Late presentation of chronic hepatitis C patients in the era of direct acting antivirals - Data from the German Hepatitis C-Registry.

Bischoff, Jenny; Mauss, Stefan; Lutz, Thomas; Cordes, Christiane; Klausen, Gerd; Scholten, Stefan; Hillenbrand, Heribert; Cornberg, Markus; Baumgarten, Axel; Rockstroh, Jürgen K

Late presentation for care in chronic viral hepatitis has been estimated to occur in approximately 25% of patients initiating treatment with direct acting antivirals. We evaluated the extent of late presentation since the implementation of direct acting antivirals and established differences between HCV monoinfected and HIV/HCV coinfected patients. The German Hepatitis C Registry is a multicenter non-interventional registry study. We analysed patients enrolled between 02/2014 and 12/2018. Advanced liver disease was defined as an aspartate aminotransferase to platelet-ratio-index score ≥ 1.5, a FibroScan ≥ 9.5 kPa or a METAVIR stage ≥ F3. HCV monoinfected and HIV/HCV coinfected patients were analysed separately and baseline characteristics of both subgroups were compared. 8003 treatment naive patients were analysed. Overall, 2197/8003 (28%) patients presented late for care (HCV monoinfection: 2067/7452 (28%); HIV/HCV coinfection: 130/551 (24%)). Late presentation decreased comparing the year 2014 to the years 2015 (p≤0.001), 2017 (p≤0.001) and 2018 (p≤0.001) and was significantly lower in 2018 in HIV/HCV coinfected patients compared to HCV monoinfected patients (HIV/HCV: 15/89 (17%) vs. 415/1566 (27%); p=0.047). We observed a significant decrease of late presentation from 2014 to 2018. Despite the decrease during the observation period, approximately one in four patients continued to be affected in 2018, with a lower proportion of late presentation being seen in patients coinfected with HIV/HCV. This trend might indicate effects of a closer linkage to care and a more frequent detection of acute HCV infections of HIV+ patients.