Associated screening for HCV and SARS‐Cov2 infection in an urban area of Southern Italy: A cohort study

BACKGROUND AND AIMS
The SARS-Cov2 pandemic led to reorganize the clinical activities in Italy, reducing the available resources to manage other diseases. In particular,important milestones achieved towards HCV elimination are now at risk of being nullified. Moreover, the burden of SARS-Cov2 asymptomatic carriers remains still an unresolved issue. To associate those two screenings, in order to respond to these clinical needs seems of actual interest.


METHODS
A prospective cohort study was set-up in an urban area of the Naples province, in which a contemporary screening for HCVAb and SARS-Cov-2-Ab rapid blood tests was performed.


RESULTS
Of the 3556 eligible subjects,2740(77.05%) participated.Of them,1.4% resulted SARS-Cov2-positive, none resulting positive for SARS-Cov2-RNA, whereas 1.5% were HCVAb-positive and 0.18% HCVRNA-positive. Of those HCVAb positive,87.8% were already aware and treated in 88.8% of cases .Of the other 4 patients aware of their positivity,2(50%) were HCVRNA-positive. Of the 5 HCVAb-positive unaware of their positivity, 2 were HCVRNA-positive. HCVAb-positivity was only detected in patients of >41 years.


CONCLUSIONS
The screening in an urban area of Southern Italy showed a seroprevalence of SARS-Cov2-Ab and HCV-Ab of 1.4% and 1.5%, respectively,whereas 0.18% had an active HCV infection. This demonstrates how the pandemic can be an opportunity to promote prevention activities for HCV.


| S HORT COMMUNIC ATION
In Italy, since the first months of 2020, the COVID-19 pandemic has led the government to set a series of strict rules limiting all the nonessential clinical activities. 1 These measures reduced the resources for managing potentially curable diseases such as HCV infection. As a matter of fact, this negative impact has been demonstrated by a recent survey carried out by the Italian Association for the Study of the Liver (AISF) where a nearly total interruption of HCV therapies during the first lockdown phase was reported. 2 In addition to that, the principal barriers to obtaining HCV elimination are related to the actual ability to reach all infected patients rather than to the effectiveness of the therapy, as it has been reported that only 20% of the HCV-infected subjects have been already diagnosed worldwide. 3 In Italy, the latest available data estimate that there is 20% of undiagnosed subjects, as well as that 50% of diagnosed patients, are still awaiting a cure. 4 Moreover, updated data on the real prevalence in the Italian general population are scarce and incomplete. 4 Finally, many speculations have been made about the effective number of SARS-CoV2 asymptomatic carriers and their importance on its spreading across the globe. 5 However, there is limited evidence on this burden, also because universal screening for SARS-CoV2 has not been initiated yet. Here we report the results of an associated screening program for SARS-CoV2 and HCV infection on the whole available population of a small town, to be used as a representative cohort of a Southern Italy population, aimed at finding out the real prevalence of both diseases.

| PATIENTS AND ME THODS
A prospective observational cohort study was set up with the aim of testing for both SARS-CoV2 and anti-HCV antibodies using rapid blood tests in all the available populations of Casola Di Napoli, a small town in the southern province of Naples. This town has been specifically chosen because it is in the Campania region, previously reported as one of the areas with the highest prevalence of HCV, but also with the higher treated and untreated patients' ratio in Italy. From a total of 3,845 inhabitants, 3,556 were considered eligible, after excluding 225 subjects of age <6 years and 64 who were resident abroad at the time. Of them, 2,740 (77.05%) partici-

| RE SULTS
The screening was carried out from June 25 to July 12, 2020. A total of 39 patients (1.4% of the total) were positive for either SARS-CoV2 IgM or IgG. None of these patients were positive for SARS-CoV2-RNA nor anyone reported symptoms suggesting an actual/previous COVID-19 disease. Fifty-four patients (1.97% of the total) were positive for anti-HCV by a rapid blood test. These patients underwent a confirmatory serum anti-HCV test with a commercial ELISA assay.
Thirteen patients (13/54; 24.07%) were negative in the confirmatory test, therefore false-positive with the rapid blood-test ( Table 1). In only one case a combined positivity for SARS-CoV-2 and HCV was found. The only significant difference between anti-HCV-positive and anti-HCV-negative subjects was an older age in HCV-positive.  (Table 1). Therefore, from the data obtained by the present screening, the seroprevalence of anti-SARS-CoV2 and anti-HCV was 1.4% and 1.49%, respectively. No active infections of SARS-CoV2 were detected, whereas five patients (0.18%) had an active HCV infection.

| DISCUSS ION
Even though the SARS-CoV2 pandemic has profoundly influenced the diagnosis and the cure of HCV infection, against all odds, recent estimates tell us that Italy could still be on track to reach HCV elimination by 2030. 8  The most plausible explanation could be that the health workers performing the screening were instructed to "consider as positive" also the tests that could have been labelled as "uncertain." However, it must be noted that a higher rate of false-positive should very likely not impact the sensitivity of the test, which is reported to be as high

CO N FLI C T O F I NTE R E S T
The authors declare no conflict of interest for the present work.

DATA AVA I L A B I L I T Y S TAT E M E N T
Study data will be given upon reasonable request made to the corresponding author (Prof. Marcello Persico: mpersico@unisa.it).