The Korean Hepatitis C Virus Care Cascade in a Tertiary Institution: Current Status and Changes in Testing, Link to Care, and Treatment

Characterization of Incident Hepatitis C Virus Infection among People Living with HIV in a HIV Clinic in Korea

BACKGROUND

Coinfection with human immunodeficiency virus (HIV) and hepatitis C virus (HCV) can cause more rapid progression to cirrhosis than HCV-monoinfection. In this study, incident HCV case (IHCV)s were investigated in a HIV clinic in Korea.

MATERIALS AND METHODS

A retrospective HIV cohort was constructed who visited National Medical Center in Korea from 2013 to 2022 and performed ≥ 1 anti-HCV antibody tests (anti-HCV) during the study period. IHCV was defined as newly confirmed HCV infection by PCR with a prior negative anti-HCV and factors associated with IHCV were investigated among alanine aminotransferase (ALT) >150 IU/mL sub-cohort without plausible reasons for ALT elevation.

RESULTS

Overall, 2,567 HIV clinic visitors were recruited during the study period and 42 (1.63%) were confirmed as HIV/HCV co-infection. Fifteen IHCVs were identified during the study period. While no IHCV was observed in 2013-2015, incidence of 2016-2019 and 2020-2022 were 0.84 and 1.48 per 1000 person-year, respectively. Subtype 1a were more common among IHCVs in 2020-2022 (8/9) while subtype 2 dominated in 2016-2019 (5/6, P=0.003). Most IHCVs were identified during the evaluation of de novo liver enzyme elevation which was identified through the regularly performed blood tests (86.7%, 13/15). Comparing twelve IHCVs with ALT>150 IU/mL with 58 HIV mono-infection comparators whose peak ALT exceeded 150 IU/mL during the study period, age, sex, HIV/HCV infection risk factor, CD4 cell count, and HIV-RNA viral load were not different between two groups. However, mean peak ALT of IHCVs was higher than comparators (776 vs. 237, P<0.001) and syphilis treatment within prior 24 months of ALT elevation was more common in IHCV group (41.7% vs. 12.7%, P=0.026).

CONCLUSION

Incidence rate of HCV among PLH revealed increasing trend between 2013 and 2022 among visitors at a HIV clinic in Korea. Subtype 1a dominated among IHCVs after 2020 and recent syphilis treatment was associated with IHCVs.

Impact of Chronic Hepatitis C Virus on Acute Kidney Injury After Living Donor Liver Transplantation

BACKGROUND

Acute kidney injury (AKI) is one of the most common complications after liver transplantation (LT) and can significantly impact outcomes. The presence of hepatitis C virus (HCV) infection increases the risk of AKI development. However, the impact of HCV on AKI after LT has not been evaluated. The aim of this study was to assess the effect of HCV on AKI development in patients who underwent LT.

METHODS

Between January 2008 and April 2023, 2183 patients who underwent living donor LT (LDLT) were included. Patients were divided into 2 groups based on the presence of chronic HCV infection. We compared LT recipients using the propensity score matching (PSM) method. Factors associated with AKI development were evaluated using multiple logistic regression analysis. In addition, 1-year mortality and graft failure were assessed using a Cox proportional regression model.

RESULTS

Among 2183 patients, the incidence of AKI was 59.2%. After PSM, the patients with HCV showed a more frequent development of AKI (71.9% vs 63.9%, P = .026). In multivariate analysis after PSM, HCV was associated with AKI development (odds ratio [OR], 1.53; 95% confidence interval [CI], 1.06-2.20, P = .022), 1-year mortality (Hazard ratio [HR], 1.98; 95% CI, 1.12-3.52, P = .019), and graft failure (HR, 2.12; 95% CI, 1.22-3.69, P = .008).

CONCLUSIONS

The presence of HCV was associated with increased risk for the development of AKI, 1-year mortality, and graft failure after LT.

Hepatitis C virus infection in patients undergoing surgery in a single tertiary academic center

BACKGROUND AND AIM

Lack of awareness disturbs proper care for hepatitis C virus (HCV) infections in patients undergoing surgery. We investigated the status of HCV screening, confirmation, and treatment in patients who underwent surgery.

METHODS

Patients who underwent surgery at a tertiary academic center between 2019 and 2021 were eligible for this retrospective study.

