key: cord-0740073-wy2wci90
authors: Torre, Pietro; Annunziata, Monica; Sciorio, Roberta; Coppola, Carmine; Masarone, Mario; Persico, Marcello
title: Hepatitis C screening during SARS‐CoV‐2 testing or vaccination. Experience in an area of southern Italy in the province of Salerno
date: 2022-04-23
journal: Liver Int
DOI: 10.1111/liv.15273
sha: 318e9149e1f9e24c57b14db5e7b84bd03c9b7e3a
doc_id: 740073
cord_uid: wy2wci90

nan

To the editor,

Nowadays hepatitis C can be cured in nearly all affected people by extremely effective and safe therapies, therefore the current challenges are case finding and access to treatment. The latest estimates by the WHO report 58 million hepatitis C cases around the world and about 1.5 million new infections per year. 1 Some experts believe that the Global Health Sector Strategy goal of eliminating viral hepatitis 'as a major public health threat' by 2030 1 is somewhat optimistic in relation to the current global situation. 2

The SARS-CoV-2 pandemic has hampered the hepatitis C testing and treatment, 3 and it is estimated that it could be a major obstacle to hepatitis C elimination. 3, 4 Among the efforts to counter this scenario, it was proposed to exploit the current pandemic to enhance hepatitis C screening. 5 The first experiences of combined HCV/SARS-CoV-2 testing have already been carried out, 6,7 while although it was proposed, 8 there are still no data on the combination of screening for hepatitis C and SARS-CoV-2 vaccination.

For these reasons, we started a screening program for hepatitis C simultaneously with the SARS-CoV-2 testing or vaccination. This project took place in an urban area in the province of Salerno (Campania region).

Screening for SARS-CoV-2 infection was performed at the USCA (1); four were women and three were men; 2/7 were of foreign nationality; 5/7 reported awareness of their status. Among these latter subjects, four had previous treatment with DAAs with a SVR rate of 100%, while one of them did not undergo any therapy. The other two people who tested positive for HCV-Ab were not aware of their positivity and they did not undergo any therapy. These last three subjects were referred to our Unit, and after checking the HCV RNA status and genotype [3a (2), 1a (1)] they began antiviral therapy with DAAs. The prevalence of active HCV infection found in this project was therefore 0.1%. The total cost of performing these adjunctive HCV testing was of 11100 euros overall or 3.7 euros per screened patient. Table 1 

This project confirms that screening for hepatitis C is possible during testing for SARS-CoV-2, and demonstrates that COVID-19 vaccination could be an opportunity for HCV-Ab testing. However, we registered a high refusal rate for hepatitis C screening during both testing or vaccination for SARS-CoV-2. By administering the informed consent, all the subjects were briefly informed about HCV infection and its therapeutic options and also asked to provide the explanation for refusal. The refusal rate was significantly lower (p < .0001, chi-square test) in people who received a COVID-19 vaccine than in those who were tested for SARS-CoV-2 RNA. The reasons for HCV-Ab test refusal were lack of knowledge of the disease (55%), fear of positive results (40%), and distrust of the health system (5%). Another aspect to consider is that the prevalence of HCV-Ab positivity was found to be lower compared to that reported in the Italian general population (~2%, with a higher prevalence in southern regions compared to northern ones based on historical data). 7, 9 This could be partly explained by data reporting that in Italy the prevalence of HCV infection increases with age (a peak of 7% of HCV-Ab positive people was documented in the 1935-1944 age group), 10 and as the elders represented a minority of the people involved in our project, probably because they had already been vaccinated for SARS-CoV-2 at the time this project took place. On the other hand, we cannot exclude that those results may be also partially influenced by a 'selection bias', being those with mistrust in the health system 'self-selecting' themselves out of the screening by not performing it. These aspects lead us to question the cost/benefit ratio of hepatitis C screening during current SARS-CoV-2 testing or vaccination programs.

combined screening, COVID-19 vaccination, hepatitis C, SARS-CoV-2 

There is no financial support to be declared for this study.

Progress towards elimination goals for viral hepatitis

Assessing the impact of COVID-19 on the management of patients with liver diseases: a national survey by the Italian association for the study of the liver. Dig Liver Dis

Impact of COVID-19 on global HCV elimination efforts

SARS-CoV-2 massive testing: a window of opportunity to catch up with HCV elimination

Associated screening for HCV and SARS-Cov2 infection in an urban area of Southern Italy: a cohort study

Detecting HCV infection by means of mass population SARS-CoV-2 screening: a pilot experience in northern Italy

HCV detection is possible during SARS CoV-2 testing; and throughout COVID-19 vaccination?

Global epidemiology and genotype distribution of the hepatitis C virus infection

Declining prevalence and increasing awareness of HCV infection in Italy: a populationbased survey in five metropolitan areas