{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T23:09:06Z","timestamp":1779923346350,"version":"3.53.1"},"reference-count":60,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2023,10,31]],"date-time":"2023-10-31T00:00:00Z","timestamp":1698710400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Viruses"],"abstract":"<jats:p>HCV infection is still a major burden worldwide, and most countries are not on track to meet the WHO 2030 elimination goal. The current challenge is to identify individuals to be treated. In this study, we will describe the trend of new DAA prescriptions and the changes over time in terms of the characteristics of patients starting antiviral therapy in our unit. Data of 1646 hepatitis C patients who started therapy during the period of 2015\u20132022 regarding annual number of prescriptions, age, gender, nationality, HCV genotype, provenance, and liver disease severity were analyzed. We observed a peak in the number of new prescriptions in 2018 and a downward trend starting in 2019. Patients from the general population, centers for addictions, and prison differed significantly. The mean age in the general population remained above 60 years, the percentage of patients from centers for addictions and prison increased and, after 2016, there was no significant change in the percentage of patients with F3\u2013F4 fibrosis. As HCV screening and linkage-to-care pathways seem to be already well implemented and successful in centers for addictions and in prisons, efforts need to be focused on those of older age in the general population. To carry this out, the more structured involvement of different health professionals must be figured out.<\/jats:p>","DOI":"10.3390\/v15112199","type":"journal-article","created":{"date-parts":[[2023,10,31]],"date-time":"2023-10-31T12:44:03Z","timestamp":1698756243000},"page":"2199","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Country-Wide HCV Elimination Strategies Need to Reach Older Patients in the General Population: The Italian Experience"],"prefix":"10.3390","volume":"15","author":[{"given":"Pietro","family":"Torre","sequence":"first","affiliation":[{"name":"Internal Medicine and Hepatology Unit, Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Largo Citt\u00e0 d\u2019Ippocrate, 84131 Salerno, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberta","family":"Coppola","sequence":"additional","affiliation":[{"name":"Internal Medicine and Hepatology Unit, Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Largo Citt\u00e0 d\u2019Ippocrate, 84131 Salerno, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0550-8201","authenticated-orcid":false,"given":"Mario","family":"Masarone","sequence":"additional","affiliation":[{"name":"Internal Medicine and Hepatology Unit, Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Largo Citt\u00e0 d\u2019Ippocrate, 84131 Salerno, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1399-6498","authenticated-orcid":false,"given":"Marcello","family":"Persico","sequence":"additional","affiliation":[{"name":"Internal Medicine and Hepatology Unit, Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Largo Citt\u00e0 d\u2019Ippocrate, 84131 Salerno, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,10,31]]},"reference":[{"key":"ref_1","unstructured":"(2023, June 10). Hepatitis C. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/hepatitis-c."},{"key":"ref_2","unstructured":"(2023, June 08). CDA Foundation\u2019s Polaris Observatory. Available online: https:\/\/cdafound.org\/polaris-countries-dashboard\/."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Rosato, V., Kondili, L.A., Nevola, R., Perillo, P., Mastrocinque, D., Aghemo, A., and Claar, E. (2022). Elimination of Hepatitis C in Southern Italy: A Model of HCV Screening and Linkage to Care among Hospitalized Patients at Different Hospital Divisions. Viruses, 14.","DOI":"10.3390\/v14051096"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1002\/jmv.20376","article-title":"Different seroprevalence and molecular epidemiology patterns of hepatitis C virus infection in Italy","volume":"76","author":"Ansaldi","year":"2005","journal-title":"J. Med. Virol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1002\/jmv.24635","article-title":"Prevalence and risk factors of HCV infection in a metropolitan area in southern Italy: Tail of a cohort infected in past decades","volume":"89","author":"Morisco","year":"2017","journal-title":"J. Med. Virol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/j.ejim.2018.02.015","article-title":"Declining prevalence and increasing awareness of HCV infection in Italy: A population-based survey in five metropolitan areas","volume":"53","author":"Andriulli","year":"2018","journal-title":"Eur. J. Intern. