engleski

Trends of late presentation to care in patients with HCV during a 10-year period in Croatia

Background: Chronic hepatitis C continues to bea major public health problem and leading cause of liver cirrhosis and hepatocellular carcinoma.WHO has seta goal to reduce new viral hepatitis infections by 90% and deaths dueto viral hepatitis by 65% until 2030, which is now achievable by using highly effective direct-acting antivirals. However, linkageto careis the main obstacleto receiving treatmentand follow-up for liver disease. Consequently, a significant proportion of chronically-infected patients enter care only after developing significant fibrosis/cirrhosis.Theaim of this study was to investigatethe prevalenceand trends of late presenters (LP) at first consultations in our clinical center during a 10-year period. Materials/methods: A retrospectivecohort study included all adult patients atentranceto careat the University Hospital for Infectious Diseases, Zagreb between January 2009 and May 2018.Late presenters for care were defined as a reliableLSM ≥9.5 kPa, APRI >1.5, FIB-4 >3.25 or biopsy METAVIR F3. Results: A total of 805 patients wereincluded in thestudy (n=502, 62.3% male, median age 41 years (IQR 34-53), mainly PWID (293, 40.4%). Median age of patients atentranceto careincreased from 37 years (IQR 30-52) in 2009 to 52 years (IQR 44-54) in 2018. Changes in the HCV genotype distribution werealso observed: replacement of subtype 1b with 1a in 2009 vs 2017 (1b 32% to 24% ; 1a 21% to 37%) and increasein subtype 3a/b from 34% to 43%. A total of 293 patients (36.4%) werelate presenters and they were older (47.6, IQR 40.5-67.6), and more frequently infected with HCV 1b (100, 34.2%) and g3 (124, 42.4%).The prevalence of LP significantly increased from 31.9% in 2009 to 45.7% in 2017 and 61.9% in early 2018. Overall, 589 patients received treatment (73.2%), 44 (5.2%) were neglected to treatment, 51 (6.3%) are waiting for treatmentand 121 werelost to follow up (15.3%). Conclusions: Late presentation of CHC is increasing in Croatia and is associated with increasing age suggesting an important gap of CHC diagnosing strategies in patients over 50 years.

Care, patients, HCV, Croatia

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