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Thématique :
- Foie
Originalité :
Intermédiaire
Solidité :
Très solide
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Professeur Christine SILVAIN
Coup de coeur :
 
 
Hepatology
  2015/11  
 
  2015 Nov;62(5):1388-95  
  doi: 10.1002/hep.28018  
 
  High priority for hepatitis C screening in safety net hospitals: Results from a prospective cohort of 4582 hospitalized baby boomers  
 
  Turner BJ, Taylor BS, Hanson J, Liang Y, Veerapaneni P, Villarreal R, Perez M, Hernandez L, Sandhu J, Fiebelkorn K  
  http://www.ncbi.nlm.nih.gov/pubmed/?term=High+priority+for+hepatitis+C+screening+in+safety+net+hospitals%3A+Results+from+a+prospective+cohort+of+4582+hospitalized+baby+boomers  
 
 

Low-income populations are disproportionately affected by hepatitis C virus (HCV) infection. Thus, implementing baby boomer screening (born 1945-1965) for HCV may be a high priority for safety net hospitals. We report the prevalence and predictors of HCV infection and advanced fibrosis or cirrhosis based on the Fibrosis-4 score plus imaging for a baby boomer cohort admitted to a safety net hospital over a 21-month interval with >9 months of follow-up. Anti-HCV antibody testing was performed for 4582, or 90%, of all never-screened patients, of whom 312 (6.7%) tested positive. Adjusted odds ratios of testing anti-HCV-positive were 2.66 for men versus women (P < 0.001), 1.25 for uninsured versus insured (P = 0.06), 0.70 for Hispanics versus non-Hispanic whites (P = 0.005), and 0.93 per year of age (P < 0.001). Among 287 patients tested for HCV RNA (91% of all anti-HCV-positive cases), 175 (61%) were viremic (3.8% overall prevalence in cohort), which was 5% less likely per year of age (P < 0.03). Noninvasive staging of 148 (84.6%) chronic HCV patients identified advanced fibrosis or cirrhosis in 50 (33.8%), with higher adjusted odds ratios of 3.21 for Hispanics versus non-Hispanic whites/Asians (P = 0.02) and 1.18 per year of age (P = 0.001). Other factors associated with significantly higher adjusted odds ratios of advanced fibrosis or cirrhosis were alcohol abuse/dependence, obesity, and being uninsured.

CONCLUSION:

In this low-income, hospitalized cohort, 4% of 4582 screened baby boomers were diagnosed with chronic HCV, nearly twice the rate in the community; one-third had noninvasive testing that indicated advanced fibrosis or cirrhosis, which was significantly more likely for Hispanics, those of older age, those with obesity, those with alcohol abuse/dependence, and those who lacked insurance. (Hepatology 2015;62:1388-1395).

 
Question posée
 
Quelle est la prévalence de l’hépatite virale C chez les sujets américains baby boomers, précaires, hospitalisés ?
 
Question posée
 
La prévalence est de 4% soit 2 fois plus importante et 30% d’entre eux ont une fibrose sévère avec les facteurs de risque habituels : alcool, obésité et en plus absence d’assurance santé et d’origine hispanique.
 
Commentaires

Ces résultats sont parallèles à ceux trouvés en France avec un risque multiplié par 2,5 d’infection VHC chez les sujets CMU-C.

 
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