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1016\/j.dld.2021.03.026","article-title":"Milestones to reach Hepatitis C Virus (HCV) elimination in Italy: From free-of-charge screening to regional roadmaps for an HCV-free nation","volume":"54","author":"Kondili","year":"2022","journal-title":"Dig. Liver Dis."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1016\/S2468-1253(21)00472-6","article-title":"Global change in hepatitis C virus prevalence and cascade of care between 2015 and 2020: A modelling study","volume":"7","author":"Blach","year":"2022","journal-title":"Lancet Gastroenterol. Hepatol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"686","DOI":"10.1002\/hep.31060","article-title":"Hepatitis C Guidance 2019 Update: American Association for the Study of Liver Diseases\u2013Infectious Diseases Society of America Recommendations for Testing, Managing, and Treating Hepatitis C Virus Infection","volume":"71","author":"Ghany","year":"2020","journal-title":"Hepatology"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"European Association for the Study of the Liver (2020). EASL recommendations on treatment of hepatitis C: Final update of the series. J. Hepatol., 73, 1170\u20131218.","DOI":"10.1016\/j.jhep.2020.08.018"},{"key":"ref_11","unstructured":"World Health Organization (2016). Global Health Sector Strategy on Viral Hepatitis 2016\u20132021. Towards Ending Viral Hepatitis, World Health Organization."},{"key":"ref_12","unstructured":"(2023, October 21). Interim Guidance for Country Validation of Viral Hepatitis Elimination. Available online: https:\/\/iris.who.int\/bitstream\/handle\/10665\/341652\/9789240028395-eng.pdf?sequence=1."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1085","DOI":"10.1016\/S0140-6736(23)01320-X","article-title":"Hepatitis C","volume":"402","author":"Martinello","year":"2023","journal-title":"Lancet"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1444","DOI":"10.1016\/j.jhep.2022.06.034","article-title":"Viral hepatitis elimination: Towards a hepatitis-free world","volume":"77","author":"Buti","year":"2022","journal-title":"J. Hepatol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1016\/j.jhep.2017.06.033","article-title":"Micro-elimination\u2014A path to global elimination of hepatitis C","volume":"67","author":"Lazarus","year":"2017","journal-title":"J. Hepatol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1111\/liv.14324","article-title":"Global timing of hepatitis C virus elimination in high-income countries","volume":"40","author":"Razavi","year":"2020","journal-title":"Liver Int."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1016\/j.jhep.2021.05.025","article-title":"EASL Clinical Practice Guidelines on non-invasive tests for evaluation of liver disease severity and prognosis\u20142021 update","volume":"75","author":"Berzigotti","year":"2021","journal-title":"J. Hepatol."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"European Association for Study of Liver, and Asociacion Latinoamericana para el Estudio del Higado (2015). EASL-ALEH Clinical Practice Guidelines: Non-invasive tests for evaluation of liver disease severity and prognosis. J. Hepatol., 63, 237\u2013264.","DOI":"10.1016\/j.jhep.2015.04.006"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1016\/j.jhep.2018.03.026","article-title":"EASL Recommendations on Treatment of Hepatitis C 2018","volume":"69","author":"Pawlotsky","year":"2018","journal-title":"J. Hepatol."},{"key":"ref_20","unstructured":"(2023, June 11). Eliminazione dell\u2019Epatite C Cronica in Italia: Strategie di Screening Gratuito. Available online: https:\/\/www.iss.it\/documents\/20126\/0\/Eliminazione+epatite+C+cronica+in+Italia.pdf\/d96d4b5b-a3d3-c8c2-95a9-bdb169280259?t=1613031386658."