Evolutionary seroepidemiology of viral hepatitis and the gap in hepatitis C care cascades among uraemic patients receiving haemodialysis in Taiwan-the Formosa-Like Group
J Viral Hepat. 2021 May;28(5):719-727. doi: 10.1111/jvh.13477. Epub 2021 Feb 13.
Yu-Ju Wei 1 , Po-Yao Hsu 1 , Jia-Jung Lee 2 3 , Sheng-Wen Niu 2 3 , Jiun-Chi Huang 2 3 , Cheng-Ting Hsu 1 , Tyng-Yuan Jang 1 , Ming-Lun Yeh 1 3 4 , Ching-I Huang 1 3 4 , Po-Cheng Liang 1 , Yi-Hung Lin 1 , Ming-Yen Hsieh 1 , Meng-Hsuan Hsieh 1 3 4 , Szu-Chia Chen 2 3 , Chia-Yen Dai 1 3 4 , Zu-Yau Lin 1 3 , Shinn-Cherng Chen 1 3 , Jee-Fu Huang 1 3 4 , Jer-Ming Chang 2 3 , Shang-Jyh Hwang 2 3 , Wan-Long Chuang 1 3 4 , Chung-Feng Huang 1 3 4 , Yi-Wen Chiu 2 3 , Ming-Lung Yu 1 3 4
2 Nephrology Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
3 Faculty of Internal Medicine, College of Medicine, and Center for Cohort Study, Kaohsiung Medical University, Kaohsiung, Taiwan.
4 Hepatitis Research Center, College of Medicine and Center for Cohort Study, Kaohsiung Medical University, Kaohsiung, Taiwan.
Uraemic patients undergoing haemodialysis are at high risk of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection. We aimed to evaluate the evolutionary seroprevalence of viral hepatitis and the gap in HCV care cascades in this special population by a large-scale surveillance study in Taiwan. Uraemic patients on maintenance haemodialysis from 22 sites (FORMOSA-LIKE group) in 2012 (n = 1,680) and 2019 (n = 2,326) were recruited for this study. The distributions and sequential changes of viral hepatitis markers were analysed. The prevalence of anti-HCV antibody and hepatitis B surface antigen (HBsAg) seropositivity was 13.6% (316/2326) and 11.5% (267/2326), respectively, in 2019 compared with 17.3% (290/1680, P = .002) and 13.6% (229/1680, P = .046), respectively, in 2012. The HCV-viremic rate among anti-HCV-seropositive patients was significantly lower in 2019 than in 2012 (56.3% [178/316] vs. 73.8% [214/290], P < .001). The HCV treatment rate increased from 2.3% (5/217) in 2012 to 21.7% (49/226) in 2019 (P < .001). In the sequential analysis of the 490 patients who participated in both screens, 17 of the 55 HCV-viremic patients became HCV RNA seronegative, including 13 by antivirals and four spontaneously. By contrast, one anti-HCV-seropositive but nonviremic patient became viremic, and six anti-HCV-seronegative patients became anti-HCV-seropositive in 2019. The annual incidence of new HCV was 0.2%/year. Seven HBsAg-seropositive patients experienced HBsAg loss (1.25%/year). Two patients had new anti-HBc seropositivity (new HBV exposure: 0.57%/year). The seroprevalence of viral hepatitis decreased in an 8-year follow-up but remained prevalent, and the treatment of HCV infection was underutilized in uraemic patients. Additional efforts are needed to enhance the HCV treatment uptake of uraemic patients. Clinical Trial IDs: NCT03803410, NCT01766895.
Keywords: ESRD; HBV; HCV; prevalence; uraemic patients.
MOST 108-2314-B-037-066-MY3/Kaohsiung Medical University
MOST 108-2314-B-037-003/Kaohsiung Medical University
KMUH108-8R05/Kaohsiung Medical University Hospital
KMUHIRB-F(II)-20180057/Kaohsiung Medical University Hospital
KMUHIRB-20130034/Kaohsiung Medical University Hospital
Investigator-Initiated Studies Program of Merck Sharp &amp; Dohme Corp