Are We Aware of Hepatitis C Infection? HCV Results from the Tertiary Reference Center in the Aegean Region from Turkey

Abstract

Background. With the advent of direct-acting antiviral agents, the rate of sustained virological response in the treatment of hepatitis C virus (HCV) infection has reached 100%. However, it has been observed that many patients still do not have access to treatment. Aim. The aim of this study was to identify patients who are anti-HCV and HCV-RNA-positive, to reveal undiagnosed cases, and thus to reveal the necessity of increasing HCV follow-up tests and diagnosis. Methods. The microbiology database of Tepecik Research and Training Hospital was examined for patients who were tested for anti-HCV and HCV-RNA from January 2013 to January 2023. Patients were indexed based on their entry date, and duplicate values were manually removed. The data were then grouped according to the clinics that requested the analysis. Results. Between 2013 and 2023, a total of 334,537 anti-HCV tests were conducted without duplications. The annual average number of tests was 33,454 ± 10,027. During the ten-year period under review, the total number of patients with a positive result for the anti-HCV test was 3,943. The positivity rate among all anti-HCV tests was 1.18%. The annual average number of positive test results was 394 ± 54. Between 2013 and 2022, out of the 3,943 patients who tested positive for anti-HCV, HCV-RNA analysis was conducted on 2,500 of them (63.4%). Among the 2,500 patients who underwent HCV-RNA analysis, 682 were found to be HCV-RNA-positive (27.4%), while 1,818 were HCV-RNA-negative (72.6%). In the ten-year period, when the distribution of the 334,537 anti-HCV tests according to internal and surgical branches was evaluated, it was found that 157,680 tests (47.1%) were requested from internal branches, while 176,857 tests (52.9%) were requested from surgical branches. Of the 2,500 patients who tested positive for anti-HCV and underwent HCV-RNA analysis, 2,273 (90.9%) were requested by internal branches, while surgical branches requested 227 tests (9.1%). Among the 1,443 patients who tested positive for anti-HCV but did not have HCV-RNA tests ordered, 788 (54.6%) were evaluated in internal branches, and 655 (45.4%) were evaluated in surgical branches. Conclusion. In this study, it was observed that multiple anti-HCV tests were requested for the same individual, and HCV-RNA tests were not ordered for those testing positive for anti-HCV. Moreover, patients were not referred to the infection or gastroenterology clinics for HCV-RNA testing. Consequently, it was concluded that sufficient and necessary tests for diagnosis were not conducted, leading to the inability to access treatment. To achieve the World Health Organization’s goals for HCV eradication, it is imperative to increase the rates of HCV-RNA testing, enhance the utilization of reflex testing, and ensure proper referral to the necessary clinics.