RESULTS

Between 2019 and 2021, 96 894 patients (40 121 males; 41.4%) who underwent surgery under general anesthesia were recruited. The median age of the participants was 55.0 years. Of the 83 920 (86.6%) patients who tested positive for anti-HCV antibodies, 576 (0.7%) showed positive results, with a higher proportion of patients with diabetes mellitus (32.6% vs 18.5%), hypertension (50.5% vs 28.6%), liver cirrhosis (13.2% vs 1.7%), and unfavorable laboratory test results when compared with those with negative results (all P < 0.05). HCV RNA was tested in 215 patients (37.3%), with a positivity rate of 20.5% (n = 44). Of the 44 patients, 42 (95.5%) were referred for antiviral treatment, and 29 (69.0%) were successfully treated with direct-acting antiviral therapy. HCV RNA confirmation rates were higher in the Department of Hepatobiliary and Transplant Surgery (76.6%) than in the other surgical departments (25.0-33.5%) (P < 0.001).

CONCLUSIONS

The proportion of patients who were positive for anti-HCV antibodies and failed to receive proper management after surgery was not negligible. Increased awareness of HCV infection among surgeons through appropriate education may be required.

Improving the hepatitis C virus care cascade with the in-hospital Reflex tEsting ALarm-C (REAL-C) model

BACKGROUND

The World Health Organization (WHO) has set targets to eliminate viral hepatitis, including hepatitis C virus (HCV) infection, by 2030. We present the results of the in-hospital Reflex tEsting ALarm-C (REAL-C) model, which incorporates reflex HCV RNA testing and sending alerts to physicians.

METHODS

We conducted a retrospective study analysing the data of 1730 patients who newly tested positive for anti-HCV between March 2020 and June 2023. Three distinct periods were defined: pre-REAL-C (n = 696), incomplete REAL-C (n = 515) and complete REAL-C model periods (n = 519). The primary outcome measure was the HCV RNA testing rate throughout the study period. Additionally, we assessed the referral rate to the gastroenterology department, linkage time for diagnosis and treatment and the treatment rate.

RESULTS

The rate of HCV RNA testing increased significantly from 51.0% (pre-REAL-C) to 95.6% (complete REAL-C). This improvement was consistent across clinical departments, regardless of patients' comorbidities. Among patients with confirmed HCV infection, the gastroenterology referral rate increased from 57.1% to 81.1% after the REAL-C model. The treatment rate among treatment-eligible patients was 92.4% during the study period. The mean interval from anti-HCV positivity to HCV RNA testing decreased from 45.1 to 1.9 days. The mean interval from the detection of anti-HCV positivity to direct-acting antiviral treatment also decreased from 89.5 to 49.5 days with the REAL-C model.

CONCLUSION

The REAL-C model, featuring reflex testing and physician alerts, effectively increased HCV RNA testing rates and streamlined care cascades. Our model facilitated progress towards achieving WHO's elimination goals for HCV infection.

The Incidence and Care Cascade of the Hepatitis C Virus in Korea

Background/Aims

The 2030 hepatitis C virus (HCV) elimination targets of the World Health Organization are an 80% reduction in incidence and 65% reduction in mortality compared to the 2015 rates. However, information on the nationwide incidence and treatment rates of HCV infection are limited. We aimed to investigate the nationwide incidence and status of the care cascade for HCV infection in Korea.

Methods

This study used data from the Korea Disease Control and Prevention Agency linked with the data of the Korea National Health Insurance Service. Linkage to care was defined as visiting hospitals twice or more due to HCV infection within 1.5 years of the index date. The treatment rate was the number who had been prescribed antiviral medication within 1.5 years from the index date out of patients newly diagnosed with HCV.

Results

The new HCV infection rate was 17.2 per 100,000 person-years (n=8,810) in 2019. The number of new HCV infections was the highest in patients aged 50 to 59 years (n=2,480), and the new HCV infection rate significantly increased with age (p<0.001). Among newly infected patients with HCV, the linkage to care rate was 78.2% (78.2% men, 78.2% women) and the treatment rate was 58.1% (56.8% men, 59.3% women) within 1.5 years.

Conclusions

The new HCV infection rate was 17.2 per 100,000 person-years in Korea. It is necessary to continuously monitor the incidence and care cascade of HCV to establish proper strategies to reach the goal of HCV elimination by 2030.