title: Prevalence of elevated ALT values, HBsAg, and anti-HCV in the primary care setting and evaluation of guideline defined hepatitis risk scenarios.
abstract: OBJECTIVE
  Prevalence data for hepatitis B and C and an evaluation of a guideline based screening in the primary care setting are not yet available. We therefore implemented a hepatitis B surface antigen (HBsAg) and anti-hepatitis C virus (HCV) screening and developed guideline based screening strategies.
  
  
  METHODS
  HBsAg, anti-HCV, and alanine aminotransferase (ALT) were included in a routine check-up together with a questionnaire covering 16 guideline adapted risk scenarios. Significant risk factors were identified by stepwise logistic regression.
  
  
  RESULTS
  51 private practices screened 21,008 patients. The HBsAg, anti-HCV, and HCV-RNA prevalence was 0.52%, 0.95%, and 0.43%, respectively. Infections were previously unknown in 85% and 65% of HBsAg and anti-HCV positive individuals, respectively. Sexual risk factors were under-reported, while the following scenarios were significantly associated with viral infections (Odds ratio [95% confidence interval]). HBV: Immigration (4.4 [2.9, 6.7]), infection in household (2.5 [1.2, 4.5]), male gender (1.6 [1.1, 2.4]). Male immigrants had a 2.1% HBsAg prevalence and 80% were unaware of the infection. HCV: IV drug use (384 [233, 644]), blood transfusion before 1992 (5.3 [3.5, 7.9]), immigration (2.4 [1.5, 3.6]). Presence of either one of the HBV related guideline defined risk scenarios or elevated ALT identified 82% of previously undiagnosed patients. Presence of one of the three significant HCV risk factors or elevated ALT levels diagnosed 83% of unknown HCV-RNA positive cases by screening only 26% of the population.
  
  
  CONCLUSIONS
  Undiagnosed hepatitis B and C infections frequently exist in the primary care setting. Easy to apply guideline defined risk scenarios help to diagnose previously unknown infections.
authors.affiliation: Südstadtpraxis Paderborn, Paderborn, Germany.
authors.forename: Ingmar
authors.initials: I
authors.lastname: Wolffram
authors.affiliation: Clinical Trial Centre Leipzig, University of Leipzig, Germany.
authors.forename: David
authors.initials: D
authors.lastname: Petroff
authors.affiliation: LADR GmbH Medizinisches Versorgungszentrum Dr. Kramer und Kollegen, Geesthacht, Germany.
authors.forename: Olaf
authors.initials: O
authors.lastname: Bätz
authors.affiliation: LADR GmbH Medizinisches Versorgungszentrum Dr. Kramer und Kollegen, Geesthacht, Germany.
authors.forename: Katrin
authors.initials: K
authors.lastname: Jedrysiak
authors.affiliation: LADR GmbH Medizinisches Versorgungszentrum Dr. Kramer und Kollegen, Geesthacht, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Kramer
authors.affiliation: Universitätsklinikum Leipzig, Klinik für Gastroenterologie und Rheumatologie, Sektion Hepatologie, Leipzig, Germany.
authors.forename: Hannelore
authors.initials: H
authors.lastname: Tenckhoff
authors.affiliation: Universitätsklinikum Leipzig, Klinik für Gastroenterologie und Rheumatologie, Sektion Hepatologie, Leipzig, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Berg
authors.affiliation: Universitätsklinikum Leipzig, Klinik für Gastroenterologie und Rheumatologie, Sektion Hepatologie, Leipzig, Germany. Electronic address: johannes.wiegand@medizin.uni-leipzig.de.
authors.forename: Johannes
authors.initials: J
authors.lastname: Wiegand
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000410:Alanine Transaminase / Q000097:blood*; D002648:Child; D005260:Female; D005858:Germany / Q000453:epidemiology; D006509:Hepatitis B / Q000175:diagnosis / Q000453:epidemiology*; D006514:Hepatitis B Surface Antigens / Q000097:blood*; D006526:Hepatitis C / Q000175:diagnosis / Q000453:epidemiology*; D018937:Hepatitis C Antibodies / Q000097:blood*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D015995:Prevalence; D011320:Primary Health Care; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D006514:Hepatitis B Surface Antigens; D018937:Hepatitis C Antibodies; D000410:Alanine Transaminase
keywords: Efficacy; Hepatitis B; Hepatitis C; Screening strategy