Abstract

INTRODUCTION: After the availability of the direct-acting antivirals (DAAs), success rate of the treatment of hepatitis C virus (HCV) infection has come close to 100%. However, several patients remain to be diagnosed and await well designed screening policies. Unfortunately, none of the countries have developed an ideal HCV screening program. In Turkey, most of the surgeons empirically perform hepatitis serology in patients before surgery. We aimed to determine the prevelance of anti-HCV and HCV RNA positivity in patients who were screened for hepatitis C before surgical precedures, to investigate the rate of the patients who are unaware of their illness. 

METHODS: Anti-HCV tests requested from all surgery clinics from 2012 to 2015 were reviewed and all positive patients were investigated whether they were HCV RNA positive, and if they have treated. Hospital records were screened for HCV RNA positivity. Medicine reports were reached in Medulla System (an integrated database from Social Security System) to collect the data of treatment. Untreated anti-HCV positive patients were called whether they were aware of being positive.

RESULTS: During 4 years 19627 patients were screened for anti-HCV positivity. 158 patients were found (0.8%) to be positivite (76 M, 82F; age 58.2± 17.6). HCV RNA was tested in 83 patients, in whom 36 were HCV RNA negative, 15 were positive and treatment-naive, 22 positive and treatment experienced or treated after detection. 10 were followed in other centers. Seventy-five patients had no HCV RNA assay. These patients were telephoned by two physicians (ND, MB) and asked whether they were aware of anti-HCV positivity. Of 58 patients who could be reached, only 14 knew that they were anti-HCV positive. Totally 18 patients (7 patients who were unaware of their positivity and 11 patients who had known their positivity but did not know HCV was a curable disease) were treated by DDAs. Three patients did not accept to be treated. All patients who were treated via DAAs achieved sustained virological response (SVR)12. 

CONCLUSION: Among 19627 patients undergoing surgical procedures, 0.8% were anti-HCV positive which is the same as general population in Turkey. HCV RNA negativity was higher among these patients, mostly due to previous hepatitis C treatment. Surprisingly, almost half of the patients were not tested for HCV RNA and most of the patients were not informed that they needed to be tested and followed for HCV RNA.Surgeons should be warned how important to detect new hepatitis C patients, beyond protecting themselves.