Surveillance of HCV in Uremics and Linking to Medical Care
Surveillance of HCV in Uremics and Linking to Medical Care
HCV remains to prevail in the uremic patients under hemodialysis. The comprehensive
 surveillance in the risk population facilitates the link to care for HCV eradication.
1. Taiwan has the leading prevalence and incidence of end-stage renal disease (ESRD)
 worldwide. Uremic patients on maintenance hemodialysis (HD) are at great risk for
 hepatitis C virus (HCV) infection. The prevalence and annual incidence of HCV infection
 in ESRD patients undergoing hemodialysis have been reported to be 10%-59% and 0.2%-6.2%,
 respectively.

 2. HCV-related morbidities and mortality remain the major disease burden in the ESRD
 population. Uremic patients with HCV infection are associated with higher risk of excess
 risk of cardiovascular disease, hospitalization, worse quality of life, and mortality,
 and have more profound anemia compared to those without HCV infection..

 3. Imperatively, uremic patients remain at high risk of HCV new- or re-infection in the
 hemodialysis units.

 4. The investigators have performed a surveillance for prevalence of viral hepatitis in a
 collaborative group of Nephrologists and Hepatologists, the FORMOSA-LIKE group, which
 showed that the proportion of anti-HCV seropositivity in uremic patients is 15-19 % with
 the viremic rate of ~75% in Southern Taiwan in 2012. However, the update seroprevalence
 and disease severity of HCV infection among the uremic patients in the era of DAA in
 Taiwan is unknown. The current study aims to fully execute the surveillance program
 among the uremic population

 5. Participants with HCV infection will be directly linked to medical care without gap. The
 concept of micro-elimination in the high risk environment would help to facilitate WHO
 goal of HCV elimination by 2030.

 6. Understanding the potential drug-drug interaction (DDI) between directly acting
 antivirals (DAA) and co-medications for co-morbidities among uremic patients under
 maintenance hemodialysis would be helpful for decision-making when linking to care.

 7. Comprehensive surveillance and link-to-care among hemodialysis units might have great
 impact on the improvement of both liver-related (biochemical and virological responses,
 and hepatic fibrosis regression) and non-liver related outcomes (monthly erythropoietin
 requirement and quality of life), and the transfer rate of clean zoning among
 HCV-viremic patients.

 All uremic participants will be tested for anti-HCV antibody. HCV virology including viral
 loads (and genotypes if RNA seropositivity) will be further tested in patients with anti-HCV
 seropositivity. All infected subjects will be evaluated for the liver fibrosis by
 non-invasive methods including fibroscan, FIB-4 and APRI and Serum WFA(+) -M2BP. All
 participants with chronic hepatitis C infection will be directly referred to the
 collaborative Hepatology Departments in one medical center and 5 regional core hospitals for
 HCV treatment. The outcome of HCV-related diseases, in terms of proportion of HCV
 micro-elimination in HD facilities, liver-related outcomes (biochemistry improvement [ ALT
 and AFP decline], sustained virological response rate, and hepatic fibrosis regression) and
 non-liver related outcomes [monthly erythropoietin requirement, and quality of life [SF36,
 HCV-CLDQ] ) will be evaluated 2 years after executing link-to-care strategy.

 Year 1: Universal screen, confirmative determination of HCV viremia, genotyping and disease
 staging, education and link-to-care for HCV treatment in FORMOSA-LIKE collaborative alliances
 Year 2,3: Re-evaluate liver and non-liver related outcomes, and rate of HCV clean zoning
 among hemodialysis units.
Inclusion Criteria:

 all uremic patients and medical staffs in the hemodialysis centers

 Exclusion Criteria:

 -  patients who refuse consents