世界各地的临床肝病中心提供的 HBV 或 HCV 检测数量大幅减少

StephenW

AASLD，肝脏会议，2021 年 11 月 12-15 日马克·马斯科利尼根据在各国 37 个中心的基于网络的调查结果，当 COVID-19 大流行到来时，世界各地的临床肝病中心提供的 HBV 或 HCV 检测数量大幅减少，完成的肝炎病毒咨询也减少了，开始接受 HBV 或 HCV 治疗的人数也减少了在五大洲[1]。除 1 个中心外，所有中心都报告说开始照顾 COVID-19 患者。巴塞罗那瓦勒希伯伦大学综合医院的研究人员和欧洲各地的合作者指出，当 COVID-19 大流行来袭时，全世界很少有国家有望实现 2030 年消除 HCV 的目标——例如，欧洲只有 8 个国家。冠状病毒风暴显然挑战了世界各地的临床资源，并削弱了照顾 HBV 和 HCV 感染者的能力。数学模型估计了 COVID 对消除 HCV 的影响，表明到 2030 年，HCV 感染的诊断和治疗延迟 1 年可能会在全球增加 44,800 例肝癌病例和 72,300 例死亡。但几乎没有真实世界的数据可以解决大流行对 HBV 的影响和 HCV 护理。为了填补这一数据空白，一组欧洲肝炎研究人员创建了一项调查，比较了欧洲和全球 2019 年（COVID-19 之前）与 2020 年（大流行期间）个人实践中的肝炎护理参数。他们将这项基于互联网的调查发送给 EASL 成员、肝炎专家和大型临床中心。该调查有 10 个项目，包括护理人口规模和 COVID-19 对病毒性肝炎门诊总人数的影响； HBV 和 HCV 的新转诊；乙型肝炎表面抗原 (HBsAg)、HBV DNA 和 HCV RNA 检测；以及开始接受 HBV 和 HCV 治疗的人数。调查分发于 2021 年 5 月开始，一直持续到今天。该报告分析了截至 2021 年 7 月的结果。到目前为止，研究人员分析了来自 37 个中心的响应，包括 36 家医院和 1 个社区中心、20 个欧洲中心和 17 个世界其他地区（包括加拿大、中南美洲、埃及、中亚和东南亚以及日本）。在这 37 个中心中，31 个提供了完全答复，6 个提供了部分答复。除了 1 个中心之外，所有中心都开始照顾 COVID-19 患者。HBV 门诊总人数从 2019 年的 42,595 人下降到 2020 年的 29,629 人，下降了 30%（P < 0.001）。新的 HBV 转诊人数从 6682 人下降到 4066 人（P < 0.001），下降了 39%。 37 个中心中有 28 个 (76%) 报告 HBV 门诊人数下降，27 个中心 (73%) 的新转诊人数出现下滑。在 36 个中心，HCV 门诊总人数从 2019 年的 28,202 次下降到 2020 年的 15,589 次（P < 0.001），下降了 45%。新转诊 HCV 的人数从 4741 人下降了一半至 2432 人（P < 0.001）。 2020 年，36 个中心中有 30 个（83%）的 HCV 门诊人数少于 2019 年，28 个中心（78%）的 HCV 转诊人数减少。34 个中心的 HBsAg 检测数量从 2019 年的 229,971 次下降到 2020 年的 140,568 次（P = 0.006），而订购的 HBV DNA 检测数量下降了 24%，从 23,743 次下降到 18,047 次（P < 0.1）。这 34 个中心中有 17 个 (50%) 的 HBsAg 检测较少，17 个中心的 HBV DNA 检测较少。31 个中心的 HCV RNA 检测数量出现了适度但具有统计学意义的下降，从 COVID 之前的 57,161 次减少到 COVID 期间的 54,997 次（P = 0.003），减少了 4%。这 31 个中心中有 20 个 (64.5%) 订购了较少的 HCV RNA 检测。在 34 个中心，开始 HBV 治疗的人数从 2019 年的 3526 人下降到 2020 年的 2279 人（P = 0.001），下降了 35%。这 34 个中心中有 19 个 (56%) 开始接受抗 HBV 治疗的人数较少。在 34 个中心，开始抗 HCV 治疗的人数从 COVID 之前的 3566 人下降到 COVID 期间的 1811 人（P < 0.001）。在大流行到来后，这 34 个中心中有 26 个（76%）开始治疗较少的 HCV 感染患者。在世界卫生组织 (WHO) 欧洲地区的 21 个中心，HBV 门诊就诊人数从 2019 年的 24,326 人下降至 2020 年的 16,071 人（P = 0.002），下降了 34%，而新的 HBV 转诊人数从 1677 人大幅下滑至 1026 人（P < 0.001）。在 COVID-19 到来后，这 21 个欧洲中心中有 18 个（86%）出现了 HBV 门诊咨询和新转诊的下滑。世卫组织欧洲地区的 20 个中心报告，HCV 门诊总人数下降了 42%，从 2019 年的 18,280 人下降到 2020 年的 10,585 人（P = 0.004）。新的 HCV 转诊人数从 2742 人下降到 1398 人（P < 0.001）。在这 20 个中心中，16 个 (80%) 的 HCV 门诊咨询量下降，19 个 (90%) 的新 HCV 转诊量下降。

在世卫组织欧洲地区的 18 个中心，开始抗 HBV 治疗的人数从 COVID 前的 1063 人几乎显着下降到 COVID 期间的 879 人，下降了 17%（P = 0.055）。 这 18 个中心中有 14 个（78%）在 2020 年开始抗 HBV 治疗的人数少于 2019 年。 在 20 个欧洲中心，开始抗 HCV 治疗的人数从 2019 年的 2456 人下降到 2020 年的 1287 人，几乎减少了一半 (P < 0.001)。 这 20 个中心中有 19 个 (95%) 开始治疗较少的 HCV 患者。
研究人员得出的结论是，“COVID-19 大流行影响了全球肝炎检测和治疗服务，使消除工作进一步落后。” 他们继续收集有关这些参数的数据。

