Chronic hepatitis C – a serious public health problem. Experience from eastern Slovakia

Introduction
Chronic viral hepatitides B and C (CVH-B/CVH-C) are serious medical, public health, social and economic problems globally. In Slovakia chronic liver diseases are the fifth most common cause of death in overall, and third in people of productive age. The European Association for the Study of the Liver rankes Slovakia as the country with the fourth-highest liver diseases mortality, after Hungary, Romania and Slovenia.

Material and methods
Screening was conducted for the presence of antibodies to the hepatitis C virus (anti-HCV) in all patients who were sent to our outpatient department (Internal Clinic for Liver Disease Diagnosis and Treatment in Bardejov Spa, Remedium s.r.o.) for the purpose of differential diagnosis of liver diseases between 2010 and 2017. During that period, 3,518 new patients were sent to this clinic. In each patient an ultrasound examination of the abdominal organs and a complete differential diagnosis of liver diseases were performed. When positive antibodies to hepatitis C virus were detected, HCV-RNA was supplemented with the determination of the presence of ribonucleic acid of the hepatitis C virus and the genotype of the hepatitis C virus. A liver investigation was also conducted using transient elastography.

Results
Anti-HCV antibodies were found in 53 patients (1.5%). HCV-RNA was detected in 43 patients (1.2%). Of these, 42 (97.7%) were examined using Fibroscan. Heavier damage to the liver (F2-F4) was present in 27 of the 43 patients (62.7%). Before coming to our outpatient clinic 19 of these 27 (70.3%) had never been treated for CVH-C.

Conclusions
Chronic viral hepatitis C is currently the only chronic viral infection that can be cured. Therefore, a systematic search for patients with a slight change in liver function tests is warranted. Close interdisciplinary cooperation between general practitioners and specialists is necessary in identifying patients with CVH-C.