Beyond Risk Factors: Rethinking Hepatitis B and Hepatitis C Screening in Primary Care

IF 5.2 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Liver International Pub Date : 2025-09-19 DOI:10.1111/liv.70330

Elena Vargas-Accarino, Ariadna Rando-Segura, María Asunción Úbeda, Imma Valls, Carla Ventosa, Núria García, Ingrid Arcusa, Elena Monserrate, Eva de Diego, Marta Selvi, Adriana Palom, Marina Llorens, Maria Santos, Judit Romero-Vico, Artur Dalfo, Juan Carlos Ruiz-Cobo, Ester Pallares, María Buti

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引用次数: 0

Abstract

Introduction

Most international guidelines recommend screening for hepatitis B virus (HBV) and hepatitis C virus (HCV) only for individuals with risk factors or elevated ALT levels. However, this approach may not suffice to eradicate viral hepatitis. This study evaluates the application of EASL HBV and HCV screening guidelines in primary care centres (PCCs).

Methods

The study included two components: (1) A retrospective review (January 2021–March 2023) of microbiology data to determine testing rates, analyse clinical characteristics, and assess management; and (2) A prospective intervention (March–April 2024) involving HBV and HCV screening and risk factor surveys for all adults attending two PCCs for blood collection.

Results

In the retrospective analysis of 90 170 patients, HBV and HCV screening rates were 16% and 10%, respectively. Among HBsAg-positive patients (n = 84 (0.5%)), 67% lacked risk factors or elevated ALT. Among anti-HCV-positive (n = 277 (3%)) and HCV RNA-positive (n = 45 (0.5%)) patients, 54% and 46% respectively lacked these indicators.

In the prospective study of 1030 patients (mean age 55, 39.6% men, 73% Spanish), anti-HCV was detected in 1.16% of cases (HCV RNA in 0.19%). Of these, 67% lacked risk factors or elevated ALT. No HBsAg-positive cases were identified, and hepatitis B vaccination status was uncertain for 50% of patients.

Conclusion

Risk factor-based screening for HBV and HCV in primary care is a suboptimal approach. More than half of the patients testing positive lacked identifiable risk factors or elevated ALT levels. Universal one-time screening for all adults could address these limitations and significantly advance viral hepatitis elimination efforts.

Abstract Image

查看原文本刊更多论文

超越危险因素：重新思考乙肝和丙肝筛查在初级保健。

大多数国际指南建议仅对具有危险因素或ALT水平升高的个体进行乙型肝炎病毒（HBV）和丙型肝炎病毒（HCV）筛查。然而，这种方法可能不足以根除病毒性肝炎。本研究评估EASL HBV和HCV筛查指南在初级保健中心（PCCs）的应用。方法：本研究包括两个组成部分：(1)回顾性分析微生物学数据（2021年1月- 2023年3月），确定检测率、分析临床特征并评估管理；(2)一项前瞻性干预（2024年3月至4月），涉及HBV和HCV筛查和风险因素调查，对参加两次PCCs的所有成年人进行采血。结果：回顾性分析90170例患者，HBV和HCV筛查率分别为16%和10%。在hbsag阳性患者（n = 84(0.5%)）中，67%的患者缺乏危险因素或ALT升高。在抗HCV阳性患者（n = 277(3%)）和HCV rna阳性患者（n = 45(0.5%)）中，分别有54%和46%的患者缺乏这些指标。在1030例患者（平均年龄55岁，39.6%为男性，73%为西班牙人）的前瞻性研究中，1.16%的病例检测到抗-HCV（0.19%为HCV RNA）。其中67%缺乏危险因素或ALT升高。未发现hbsag阳性病例，50%的患者乙肝疫苗接种情况不确定。结论：初级保健中基于危险因素的HBV和HCV筛查是一种次优方法。超过一半的检测呈阳性的患者缺乏可识别的危险因素或ALT水平升高。对所有成年人进行普遍的一次性筛查可以解决这些局限性，并显著推进消除病毒性肝炎的努力。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Liver International 医学-胃肠肝病学

CiteScore

13.90

自引率

4.50%

发文量

348

审稿时长

2 months

期刊介绍： Liver International promotes all aspects of the science of hepatology from basic research to applied clinical studies. Providing an international forum for the publication of high-quality original research in hepatology, it is an essential resource for everyone working on normal and abnormal structure and function in the liver and its constituent cells, including clinicians and basic scientists involved in the multi-disciplinary field of hepatology. The journal welcomes articles from all fields of hepatology, which may be published as original articles, brief definitive reports, reviews, mini-reviews, images in hepatology and letters to the Editor.