Late Presentation of Chronic Hepatitis C in a Swiss Cohort of People on Opioid Agonist Therapy

Author: Alberto Moriggia Andrea Bregenzer Philip Bruggmann Erika Castro Pascale Della Santa Katharina Hensel-Koch Christine Thurnheer Claude Scheidegger

Theme: Clinical Research Year: 2022

HCV Late Presenters (LP) are individuals HCV diagnosed at an already advanced stage of liver
disease. Their number in a certain population could be an indicator of progress in hepatitis care and
HCV elimination.

This study was conducted in the SAMMSU cohort enrolling patients on opioid agonist therapy (OAT)
in Switzerland. HCV late presentation was defined as having an advanced liver disease stage (≥F3,
liver stiffness >9.5kPa on elastography) at the HCV first diagnosis. We considered the time period
from 2017 onwards, when access to Direct-acting antiviral (DAA) treatment in Switzerland became

Of 59 patients with HCV first diagnosis between 2017 and 2021, nobody was HIV-co-infected and 40
(68%) had chronic hepatitis C. Among the 34 patients with known fibrosis stage, 21 (62%) had
no/mild fibrosis (F0/F1), while 6 (18%) were considered LP (one F3/five F4). More than two-thirds of
newly diagnosed patients (40) had never been HCV-tested before. Among those tested before, the
last negative test was >1 year ago in 58% (11) and >2 years ago in 42% (8). 16 patients were
diagnosed with an HCV-antibody rapid test with capillary blood (15) or saliva (1). The median time
between first intravenous drug use (which is a proxy for the time of HCV infection) and HCV first
diagnosis was 16 (IQR: 5-26) years (n=44), with only 27% diagnosed during the first 5 years. Once
diagnosed, patients were promptly and successfully treated (treatment uptake 83% (33/40), SVR
100% (30/30)).

In our cohort of OAT patients, one in five newly diagnosed chronic hepatitis C patients was a late
presenter, highlighting insufficient HCV screening despite clear guidelines and unrestricted DAA
access. Lack of diagnosis is still a main barrier to HCV elimination and needs to be addressed.
However, once diagnosed, the time to cure has become short.

Disclosure of Interest Statement:
Researchers have received funding from the Swiss Federal Office of Public Health. No pharmaceutical
grants were received in the development of this study.

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