Author: C.Valente, B.Jesus, R. Carvalho, P.Carriço, M.Fraga, A. Almeida, M.PrataJ, Saraiva da Cunha

Theme: Epidemiology & Public Health Research Year: 2019

Introduction: Based on different strategies and approaches, healthcare professionals, are
involved in combat and elimination of hepatitis C. People with additive behaviors are a very
difficult population to screen, monitor and even to refer to treatment. Untreated patients
constitute an individual and public health risk.
Material and methods: With the aim of characterizing the population followed in an
Integrated Response Center for Additive and Dependence Behaviors, where more than a
thousand individuals are followed, a close collaboration with the local university hospital in the
central region of Portugal was established. In the first step, about a quarter of the patients
were evaluated regarding the presence of infection due to hepatitis C virus (HCV). This
retrospective analysis intend to evaluate the HCV testing routine, HCV testing frequency, HCVARN detection, treatment performed and outcome, as well as HIV and hepatitis B virus (HBV)
and OST use (opioid substitution treatment).
Results: From 288 individual records (median age 45 years; 19-69), 82,6% male, the authors
found 142 HCV positive, 91 HCV negative and 55 without information. HIV was positive in 33
cases and in 43 this status was unknown (15,2%); HBsAg was positive in 2,4%. In those HCV
negative, 36 (39,5%) were tested during the last year, but 16(17,5%) and 12(13,1%) were
tested 3 or 4 years ago, respectively, and 27(29,6%) were tested more than 5 years ago. In
those HCV positive, 58 were treated locally, but in 9 there is missing data; 42 were treated in
other institutions and 42 have not been treated. From this last group, HCV RNA was positive in
17, negative in 21 and unknown in 4. In those who were treated, genotype was available in 40,
with the following distribution: GT1a (35%), GT1b (17,5%), G2a/c (2,5%) and GT3a (45%);
before 2015, 12 individuals were treated with PEGIFN+RBV (PR) and after 2015, 34 were
treated with DAAs+PEGIFN (SOF/LDV-44,1%). SVR was 83,3% e 88,2% with PR and DAAs
respectively. There were 4 relapses in this last group and one confirmed reinfection. From the
total of patients 48,4% were under OST (methadone and buprenorphine) and that one who
was reinfected was under methadone.
Conclusions: In this preliminary sample the HCV prevalence was 49,3%. Although most of them
have been treated, 11,9% remain with active hepatitis C. HIV and HBV prevalence was 13,4%
and 2,4%. Testing was not performed routinely and this information was not always included
in the registers; moreover in 60,2% screening has not been repeated for more than two years.
Authors identified some gaps that need to be addressed, therefore testing and treatment rates
need to increase to achieve HCV elimination.

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