Theme: Clinical Research Year: 2022
Background:
HCV Late Presenters (LP) are individuals HCV diagnosed at an already advanced stage of liver
disease. Their number in a certain population could be an indicator of progress in hepatitis care and
HCV elimination.
Methods:
This study was conducted in the SAMMSU cohort enrolling patients on opioid agonist therapy (OAT)
in Switzerland. HCV late presentation was defined as having an advanced liver disease stage (≥F3,
liver stiffness >9.5kPa on elastography) at the HCV first diagnosis. We considered the time period
from 2017 onwards, when access to Direct-acting antiviral (DAA) treatment in Switzerland became
unrestricted.
Results:
Of 59 patients with HCV first diagnosis between 2017 and 2021, nobody was HIV-co-infected and 40
(68%) had chronic hepatitis C. Among the 34 patients with known fibrosis stage, 21 (62%) had
no/mild fibrosis (F0/F1), while 6 (18%) were considered LP (one F3/five F4). More than two-thirds of
newly diagnosed patients (40) had never been HCV-tested before. Among those tested before, the
last negative test was >1 year ago in 58% (11) and >2 years ago in 42% (8). 16 patients were
diagnosed with an HCV-antibody rapid test with capillary blood (15) or saliva (1). The median time
between first intravenous drug use (which is a proxy for the time of HCV infection) and HCV first
diagnosis was 16 (IQR: 5-26) years (n=44), with only 27% diagnosed during the first 5 years. Once
diagnosed, patients were promptly and successfully treated (treatment uptake 83% (33/40), SVR
100% (30/30)).
Conclusion:
In our cohort of OAT patients, one in five newly diagnosed chronic hepatitis C patients was a late
presenter, highlighting insufficient HCV screening despite clear guidelines and unrestricted DAA
access. Lack of diagnosis is still a main barrier to HCV elimination and needs to be addressed.
However, once diagnosed, the time to cure has become short.
Disclosure of Interest Statement:
Researchers have received funding from the Swiss Federal Office of Public Health. No pharmaceutical
grants were received in the development of this study.