Community-based primary care fibrosis screening feasible for chronic HCV
Researchers using liver stiffness measurement found significant and comparable prevalence of advanced fibrosis between patients with chronic hepatitis C recruited from primary care practices and those recruited from a hospital cohort, according to a recently published study.
“In order to reach the WHO goal of [chronic HCV (CHC)] elimination, the engagement of nonspecialist physicians in CHC treatment and management is paramount,” Stephen Bloom, PhD, from Eastern Health in Victoria, Australia, and colleagues wrote. “Our study suggests a comprehensive community-based CHC screening program is feasible and may identify those at risk of liver-related events and [hepatocellular carcinoma (HCC)].”
To determine the prevalence of elevated liver stiffness measurement (LSM) among community-managed patients, Bloom and colleagues recruited 780 patients with CHC from 21 primary care practices and 207 patients with CHC from a hospital cohort.
In the community-managed cohort, LSM identified 17.3% of patients at risk for advanced fibrosis or cirrhosis (LSM 12.5 kPa) who would have been misclassified based on aspartate-to-platelet ratio index, Fibrosis-4 index and ultrasound assessments.
Among community patients with LSM between 8 kPa and less than 12.5 kPa, 18.8% had no biochemical evidence of active liver disease. Similarly, those with LSM of 12.5 kPa or higher had no biochemical evidence of portal hypertension or active liver disease.
The researchers found no significant difference in the median LSM between the community patients and the hospital cohort, including the rates of LSM of 12.5 kPa or higher. HCV genotype distribution was similar between the two groups.
“Non-invasive tests for the detection of advanced liver disease have been extensively validated in hospital cohorts; however, their role in community groups is less clear,” the researchers wrote. “Our findings would suggest that a percentage of individuals, comparable to a hospital referral cohort, are living with advanced liver disease in the community without specialist support. This underscores the importance of community-based care programs.” – by Talitha Bennett
Disclosure: The authors report no relevant financial disclosures.