StephenW

COVID Takes Big Bite Out of HBV/HCV Care in 37-Center Global Study

AASLD, The Liver Meeting, November 12-15, 2021

Mark Mascolini

When the COVID-19 pandemic arrived, clinical hepatology centers worldwide offered substantially fewer HBV or HCV tests, completed fewer hepatitis virus consultations, and started fewer people on HBV or HCV therapy, according to  results of a 37-center Web-based survey in countries on 5 continents [1]. All but 1 center reported starting caring for people with COVID-19.

Researchers from Barcelona’s Hospital General Universitari Valle Hebron and collaborators across Europe noted that few countries worldwide were on track to meet 2030 HCV elimination goals—only 8 countries in Europe, for example—when the COVID-19 pandemic struck. The coronavirus firestorm clearly challenged clinical resources across the world and diminished capabilities to care for people with HBV and HCV infection.

Mathematical models have estimated COVID’s impact on HCV elimination, suggesting that a 1-year delay in diagnosing and treating HCV infection could add 44,800 liver cancer cases and 72,300 deaths worldwide by 2030. But little real-world data address the impact of the pandemic on HBV and HCV care.

To fill that data gap, a team of European hepatitis researchers created a survey that compared hepatitis care parameters in individual practices in 2019 (before COVID-19) versus 2020 (during the pandemic) in Europe and across the globe. They sent this Internet-based survey to EASL members, hepatitis experts, and large clinical centers. The survey has 10 items, including the size of the population in care and the impact of COVID-19 on total viral hepatitis outpatient consultations; new referrals for HBV and HCV; testing for hepatitis B surface antigen (HBsAg), HBV DNA, and HCV RNA; and numbers of people who started therapy for HBV and HCV. Survey distribution began in May 2021 and continues today. This report analyzed results through July 2021.

So far the researchers have analyzed responses from 37 centers, including 36 hospitals and 1 community center, 20 European centers and 17 in other parts of the world (including Canada, Central and South America, Egypt, Central and Southeast Asia, and Japan). Of these 37 centers, 31 provided complete responses and 6 gave partial responses. All but 1 of these centers started caring for people with COVID-19.

Overall number of outpatient HBV consultations sank 30% from 42,595 in 2019 to 29,629 in 2020 (P < 0.001). New HBV referrals dropped 39% from 6682 to 4066 (P < 0.001). Twenty-eight of 37 centers (76%) reported falling numbers of HBV outpatients, and 27 centers (73%) saw slippage in new referrals.

At 36 centers overall number of HCV outpatient consultations plunged 45% from 28,202 in 2019 to 15,589 in 2020 (P < 0.001). Number of new HCV referrals fell by half from 4741 to 2432 (P < 0.001). Thirty of 36 centers (83%) saw fewer HCV outpatients in 2020 than in 2019, and 28 centers (78%) had fewer HCV referrals.

Thirty-four centers saw the number of HBsAg tests slip 39% from 229,971 in 2019 to 140,568 in 2020 (P = 0.006), while the number of HBV DNA assays ordered fell 24% from 23,743 to 18,047 (P < 0.001). Seventeen of these 34 centers (50%) got fewer HBsAg tests and 17 got fewer HBV DNA assays.

Thirty-one centers saw a modest but statistically significant dip in number of HCV RNA assays, a 4% dwindling from 57,161 before COVID to 54,997 during COVID (P = 0.003). Twenty of these 31 centers (64.5%) ordered fewer HCV RNA tests.

At 34 centers the number of people who started HBV therapy sank 35% from 3526 in 2019 to 2279 in 2020 (P = 0.001). Nineteen of these 34 centers (56%) started fewer people on anti-HBV treatment. At 34 centers the number of people starting anti-HCV therapy fell by half from 3566 before COVID to 1811 during COVID (P < 0.001). Twenty-six of these 34 centers (76%) started treating fewer people for HCV infection after the pandemic arrived.

At 21 centers in the World Health Organization (WHO) European region, HBV outpatient consultations sank 34% from 24,326 in 2019 to 16,071 in 2020 (P = 0.002), while new HBV referrals slipped significantly from 1677 to 1026 (P < 0.001). Eighteen of these 21 European centers (86%) saw HBV outpatient consultations and new referrals slide after COVID-19 arrived.

Twenty centers in the WHO European region reported a 42% fall in overall HCV outpatient consultations, from 18,280 in 2019 to 10,585 in 2020 (P = 0.004). New HCV referrals fell by half from 2742 to 1398 (P < 0.001). Of these 20 centers, 16 (80%) saw a decline in HCV outpatient consultations and 19 (90%) had a drop in new HCV referrals.
At 18 centers in the WHO European region, the number of people who started anti-HBV therapy fell nearly significantly from 1063 pre-COVID to 879 during COVID, a 17% slip (P = 0.055). Fourteen of these 18 centers (78%) started anti-HBV therapy in fewer people in 2020 than in 2019. At 20 European centers, the number of people who started anti-HCV therapy fell by almost half from 2456 in 2019 to 1287 in 2020 (P < 0.001). Nineteen of these 20 centers (95%) started treating fewer people for HCV.

The researchers concluded that “the COVID-19 pandemic has affected hepatitis testing and treatment services globally, putting elimination efforts further behind.” They continue to collect data on these parameters.