The Need for Sistematic Monitoring and Improved Surveillance of Hepatitis C Patients in Croatia

Aim: The aim of this study was emphasizing the need for a more systematic monitoring of patients diagnosed with HCV in Croatia. Methods: From 2014 to 2018, at the University Hospital for Infectious Diseases, sera from 23,524 patients were tested for HCV. Confirmatory testing was performed by Western Blot. Adult patients with an anti-HCV positive screening test were analysed. HCV RNA was quantified by real-time PCR, while HCV genotypes and subtypes were determined by PCR and the reverse hybridization method. Results: A total of 428 anti-HCV ELISA-positive adults were analysed (68.7% males, 31.3% females, median age 43 years, range 19-88 years). Hepatitis C was confirmed by WB in 390, while 28 patients had borderline WB results. Anti-HCV was not confirmed by WB in 10 patients. HCV RNA was tested in 331 patients and viremia was detected in 218 patients. There was no data on HCV RNA in 97 patients (22.66%). HCV genotypes/subtypes were determined in 185 of 218 anti-HCV WB positive patients. Genotype 1 was detected in 97/185 (52.43%), genotype 2 was detected in 3/185 (1.62%), while subtype 3a was detected in 76/185 (41.08%) and genotype 4 in 9/185 patients (4.86%). Conclusion: In a five-year period, the HCV seroprevalence rate in subjects tested at the University Hospital for Infectious Diseases was 1.81%. According to the data analysed, almost one quarter of patients with detected anti-HCV antibodies were not treated further, which indicates the need for a systematic monitoring of patients diagnosed with HCV. It is necessary to determine viremia after a positive anti-HCV screening result in order to initiate treatment and prevent HCV-related complications.