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J Hepatol. 2015 Jun;62(6):1256-64. doi: 10.1016/j.jhep.2015.01.011. Epub 2015 Jan 21.

Prevalence of elevated ALT values, HBsAg, and anti-HCV in the primary care setting and evaluation of guideline defined hepatitis risk scenarios.

Author information

1
Südstadtpraxis Paderborn, Paderborn, Germany.
2
Clinical Trial Centre Leipzig, University of Leipzig, Germany.
3
LADR GmbH Medizinisches Versorgungszentrum Dr. Kramer und Kollegen, Geesthacht, Germany.
4
Universitätsklinikum Leipzig, Klinik für Gastroenterologie und Rheumatologie, Sektion Hepatologie, Leipzig, Germany.
5
Universitätsklinikum Leipzig, Klinik für Gastroenterologie und Rheumatologie, Sektion Hepatologie, Leipzig, Germany. Electronic address: johannes.wiegand@medizin.uni-leipzig.de.

Abstract

BACKGROUND & AIMS:

Prevalence data for hepatitis B and C and an evaluation of a guideline based screening in the primary care setting are not yet available. We therefore implemented a hepatitis B surface antigen (HBsAg) and anti-hepatitis C virus (HCV) screening and developed guideline based screening strategies.

METHODS:

HBsAg, anti-HCV, and alanine aminotransferase (ALT) were included in a routine check-up together with a questionnaire covering 16 guideline adapted risk scenarios. Significant risk factors were identified by stepwise logistic regression.

RESULTS:

51 private practices screened 21,008 patients. The HBsAg, anti-HCV, and HCV-RNA prevalence was 0.52%, 0.95%, and 0.43%, respectively. Infections were previously unknown in 85% and 65% of HBsAg and anti-HCV positive individuals, respectively. Sexual risk factors were under-reported, while the following scenarios were significantly associated with viral infections (Odds ratio [95% confidence interval]). HBV: Immigration (4.4 [2.9, 6.7]), infection in household (2.5 [1.2, 4.5]), male gender (1.6 [1.1, 2.4]). Male immigrants had a 2.1% HBsAg prevalence and 80% were unaware of the infection. HCV: IV drug use (384 [233, 644]), blood transfusion before 1992 (5.3 [3.5, 7.9]), immigration (2.4 [1.5, 3.6]). Presence of either one of the HBV related guideline defined risk scenarios or elevated ALT identified 82% of previously undiagnosed patients. Presence of one of the three significant HCV risk factors or elevated ALT levels diagnosed 83% of unknown HCV-RNA positive cases by screening only 26% of the population.

CONCLUSIONS:

Undiagnosed hepatitis B and C infections frequently exist in the primary care setting. Easy to apply guideline defined risk scenarios help to diagnose previously unknown infections.

KEYWORDS:

Efficacy; Hepatitis B; Hepatitis C; Screening strategy

PMID:
25617500
DOI:
10.1016/j.jhep.2015.01.011
[Indexed for MEDLINE]

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