Saint Vincent's University Hospital, Department of Dermatology, Dublin, Ireland.
Screening for HCV prior to the commencement of anti-TNF-α therapies for dermatological disease is recommended for all patients.
To determine the incidence of HCV infection amongst dermatology patients who were screened for HCV infection prior to commencing anti-TNF-α therapies.
We reviewed the HCV infection status of all patients attending our dermatology department who had been tested for evidence of HCV infection between January 2005 and November 2012. We identified patients who had been tested as part of routine screening prior to commencing anti-TNF-α therapy using dermatology departmental records.
Two hundred and fifteen patients were screened for HCV infection prior to commencing anti-TNF-α therapies. Amongst this group, 143 (66.5%) patients were male and 72 (33.5%) were female. None of these patients tested positive for active HCV infection. One patient tested positive for HCV antibody with negative HCV antigen and HCV RNA. This indicated previous HCV infection that had cleared. This patient had abnormal liver function tests and a history of alcohol excess.
There were no cases of active HCV infection diagnosed through pre-anti-TNF-α screening in our department, which is located in a low prevalence area for HCV infection. In view of the lack of evidence of harm associated with anti-TNF-alpha use in HCV infected patients, we propose that screening for HCV infection in low prevalence areas should be targeted to those with pre-existing risk factors. This is consistent with current guidelines from the Royal College of General Practitioner (RCGP). Targeted screening rather than universal screening may be a safe and cost-effective option amongst patients being evaluated for anti-TNF-α therapies