EFFECTIVE RE-ENGAGEMENT OF HEPATITIS C PATIENTS: A MULTICENTER STUDY BASED ON LABORATORY RECORDS IN ARGENTINA

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology Pub Date : 2025-09-01 DOI:10.1016/j.aohep.2025.101958

Fernando Cairo , Manuel Barbero , Nicolas Dominguez , Stefania Burgos , Lucia Navarro , Ignacio Roca , Adrian Bologna , Daniel Calfunao , Rodrigo Belloni , Andrea Curia , Ayelen Trillo , Susana Melina , Omar Galdame , Esteban Gonzalez Ballerga

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Abstract

Introduction and Objectives

Hepatitis C virus (HCV) remains a significant cause of global morbidity despite the availability of highly effective direct-acting antivirals (DAAs). In Argentina, fragmented healthcare access and a high prevalence of advanced liver disease underscore the need for re-engagement strategies to achieve HCV elimination. This study aimed to assess the effectiveness of a multicenter re-engagement program for HCV patients lost to follow-up in high-complexity healthcare settings.

Materials and Methods

A multicenter prospective study (March–November 2024) analyzed blood samples from five hospitals to identify HCV antibody-positive patients. Positive cases were contacted to confirm viremia, undergo clinical evaluation, and initiate treatment. Data collected included re-engagement rates, fibrosis staging (FibroScan), genotype distribution, treatment regimens, and sustained virologic response (SVR) rates. Chi-square tests were used to compare positivity rates, genotype distribution, and treatment regimens.

Results

Among 206,053 samples, 3,334 (1.62%) tested positive for HCV antibodies, and 2,149 (64.5%) were potentially eligible for re-engagement. Non-re-engagement causes included deaths (419), previous cure (741), and liver transplants (25). Positive cases were 54.16% male (p = 0.03). A total of 422 patients (19.6%) were successfully re-engaged, of whom 311 (73.8%) exhibited advanced fibrosis (≥F2). Genotype 3 prevalence was similar to others (p = 0.3). Among re-engaged patients, 167 initiated treatment with Sofosbuvir/Velpatasvir (70.08%), Glecaprevir/Pibrentasvir (29.92%) (p = 0.12). Overall SVR12 rate was 97.98% among treated patients. SVR4 was assessed in 112 patients, showing a 100% correlation with SVR12.

Conclusions

This program successfully re-engaged HCV patients lost to follow-up, achieving high SVR12 rates and demonstrating the utility of SVR4 as an early predictor. A significant proportion of patients were unaware of their diagnosis, available treatments, or disease progression. The majority of treated patients had advanced fibrosis, highlighting the need for proactive strategies targeting high-risk populations. These findings underscore the necessity of establishing elimination programs in countries with complex healthcare systems like Argentina.

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丙型肝炎患者的有效再参与：阿根廷一项基于实验室记录的多中心研究

导语和目的尽管有高效的直接作用抗病毒药物（DAAs），丙型肝炎病毒（HCV）仍然是全球发病率的一个重要原因。在阿根廷，不完整的卫生保健可及性和晚期肝病的高流行率突出了为实现消除丙肝病毒而制定再参与战略的必要性。本研究旨在评估一个多中心再参与项目对在高复杂性医疗环境中失去随访的HCV患者的有效性。材料与方法一项多中心前瞻性研究（2024年3月- 11月）分析了来自五家医院的血液样本，以确定HCV抗体阳性患者。接触阳性病例以确认病毒血症，进行临床评估并开始治疗。收集的数据包括再参与率、纤维化分期（FibroScan）、基因型分布、治疗方案和持续病毒学反应（SVR）率。采用卡方检验比较阳性率、基因型分布和治疗方案。结果在206053份样本中，3334份（1.62%）HCV抗体检测呈阳性，2149份（64.5%）可能符合再参与条件。非再订婚原因包括死亡（419）、先前治愈（741）和肝移植（25）。阳性病例中男性占54.16% （p = 0.03）。共有422例（19.6%）患者成功再入，其中311例（73.8%）表现为晚期纤维化（≥F2）。基因3型患病率与其他类型相似（p = 0.3）。在重新参与的患者中，167人开始使用Sofosbuvir/Velpatasvir (70.08%), Glecaprevir/Pibrentasvir (29.92%) （p = 0.12）。总SVR12率为97.98%。112例患者进行了SVR4评估，结果显示SVR12与SVR4的相关性为100%。结论：该项目成功地重新吸引了失去随访的HCV患者，获得了较高的SVR12率，并证明了SVR4作为早期预测指标的实用性。相当大比例的患者不知道他们的诊断、可用的治疗方法或疾病进展。大多数接受治疗的患者患有晚期纤维化，这突出了针对高危人群的主动策略的必要性。这些发现强调了在阿根廷等医疗体系复杂的国家建立消除项目的必要性。

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

Annals of hepatology 医学-胃肠肝病学

CiteScore

7.90

自引率

2.60%

发文量

183

审稿时长

4-8 weeks

期刊介绍： Annals of Hepatology publishes original research on the biology and diseases of the liver in both humans and experimental models. Contributions may be submitted as regular articles. The journal also publishes concise reviews of both basic and clinical topics.