Conclusion: In times of unrestricted DAA access, late diagnosis and late treatment are still common (one in four). But, once diagnosed or relinked to care, patients are promptly treated.
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