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    Home > Active Ingredient News > Digestive System Information > It is imperative to eliminate hepatitis C and expand the scope of screening population

    It is imperative to eliminate hepatitis C and expand the scope of screening population

    • Last Update: 2022-01-09
    • Source: Internet
    • Author: User
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    It is only for medical professionals to read and refer to.
    Accurate detection builds the first line of defense, helping hepatitis C prevention and control early screening and early diagnosis
    .

    With the advent of direct antiviral drugs (DAA), hepatitis C became the first chronic viral infection that can be completely cured
    .

    However, due to the hidden incidence of hepatitis C, its prevention and treatment still face the grim reality of low awareness, low diagnosis rate, and low treatment rate
    .

    It is estimated that there are about 10 million people infected with hepatitis C virus (HCV) in China, and currently less than 1.
    3% of those receiving treatment[1]
    .

    Hepatitis C patients lurking in the population are not only at great risk to their own health, but at the same time as a source of infection is also a hidden danger that threatens the public health of the society [2]
    .

    During the "20th National Academic Conference on Viral Hepatitis and Liver Diseases", Professor Rao Huiying from Peking University People's Hospital shared the theme of "The Medical and Economic Significance of Hepatitis C Screening Pathways", focusing on explaining and analyzing the importance of HCV screening The current status and development direction of HCV screening in China and the development trend of HCV diagnosis and treatment technology
    .

     Professor Rao Huiying, Peking University People’s Hospital, hepatitis C screening is cost-effective, and it is imperative to expand the screening population.
    At present, patients with hepatitis C in China are often already in serious condition when they go to a doctor.
    It takes an average of 43 days to be admitted to the hospital due to decompensated cirrhosis, resulting in a huge medical economy Burden [3]
    .

    A survey of the diagnosis and treatment status of hepatitis C patients in 9 hospitals in 5 provinces in China showed that the proportion of hepatitis C patients who had liver fibrosis or cirrhosis at the time of initial diagnosis was as high as 16.
    5% [4]
    .

    On the other hand, untreated hepatitis C patients may lead to a potential risk of infection, so HCV screening should be strengthened and standardized
    .

    The World Health Organization (WHO) provides three reference opinions for countries to formulate hepatitis C screening strategies: 1) Strengthen the screening of people with a history of HCV exposure or high-risk behaviors and high-risk groups suspected of having chronic viral hepatitis; 2) Recommendations Anti-HCV seropositive rate ≥ 2% or ≥ 5% of all adults in the population for HCV testing; 3) in the population with a lower overall infection rate, screening the age group with a higher risk of HCV infection Check [5]
    .

    In recent years, more and more research evidence supports the screening of HCV in a wider range of people
    .

    Two cost-effectiveness studies of comprehensive HCV screening for pregnant women in the United States have reached the cost-effectiveness threshold.
    One of the studies showed that comprehensive screening of pregnant women can improve the detection rate and cure rate for 5 years, 10 years and lifelong benefits [6 ,7]
    .

    Studies in South Korea and Japan carried out HCV screening for the general population over the age of 40, and the results showed that screening will reduce disease progression, improve patient prognosis, significantly reduce the incidence of end-stage liver disease, and is cost-effective [8,9]
    .

    Professor Rao Huiying pointed out that HCV screening in high-prevalence groups (including high-risk groups, intravenous drug users and high-age groups) and high-prevalence areas is very cost-effective, and the screening population (such as pregnant women, people over 40, etc.
    ) It is also cost-effective in the era of DAA treatment
    .

    At the same time, if conditions such as high morbidity, low DAA drug prices, and sound infrastructure are available, universal screening is also cost-effective
    .

    In the long run, early and comprehensive screening is often more cost-effective.
    Early screening and early treatment can prevent offspring from the risk of HCV infection and have long-term economic benefits
    .

    The level of implementation of screening standards in China and foreign countries remains to be improved.
    The screening population recommended by China’s latest guidelines and expert consensus includes: people at high risk of HCV infection, people preparing for special or invasive medical procedures, people with unexplained abnormal liver biochemical tests, and all For patients with chronic kidney disease and pregnant women of childbearing age, medical and health institutions and physical examination institutions can incorporate hepatitis C testing into the category of health physical examinations with the informed consent of the medical examiners
    .

    "China's hepatitis C screening has been increasing year by year.
    The current HCV screening standards are basically the same as those abroad.
    However, there is still a gap between the actual implementation and standards in various regions.
    This is mainly reflected in the high missed diagnosis rate, diagnosis rate and low treatment rate after screening.
    Insufficient awareness of screening in non-infectious departments and insufficient number of surveillance sites for high-risk groups
    .

