oa Early detection and treatment of chronic hepatitis C in a community-based setting in Doha, Qatar: A dynamic preventive model

Background: Detecting early infection of chronic hepatitis C (CHC) can prevent late-stage complications including the need for transplant and death. However, screening hepatitis C virus for early detection of the disease has not been found to be beneficial in average risk individuals according to US Food and Drug Administration guidelines. Objectives: The primary aim of this study was to detect infection with hepatitis C antibodies using a rapid immunochromatographic assay in a community setting. The secondary aims included assessment of prevalence rate, disease characteristics and response to the standard treatment. Methods: A screening survey of 13,704 people (0.9% of the population) was conducted from December 2008 through July 2010. It was carried out in three phases involving 4000, 3212 and 6492 average and high risk people. Hepatitis C antibodies were detected using a colloidal gold enhanced rapid immunochromatographic assay. The diagnosis of CHC was confirmed by measuring the viral load using highly sensitive molecular assays. All patients that were detected as having at least stage 1 disease on the liver biopsy were offered standard treatment with pegylated interferon and ribavirin. The complete cost of investigation and treatment was either state funded or supported through governmental charities. Results: 272 (2%) people were detected to have antibodies against hepatitis C virus. 148 subjects (62%) consented for further confirmation of the disease by molecular assays. 69 subjects (70%) agreed to be treated of which 18 were finally excluded due to detection of minimal disease (stage zero) on the liver biopsy. Overall, 78% of patients were detected as having mild disease (stage 1-2) on histology. Of the 51 actually treated with dual antiviral therapy, 37 (72.4%) responded to the treatment and achieved a sustained viral response (SVR). The response rate was found to be superior to the standard of care at present. The screening strategy resulted in six times better the response rate (odds ratio 6.4, p-value 0.002, 95% CI 2.0-20.5). Conclusion: Hepatitis C was detected in 2% of the population using this novel method. A dynamic model (screening) resulted in detection of mild disease with a consequently higher response rate compared to the standard of care.