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Coppola, C., Kondili, L.A., Staiano, L., Cammarota, S., Citarella, A., Aloisio, M.P., Annunziata, A., Bernardi, F.F., D\u2019Avino, A., and D\u2019Orazio, M. (2023). Hepatitis C Virus Micro-Elimination Plan in Southern Italy: The \u201cHCV ICEberg\u201d Project. Pathogens, 12.","DOI":"10.3390\/pathogens12020195"},{"key":"ref_22","unstructured":"(2023, May 12). Ridefinizione dei Criteri di Trattamento per la Terapia dell\u2019Epatite C Cronica, Available online: https:\/\/www.aifa.gov.it\/sites\/default\/files\/Determina_n._500-2017_Epatite-C.pdf."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2190","DOI":"10.1111\/liv.13901","article-title":"Forecasting Hepatitis C liver disease burden on real-life data. Does the hidden iceberg matter to reach the elimination goals?","volume":"38","author":"Kondili","year":"2018","journal-title":"Liver Int."},{"key":"ref_24","unstructured":"(2023, July 04). HCV: Eradicazione del Virus sul Territorio Nazionale. Available online: https:\/\/www.epac.it\/cm-files\/2019\/10\/03\/position-paper-hcv-def.pdf."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/j.jhep.2020.07.042","article-title":"Impact of COVID-19 on global HCV elimination efforts","volume":"74","author":"Blach","year":"2021","journal-title":"J. Hepatol."},{"key":"ref_26","unstructured":"(2023, June 08). Report_Survey. Available online: https:\/\/www.webaisf.org\/wp-content\/uploads\/2020\/05\/Report_Survey_110520MM.pdf."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"937","DOI":"10.1016\/j.dld.2020.07.008","article-title":"Assessing the impact of COVID-19 on the management of patients with liver diseases: A national survey by the Italian association for the study of the Liver","volume":"52","author":"Aghemo","year":"2020","journal-title":"Dig. Liver Dis."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Kondili, L.A., Andreoni, M., Aghemo, A., Mastroianni, C.M., Merolla, R., Gallinaro, V., D\u2019Offizi, G., and Crax\u00ec, A. (2023). Forecasting the long-term impact of COVID-19 on hepatitis C elimination plans in Italy: A mathematical modelling approach. Liver Int.","DOI":"10.1111\/liv.15712"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1545","DOI":"10.1111\/liv.14408","article-title":"Optimization of hepatitis C virus screening strategies by birth cohort in Italy","volume":"40","author":"Kondili","year":"2020","journal-title":"Liver Int."},{"key":"ref_30","unstructured":"(2023, June 08). GU n. 51 del 29 Febbraio 2020. Available online: https:\/\/www.gazzettaufficiale.it\/eli\/gu\/2020\/02\/29\/51\/so\/10\/sg\/pdf."},{"key":"ref_31","unstructured":"(2023, June 08). GU Serie Generale n.33 del 09-02-2023. Available online: https:\/\/www.gazzettaufficiale.it\/eli\/gu\/2023\/02\/09\/33\/sg\/pdf."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"966","DOI":"10.1016\/j.jhep.2020.10.001","article-title":"SARS-CoV-2 massive testing: A window of opportunity to catch up with HCV elimination","volume":"74","author":"Crespo","year":"2021","journal-title":"J. Hepatol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1016\/j.jhep.2021.03.009","article-title":"Let\u2019s leverage SARS-CoV2 vaccination to screen for hepatitis C in Spain, in Europe, around the world","volume":"75","author":"Crespo","year":"2021","journal-title":"J. Hepatol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1918","DOI":"10.1111\/liv.15314","article-title":"Screening for hepatitis C at the time of the pandemic: Need to adjust the shot","volume":"42","author":"Torre","year":"2022","journal-title":"Liver Int."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1915","DOI":"10.1111\/liv.15316","article-title":"Hepatitis C virus screening in the 1969\u20131989 birth cohort: Is not enough!","volume":"42","author":"Cerini","year":"2022","journal-title":"Liver Int."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1012","DOI":"10.1111\/liv.15216","article-title":"Implementation of HCV screening in the 1969\u20131989 birth-cohort undergoing COVID-19 vaccination","volume":"42","author":"Rizzardini","year":"2022","journal-title":"Liver Int."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1467","DOI":"10.1111\/liv.15273","article-title":"Hepatitis C screening during SARS-CoV-2 testing or vaccination. Experience in an area of southern Italy in the province of Salerno","volume":"42","author":"Torre","year":"2022","journal-title":"Liver Int."