Territory-wide study on the clinical characteristics and treatment uptake of patients with chronic hepatitis C in public hospitals in Hong Kong

Abstract

Background: To study the clinical characteristics and treatment uptake of HCV infection in Hong Kong. Methods: From January 2005 to March 2017, patients who were tested positive for anti-HCV were retrospectively retrieved from all public hospitals. The epidemiological data of 15 participating hospitals were further analyzed. Results: A total of 12747 anti-HCV+ patients were identified. Among the 15 participating hospitals, there were 11309 anti-HCV+ cases, which accounted for 88.7% of the whole registry. Their median age was 59 years old (IQR 47 ––67, 47.2% ≥ 60 years), and 69% of them were male. Majority of them were Chinese (91.4%), followed by Pakistan (1.1%), Vietnamese (0.8%), Nepalese (0.5%), and Indian (0.4%). Genotypes were checked in 2397 patients, and the distribution were was genotype 1 (50.4%; 1b 95.7%, 1a 4.3%), genotype 6 (35.2%), genotype 3 (10.9%), and genotype 2 (3.4%). Other comorbidities included diabetes mellitus (23.6%), HBV co-infection (7.8%), severe renal impairment with eGFR< 30 ml/min/1.73 m 2 (7.1%), HIV co-infection (N = 158, 1.4%), hemophilia (N = 94, 0.8%), Cooley’s anemia and Hemoglobin H disease (N = 89, 0.8%). Organ transplantation were performed in 202 patients (kidney N = 118, 1.0%, liver N = 103, 0.9%, heart N = 1). The overall treatment uptake was 24.3% (N = 2201). Most of them had received PegInterferon / Ribavirin (N = 2061). The other antivirals used included Ombitasvir/ Paritaprevir/ Dasabuvir (N = 116), Boceprevir-based therapy (N = 54), Ledipasvir / Sofosbuvir (N = 37), Sofosbuvir-based therapy (N = 23), and Daclastavir/Asunaprevir (N = 7). Around 30.6% (N = 3456, annual all-cause mortality rate = 2.5%) of them were dead at the time of review, of which 26.0% were due to liver-related cause of death. The estimated number of untreated alive patients was 5224. Conclusion: Hepatitis C infection is not common in Hong Kong. However, more than a quarter of them will eventually die of liver-related complications. The treatment uptake remains suboptimal, and a more generalized use of direct-acting antivirals may help to improve the situation.