Abstract：
Screening strategies for undiagnosed infections are fundamental for hepatitis C virus (HCV) elimination. We previously investigated HCV prevalence and screening strategies in an urban primary care setting. IV drug abuse, blood transfusion before 1992, immigration, or elevated ALT were identified as risk factors in a post hoc analysis and diagnosed 83% of unknown HCV-RNA-positive cases by screening only 26% of the population. We aimed to validate prospectively the proposed screening algorithm in two independent urban and rural cohorts and to analyse for potential differences.
Anti-HCV and ALT were included in a routine check-up together with a questionnaire covering risk factors. HCV-RNA was analysed in anti-HCV-positive individuals.
In urban and rural areas, 4323 and 9321 individuals were recruited. The anti-HCV prevalence was 0.56% and 0.49%, and 0.1% of patients were HCV-RNA-positive in both regions. Fifty-two anti-HCV positive patients including eight HCV-RNA-positive cases were unaware of the infection (number needed to screen to detect one unknown anti-HCV-positive individual: 262). At least one of the three aforementioned risk factors or elevated serum ALT was present in 3000 patients (22%). Restricting HCV screening to only those with risk factors, 52% and 75% of all anti-HCV and HCV-RNA-positive undiagnosed patients were identified (number needed to screen: 111).
We confirm prospectively the efficiency of a risk-based HCV screening. The risk-based algorithm should be evaluated in other countries with similarly low HCV prevalence as in Germany to achieve WHO HCV elimination goals.
Anti-HCV and ALT were included in a routine check-up together with a questionnaire covering risk factors. HCV-RNA was analysed in anti-HCV-positive individuals.
In urban and rural areas, 4323 and 9321 individuals were recruited. The anti-HCV prevalence was 0.56% and 0.49%, and 0.1% of patients were HCV-RNA-positive in both regions. Fifty-two anti-HCV positive patients including eight HCV-RNA-positive cases were unaware of the infection (number needed to screen to detect one unknown anti-HCV-positive individual: 262). At least one of the three aforementioned risk factors or elevated serum ALT was present in 3000 patients (22%). Restricting HCV screening to only those with risk factors, 52% and 75% of all anti-HCV and HCV-RNA-positive undiagnosed patients were identified (number needed to screen: 111).
We confirm prospectively the efficiency of a risk-based HCV screening. The risk-based algorithm should be evaluated in other countries with similarly low HCV prevalence as in Germany to achieve WHO HCV elimination goals.
摘要：
目的：未确诊感染的筛查策略是消除丙型肝炎病毒（HCV）的基础。我们先前调查了城市初级保健环境中的HCV患病率和筛查策略。IV药物滥用，1992年之前的输血，移民，或ALT升高在事后分析中被确定为危险因素,通过筛查仅26%的人群,确诊了83%的未知HCV-RNA阳性病例.我们旨在在两个独立的城市和农村队列中前瞻性地验证所提出的筛选算法，并分析潜在的差异。
方法：常规检查包括抗HCV和ALT以及涵盖风险因素的问卷。在抗HCV阳性个体中分析HCV-RNA。
结果：在城市和农村地区，招募了4323人和9321人。抗-HCV患病率分别为0.56%和0.49%,0.1%的患者在两个地区均为HCV-RNA阳性。包括8例HCV-RNA阳性病例在内的52例抗HCV阳性患者未意识到感染（需要筛选以检测一名未知的抗HCV阳性个体的人数：262）。在3000名患者中存在上述三个危险因素中的至少一个或升高的血清ALT(22%)。限制HCV筛查仅适用于有危险因素的人群，所有抗-HCV和HCV-RNA阳性的未诊断的患者中有52%和75%被鉴定(需要筛选的人数:111)。
结论：我们前瞻性地确认了基于风险的HCV筛查的有效性。应在与德国相似的低HCV流行率的其他国家评估基于风险的算法，以实现WHOHCV消除目标。
方法：常规检查包括抗HCV和ALT以及涵盖风险因素的问卷。在抗HCV阳性个体中分析HCV-RNA。
结果：在城市和农村地区，招募了4323人和9321人。抗-HCV患病率分别为0.56%和0.49%,0.1%的患者在两个地区均为HCV-RNA阳性。包括8例HCV-RNA阳性病例在内的52例抗HCV阳性患者未意识到感染（需要筛选以检测一名未知的抗HCV阳性个体的人数：262）。在3000名患者中存在上述三个危险因素中的至少一个或升高的血清ALT(22%)。限制HCV筛查仅适用于有危险因素的人群，所有抗-HCV和HCV-RNA阳性的未诊断的患者中有52%和75%被鉴定(需要筛选的人数:111)。
结论：我们前瞻性地确认了基于风险的HCV筛查的有效性。应在与德国相似的低HCV流行率的其他国家评估基于风险的算法，以实现WHOHCV消除目标。
