• Maria Laura Mariano de Matos, Rosário Quiroga Ferrufino, Ana Catharina de Seixas Santos Nastri, Fatuma Catherine Atieno Odongo, Aléia Faustina Campos, André Machado Luiz, Gaspar Lisboa-Neto, Steven S Witkin, and Maria Cássia Mendes-Correa.
• Departamento de Molestias Infecciosas e Parasitarias, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, SP, BR.
• Clinics (Sao Paulo). 2019 Jan 1; 74: e1286.

ObjectivesOur objective was to analyze, in a population treated for hepatitis C infection at a tertiary care treatment unit, the prevalence of comorbidities and extrahepatic manifestations, the range and degree of the clinical complexity and the associations between advanced liver disease and clinical variables.MethodsMedical records from chronically infected hepatitis C patients seen at a dedicated treatment facility for complex cases in the Infectious Diseases Division of Hospital das Clínicas in Brazil were analyzed. Clinical complexity was defined as the presence of one or more of the following conditions: advanced liver disease (Metavir score F3 or F4 and/or clinical manifestations or ultrasound/endoscopy findings consistent with cirrhosis) or hepatocellular carcinoma and/or 3 or more extrahepatic manifestations and/or comorbidities concomitantly.ResultsAmong the 1574 patients analyzed, only 41% met the definition of being clinically complex. Cirrhosis or hepatocarcinoma was identified in 22.2% and 1.8% of patients, respectively. According to multiple logistic regression analysis, male sex (p=0.007), age>40 years (p<0.001) and the presence of metabolic syndrome (p=0.008) were independently associated with advanced liver disease.ConclusionThe majority of patients did not meet the criteria for admittance to this specialized tertiary service, reinforcing the need to reevaluate public health policies. Enhanced utilization of existing basic and intermediate complexity units for the management of less complex hepatitis C cases could improve care and lower costs.

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