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COVID Takes Big Bite Out of HBV/HCV
Care in 37-Center Global Study
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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.
Reference
1. Buti M, Maticic M, Negro F, et al. COVID-19 impact on viral hepatitis B and C elimination: preliminary results in 31 centres worldwide. AASLD, The Liver Meeting, November 12-15, 2021. Parallel session 4: COVID-19 Clinical.
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