    ” Professor Rao Huiying said, “Further implement screening of high-risk groups and establish a standardized hepatitis C screening-referral path in the hospital, and try to do as much as possible.
    Simplifying the process and shortening the time for sample detection, providing one-stop screening, diagnosis, referral and treatment services with the patient as the center, will help greatly increase the screening, diagnosis, and treatment rate, and help hepatitis C patients get it as soon as possible Timely treatment
    .

    ” Picture: Hepatitis C Screening-Referral Path [10] According to data from two Grade A hospitals in Jiangsu Province, after the hepatitis C screening-referral path was initiated, the proportion of hepatitis C antibody screening increased from 47% to 70%.
    The proportion of RNA screening for hepatitis C antibody-positive patients increased from 27% to 100%, the proportion of screened positive patients increased from 37% to 47%, and the proportion of RNA-positive patients receiving antiviral treatment increased from 10% to 62%[11]
    .

    In addition, focusing on how to further improve the status quo of HCV screening, Professor Rao Huiying also put forward corresponding measures and suggestions in four aspects: the formation of normative guidelines, education and training, further expansion of hospital screening, and improvement of DAA drug accessibility
    .

    Accurate detection builds the first line of defense to help hepatitis C prevention and control, early screening and early diagnosis of hepatitis C virus The existing detection methods mainly include anti-HCV detection, HCV antigen detection, HCV RNA detection, and simultaneous detection of HCV antigen and antibody
    .

    The general screening population first uses the serological anti-HCV test for preliminary screening.
    Those who are positive and those who are highly suspected of being infected with HCV need to be confirmed by HCV RNA quantitative testing
    .

    For people who may be false-negative against HCV [patients with severe immunodeficiency or low immunity, such as human immunodeficiency virus (HIV) infection, organ transplant recipients, hypoglobulinemia, hemodialysis patients, etc.
    ] and those in HCV For special populations in the acute infection window period, HCV RNA quantitative detection is directly used [12,13]
    .

    Professor Zhang Xinxin from Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Chairman of this meeting, concluded: “Early detection and treatment of HCV infection can not only prevent the progression of the patient’s disease, but also prevent the spread of infection.
    It must be strengthened from the perspective of people’s health and socio-economic benefits.
    HCV screening and diagnosis and treatment
    .

    Effective screening is inseparable from reliable and high-quality detection methods.
    The continuous advancement of HCV detection technology has also provided strong support for HCV screening
    .

    I hope that colleagues in the industry will pay attention to the establishment and improvement of hepatitis C The screening-referral path will help China eliminate hepatitis C as soon as possible
    .

    " Professor Zhang Xinxin from Ruijin Hospital, Shanghai Jiaotong University School of Medicine, as a global leader in the field of in vitro diagnostics, Roche Diagnostics provides comprehensive solutions for hepatitis C infection diagnosis including serology and molecular diagnosis , Including the second-generation Elecsys HCV antibody detection using the double antigen sandwich method and the cobas HCV RNA detection with a wide linear range (15~1.
    0x108 IU/ml).
    The combination of the two meets the requirements of various domestic and foreign guidelines, which is helpful for early clinical trials.
    Discovery of patients with HCV infection and improve the level of hepatitis C prevention and control
    .

    Reference materials: [1] Zhuang Hui.
    Research report on the current status of hepatitis C infection in China and its prevention and treatment strategies.
    People's Medical Publishing House, 2017, 9 [2] Chen Yuxin, Wu Chao.
    Chinese Journal of Hepatology 2020;28(10):820-823 .
    [3]McDonald SA, et al.
    Liver Int.
    2018 Aug;38(8):1402-1410.
    [4] Wen Jing et al.
    China AIDS and STD 2018;24(6):581-584.
    [5]WHO .
    Guidelines on hepatitis B and C testing.
    Geneva: World Health Organization 2017.
    [6]Saab S, et al.
    J Clin Gastroenterol.
    2020 Apr 21.
    doi: 10.
    1097/MCG.
    0000000000001360.
    [7]Tasillo A, et al.
    Obstet Gynecol.
    2019;133:289–300.
    [8]Kim DY, et al.
    Curr Med Res Opin.
    2020 Jun;36(6):993-1002.
    [9]Nagai K, et al.
    Hepatol Res.
    2020 May;50(5):542-556.
    [10]Chen Yuxin, Wu Chao.
    Chinese Journal of Hepatology 2020;28(10):820-823.
    [11]Liu LG, et al.
    APASL 2020 Abstract 417.
    [12 National Health and Family Planning Commission of the People’s Republic of China.
    Screening and Management of Hepatitis C Virus.
    Infectious Disease Information 2015;28(1):1-2+22[13] Diagnosis and treatment of chronic kidney disease combined with hepatitis C virus infection Expert consensus of 2019.
    Journal of Clinical Nephrology 2019;19(5):305-310.
    This information is for medical and scientific reference only.
    It is not recommended to use this product in any way that is inconsistent with the prescription information approved by your country.
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