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Continuum of hepatitis C care in France: A 20-year cohort study
BACKGROUND: Hepatitis C virus (HCV)-infected patients require a specific continuum of care (CoC) from HCV screening to treatment. We assessed CoC of HCV-infected patients in a longitudinal study. METHODS: We established a cohort of subjects undergoing HCV screening (high alanine aminotransferase lev...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5574535/ https://www.ncbi.nlm.nih.gov/pubmed/28850623 http://dx.doi.org/10.1371/journal.pone.0183232 |
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author | Hermetet, Coralie Dubois, Frederic Gaudy-Graffin, Catherine Bacq, Yannick Royer, Bernard Gaborit, Christophe D’Alteroche, Louis Desenclos, Jean Claude Roingeard, Philippe Grammatico-Guillon, Leslie |
author_facet | Hermetet, Coralie Dubois, Frederic Gaudy-Graffin, Catherine Bacq, Yannick Royer, Bernard Gaborit, Christophe D’Alteroche, Louis Desenclos, Jean Claude Roingeard, Philippe Grammatico-Guillon, Leslie |
author_sort | Hermetet, Coralie |
collection | PubMed |
description | BACKGROUND: Hepatitis C virus (HCV)-infected patients require a specific continuum of care (CoC) from HCV screening to treatment. We assessed CoC of HCV-infected patients in a longitudinal study. METHODS: We established a cohort of subjects undergoing HCV screening (high alanine aminotransferase levels or risk factors) during preventive consultations at a French regional medical center from 1993 to 2013. Patients were considered to be HCV-infected if HCV RNA was detected in their serum. CoC was assessed as described by Viner et al. (Hepatology 2015): Stage 1, HCV screening; Stage 2, HCV RNA testing; Stage 3, continuing care; Stage 4, antiviral treatment. Cox multivariate analysis was performed to identify factors favoring CoC, defined as at least one course of antiviral treatment. RESULTS: In total, 12,993 HCV tests were performed and 478 outpatients were found to be HCV-seropositive. We included 417 seropositive patients, after excluding false positives and patients lost to follow-up. The baseline characteristics of the patients were: sex ratio (M/F) 1.4; mean age 38.5 years; intravenous drug use (IDU) in 55%; and 28% in unstable social situations, estimated by the EPICES deprivation score. Antiviral treatment was initiated for 179 (42.9%) of the 379 (90.9%) patients attending specialist consultations. CoC was associated with screening after 1997 (HR 2.0, 95%CI 1.4–2.9), age > 45 years (HR 1.5, 95%CI 1.02–2.3), patient acceptance of care (HR 9.3, 95%CI 5.4–16.10), specialist motivation for treatment (HR 10.9, 95%CI 7.4–16.0), and absence of cancer (HR 6.7, 95%CI 1.6–27.9). Other comorbid conditions, such as depression and IDU, were not associated with CoC. CONCLUSIONS: Our 20-year cohort study reveals the real-life continuum of care for HCV-infected patients in France. The number of patients involved in HCV care after positive testing was substantial due to the organization of healthcare in France. An improved CoC along with new direct-acting antivirals should help to decrease chronic HCV infection. |
format | Online Article Text |
id | pubmed-5574535 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-55745352017-09-15 Continuum of hepatitis C care in France: A 20-year cohort study Hermetet, Coralie Dubois, Frederic Gaudy-Graffin, Catherine Bacq, Yannick Royer, Bernard Gaborit, Christophe D’Alteroche, Louis Desenclos, Jean Claude Roingeard, Philippe Grammatico-Guillon, Leslie PLoS One Research Article BACKGROUND: Hepatitis C virus (HCV)-infected patients require a specific continuum of care (CoC) from HCV screening to treatment. We assessed CoC of HCV-infected patients in a longitudinal study. METHODS: We established a cohort of subjects undergoing HCV screening (high alanine aminotransferase levels or risk factors) during preventive consultations at a French regional medical center from 1993 to 2013. Patients were considered to be HCV-infected if HCV RNA was detected in their serum. CoC was assessed as described by Viner et al. (Hepatology 2015): Stage 1, HCV screening; Stage 2, HCV RNA testing; Stage 3, continuing care; Stage 4, antiviral treatment. Cox multivariate analysis was performed to identify factors favoring CoC, defined as at least one course of antiviral treatment. RESULTS: In total, 12,993 HCV tests were performed and 478 outpatients were found to be HCV-seropositive. We included 417 seropositive patients, after excluding false positives and patients lost to follow-up. The baseline characteristics of the patients were: sex ratio (M/F) 1.4; mean age 38.5 years; intravenous drug use (IDU) in 55%; and 28% in unstable social situations, estimated by the EPICES deprivation score. Antiviral treatment was initiated for 179 (42.9%) of the 379 (90.9%) patients attending specialist consultations. CoC was associated with screening after 1997 (HR 2.0, 95%CI 1.4–2.9), age > 45 years (HR 1.5, 95%CI 1.02–2.3), patient acceptance of care (HR 9.3, 95%CI 5.4–16.10), specialist motivation for treatment (HR 10.9, 95%CI 7.4–16.0), and absence of cancer (HR 6.7, 95%CI 1.6–27.9). Other comorbid conditions, such as depression and IDU, were not associated with CoC. CONCLUSIONS: Our 20-year cohort study reveals the real-life continuum of care for HCV-infected patients in France. The number of patients involved in HCV care after positive testing was substantial due to the organization of healthcare in France. An improved CoC along with new direct-acting antivirals should help to decrease chronic HCV infection. Public Library of Science 2017-08-29 /pmc/articles/PMC5574535/ /pubmed/28850623 http://dx.doi.org/10.1371/journal.pone.0183232 Text en © 2017 Hermetet et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Hermetet, Coralie Dubois, Frederic Gaudy-Graffin, Catherine Bacq, Yannick Royer, Bernard Gaborit, Christophe D’Alteroche, Louis Desenclos, Jean Claude Roingeard, Philippe Grammatico-Guillon, Leslie Continuum of hepatitis C care in France: A 20-year cohort study |
title | Continuum of hepatitis C care in France: A 20-year cohort study |
title_full | Continuum of hepatitis C care in France: A 20-year cohort study |
title_fullStr | Continuum of hepatitis C care in France: A 20-year cohort study |
title_full_unstemmed | Continuum of hepatitis C care in France: A 20-year cohort study |
title_short | Continuum of hepatitis C care in France: A 20-year cohort study |
title_sort | continuum of hepatitis c care in france: a 20-year cohort study |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5574535/ https://www.ncbi.nlm.nih.gov/pubmed/28850623 http://dx.doi.org/10.1371/journal.pone.0183232 |
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