Too many people with viral hepatitis are diagnosed late — with dire consequences

Late presentation to hepatitis B virus and hepatitis C virus care is common, hindering global efforts to reduce the morbidity and mortality associated with liver disease. Models of care promoting and simplifying early testing of viral hepatitis are needed if we are to eliminate viral hepatitis as a major public health threat by 2030.

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Fig. 1: Examples of different point-of-care HCV testing.


  1. 1.

    World Health Organization. Global Hepatitis Report, 2017. WHO (2017).

  2. 2.

    GBD 2016 Causes of Death Collaborators. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 390, 1151–1210 (2017).

    Article  Google Scholar 

  3. 3.

    Rodger, A. J. et al. Sexual activity without condoms and risk of HIV transmission in serodifferent couples when the HIV-positive partner is using suppressive antiretroviral therapy. JAMA 316, 171–181 (2016).

    Article  Google Scholar 

  4. 4.

    Crespo, G. et al. The efficacy of direct anti-HCV drugs improves early post-liver transplant survival and induces significant changes in waiting list composition. J. Hepatol. 69, 11–17 (2018).

    CAS  Article  Google Scholar 

  5. 5.

    Mauss, S. et al. Late presentation of chronic viral hepatitis for medical care: a consensus definition. BMC Med. 15, 92 (2017).

    Article  Google Scholar 

  6. 6.

    Cortesi, P. A. et al. Systematic review: economic evaluations of HCV screening in the direct-acting antivirals era. Aliment. Pharmacol. Ther. 49, 1126–1133 (2019).

    Article  Google Scholar 

  7. 7.

    Grebely, J. et al. Hepatitis C point-of-care diagnostics: in search of a single visit diagnosis. Expert Rev. Mol. Diagn. 17, 1109–1115 (2017).

    CAS  Article  Google Scholar 

  8. 8.

    Fuglsang Hansen, J. et al. Late presentation for care among patients with chronic hepatitis C: prevalence and risk factors. Open Forum Infect. Dis. 5, ofx257 (2017).

    Google Scholar 

  9. 9.

    Bischoff, J. et al. Has increased rollout of direct acting antiviral therapy decreased the burden of late presentation and advanced liver disease in patients starting hepatitis C virus therapy in Germany? J. Clin. Gastroenterol. (2019).

    Article  PubMed  Google Scholar 

  10. 10.

    Sangiovanni, A. et al. The natural history of compensated cirrhosis due to hepatitis C virus: a 17-year cohort study of 214 patients. Hepatology 43, 1303–1310 (2006).

    Article  Google Scholar 

Download references

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Correspondence to Jeffrey V. Lazarus.

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Lazarus, J.V., Picchio, C., Dillon, J.F. et al. Too many people with viral hepatitis are diagnosed late — with dire consequences. Nat Rev Gastroenterol Hepatol 16, 451–452 (2019).

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