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Published on: February 25, 2022
Prevalence of Hepatitis C Virus Infection in the Veteran Population Undergoing Total Joint Arthroplasty: An Update
Cdr Bennett H Shapiro1, Ramsey C Cheung2, Nicholas J Giori3
1Department of Orthopaedic Surgery, Stanford Hospital and Clinics, Redwood City, CA and Navy Education and Training Command.
Insights
Hepatitis C virus (HCV) viremia in Veterans Affairs patients undergoing total joint arthroplasty (TJA) significantly decreased from 4.5% to 0.4% following the introduction of direct-acting antiviral treatments. This highlights the success of HCV eradication programs in the veteran population.
Area of Science:
- Hepatology
- Infectious Diseases
- Orthopedic Surgery
Background:
- In 2012, hepatitis C virus (HCV) infection prevalence in Veterans Affairs (VA) patients undergoing total joint arthroplasty (TJA) was 8.4% antibody positive and 4.5% viremic.
- The introduction of all-oral direct-acting antiviral (DAA) treatments in 2014 prompted an aggressive VA program to eliminate HCV in veterans.
Purpose of the Study:
- To update the prevalence of HCV viremia in patients undergoing primary TJA at a specific VA center.
- To compare current HCV viremia rates with historical data from a pre-DAA era cohort.
Main Methods:
- A retrospective review of patients undergoing primary TJA in 2019 at a single VA medical center.
- Calculation of anti-HCV antibody and HCV viremia prevalence.
- Comparison with a cohort from 2007-2009.
Main Results:
- Of 285 patients screened in 2019, 11.6% were anti-HCV antibody positive.
- Only one patient (0.4%) was viremic, a significant decrease from the prior cohort's 4.5% viremia rate.
- No significant difference was observed in birth year or anti-HCV antibody-positive rates between cohorts.
Conclusions:
- Direct-acting antiviral HCV treatment has drastically reduced HCV viremia in VA patients undergoing TJA from 4.5% to 0.4%.
- The findings underscore the effectiveness of DAA therapy in reducing HCV prevalence within this patient group.
- Continued vigilance regarding sharps injury prevention in surgical settings remains important.
Background:
In 2012, we reported on the prevalence of hepatitis C virus (HCV) infection in Veterans Affairs (VA) patients undergoing total joint arthroplasty (TJA) at our center. In this patient population, 8.4% were antibody positive and 4.5% were viremic with HCV. In 2014, the first all-oral direct-acting antiviral treatment for hepatitis C became available. The Department of Veterans Affairs then underwent an aggressive program to eradicate hepatitis C from the veteran population. The purpose of this report is to provide updated information on the prevalence of HCV viremia among patients undergoing primary TJA at the same center.
Methods:
A retrospective review was performed of all patients undergoing primary TJA at a single VA medical center in 2019. Anti-HCV antibody and HCV viremia prevalence were calculated. Comparisons were made to data from a previously reported cohort of patients who had undergone TJA at the same center from 2007 to 2009.
Results:
Thirty-three (11.6%) of 285 patients screened preoperatively were positive for the hepatitis C antibody. Only one of the 33 anti-HCV-positive patients was viremic at the time of screening for an overall viremic prevalence of 0.4%. We found no statistically significant difference in the birth year, or anti-HCV antibody-positive rate from the prior cohort, but the prevalence of HCV viremia decreased significantly.
Conclusion:
Because direct-acting antiviral HCV treatment has become available, HCV viremia among VA patients undergoing TJA has been reduced from 4.5% to 0.4%. Surgeons are still advised to minimize the risk of sharps injury.
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