Territory‐wide population‐based study of chronic hepatitis C infection and implications for hepatitis elimination in Hong Kong

摘要

Abstract Background To study the epidemiology of chronic hepatitis C virus infection in Hong Kong and to estimate the service gap for achieving the WHO hepatitis elimination targets of attaining a diagnosis rate of 90%, treatment rate of 80% and 65% reduction in mortality rate by 2030. Methods From January 2005 to March 2017, patients who were tested positive for anti‐ HCV were retrospectively retrieved from all public hospitals in Hong Kong. The epidemiological data of 15 participating hospitals were analysed. Results A total of 11?309 anti‐ HCV + patients were identified and the estimated diagnosis rate was 50.9%. Our HCV ‐infected patients were ageing (median age 59). The all‐cause mortality rate increased from 26.2 to 54.8 per 1000 person‐years over the last decade. Our estimated treatment rate was 12.4%. Among the treated patients, 93.6% had received pegylated interferon/ribavirin (Peg‐ IFN / RBV ) but only 10.8% had received interferon‐free direct‐acting antivirals ( DAA s). In a cohort of 1533 patients, 39% already had advanced liver fibrosis or cirrhosis. The sustained virological response rate for Peg‐ IFN / RBV and DAA s were 74.8% and 97.2% respectively. However, more than 70% of patients were not subjected to interferon treatment for various reasons. Patients who achieved SVR were associated with a significantly lower risk of HCC (4.7% vs 9.6%, P? = ? 0.005) and death (1.7% vs 23.8%, P? ? 0.001). Conclusion Our diagnosis rate, treatment rate and mortality rate reduction were still low, particularly the Peg‐ IFN outcomes, making it difficult to meet the WHO hepatitis elimination targets. A more generalized use of DAA s is urgently needed to improve the situation.