Hepatitis C: more attention to risk factors improve the dépistage4

The main obstacle to testing for hepatitis C is the lack of identification of risk factors by the physician, according to a study published Monday in the Weekly Epidemiological Bulletin (BEH).
"Despite campaigns promoting screening for hepatitis C virus (HCV) infection with HCV is still underdiagnosed and its clinical and therapeutic suboptimal care," recalls Michelle Bentata, the Panel ' study and research-hospital (Gervih) in Paris, and colleagues.

The researchers conducted a multicenter prospective observational study in early December 2002 in 11 city-hospital networks specializing in the management of HIV and its related diseases, to understand the barriers to screening for hepatitis C.

The study involved 101 physicians (80 general hospitals and 21) and 4935 patients aged 45 years on average.
A steering committee has 13 predefined risk factors for HCV infection. The five major risk factors were transfusion before 1992, hemophilia, chronic hemodialysis, the use of intravenous drugs and HIV infection.

The minor risk factors were the tattoo or piercing, intranasal drug use, history of incarceration, medical care in developing countries or endoscopy, colonoscopy and laparoscopy, the existence of a partner sexual HCV infected or close family member infected with HCV and membership in a health profession.

In 2001, the National Agency for Accreditation and Evaluation in Health (Anaes), became the High Authority for Health (HAS) - issued recommendations for screening for hepatitis C, which in particular does not include the use of drugs sniffed, endoscopic instruments or membership in a health profession as a risk factor, say the authors.

At least one of the risk factors predefined by the steering committee of the study was present in 85.8% of patients, at least one major in 36% of patients and at least a minor in 64% of patients.

Only 38.6% of patients with at least one risk factor were tested for HCV, the proportion climbing to 68.4% considering only the five major risk factors and 93.6% taking into account only patients infected with HIV.

RECOGNITION OF RISK BY DOCTORS IS INSUFFICIENT

The main reason for the lack of screening for hepatitis C in patients with at least one risk factor, found in 70.6% of cases, is that the practitioner has not identified risk factor in patient But then he knows.

In a multivariate analysis, the recognition of risk by the doctor is 16.5 times greater when the subject is infected with HIV, 5.8 times higher when the subject is a drug addict and administering intravenous drugs, 4 , 1 times greater when the subject is a drug addict and using a means other than intravenously, 2.7 times higher when the subject was on hemodialysis and less than 2 times higher for all other predefined risk factors , knowing that the patient has pierced ears is not recognized as a risk by the practitioner.

HCV infection was found in 28% of patients screened. Some 47.9% of patients infected with HCV were also HIV. Among patients with at least one of the five major risk factors, 37.5% were infected with HCV, while only 5.5% were patients with at least one of the eight minor risk factors and 0.3% of patients with no known risk factor. Finally, none of the tested patients whose sole risk factor for pierced ears was infected with HCV.

"Concerted efforts must be made to improve the recognition of risk factors for HCV infection and the doctor-patient relationship," the authors conclude.