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"103055","DOI":"10.1016\/j.drugpo.2020.103055","article-title":"HCV testing and treatment initiation in an Italian prison setting: A step-by-step model to micro-eliminate hepatitis C","volume":"90","author":"Fiore","year":"2021","journal-title":"Int. J. Drug Policy"},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Fiore, V., De Vito, A., Pontali, E., Lucania, L., Madeddu, G., and Babudieri, S. (2021). Chronic Viral Hepatitis in the Italian Prison Setting: Prevalence, Outcomes, Literature Needs and Perspectives. Healthcare, 9.","DOI":"10.3390\/healthcare9091186"},{"key":"ref_40","first-page":"5","article-title":"HCV and drug addiction in the historical scenario of infection entry in Italy","volume":"89","author":"Galli","year":"2018","journal-title":"Acta Biomed. Atenei Parm."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1159\/000348506","article-title":"Age and Gender Distribution of Hepatitis C Virus Genotypes in the Metropolitan Area of Naples","volume":"56","author":"Petruzziello","year":"2013","journal-title":"Intervirology"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Petruzziello, A., Sabatino, R., Loquercio, G., Guzzo, A., Di Capua, L., Labonia, F., Cozzolino, A., Azzaro, R., and Botti, G. (2019). Nine-year distribution pattern of hepatitis C virus (HCV) genotypes in Southern Italy. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0215559"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1016\/S2468-1253(16)30181-9","article-title":"Global prevalence and genotype distribution of hepatitis C virus infection in 2015: A modelling study","volume":"2","author":"Blach","year":"2017","journal-title":"Lancet Gastroenterol. Hepatol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1296","DOI":"10.1002\/jmv.20692","article-title":"Molecular epidemiology of hepatitis C virus subtype 3a in injecting drug users","volume":"78","author":"Morice","year":"2006","journal-title":"J. Med. Virol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1016\/j.dld.2010.12.004","article-title":"Recommendations for the prevention, diagnosis, and treatment of chronic hepatitis B and C in special population groups (migrants, intravenous drug users and prison inmates)","volume":"43","author":"Almasio","year":"2011","journal-title":"Dig. Liver Dis."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1016\/j.jiph.2022.04.003","article-title":"Hepatitis C virus (HCV) micro-elimination in the hospital setting: The results of the HCV Caserta hospital project","volume":"15","author":"Messina","year":"2022","journal-title":"J. Infect. Public Health"},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"D\u2019Ambrosio, R., Piccinelli, S., Beccalli, B., Spinetti, A., Puoti, M., Fagiuoli, S., Magni, C.F., Vavassori, A., Sacchi, P., and Castaldi, S. (2023). A territory-wide opportunistic, hospital-based HCV screening in the general population from northern Italy: The 1969\u20131989 birth-cohort. Liver Int.","DOI":"10.1111\/liv.15727"},{"key":"ref_48","unstructured":"(2023, October 20). Coalition for Global Hepatitis Elimination. Available online: https:\/\/www.globalhep.org\/country-progress\/italy."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"S211","DOI":"10.1093\/infdis\/jiad038","article-title":"From Prioritization to Universal Treatment: Successes and Challenges of Hepatitis C Virus Elimination in Italy","volume":"228","author":"Kondili","year":"2023","journal-title":"J. Infect. Dis."},{"key":"ref_50","unstructured":"(2023, July 11). Screening Epatite. Test Rapido HCV in Farmacia: Il Protocollo Siglato in Campania e L\u2019operativit\u00e0 per i Farmacisti. Available online: https:\/\/www.epac.it\/notizie\/ultime-notizie\/screening-epatite-test-rapido-hcv-in-farmacia-il-protocollo-siglato-in-campania-e-l-operativit%C3%A0-per-i-farmacisti."},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Citarella, A., Cammarota, S., Bernardi, F.F., Coppola, C., D\u2019Ant\u00f2, M., Fogliasecca, M., Giusto, E., Masarone, M., Salomone Megna, A., and Sellitto, C. (2020). Screening, Linkage to Care and Treatment of Hepatitis C Infection in Primary Care Setting in the South of Italy. Life, 10.","DOI":"10.3390\/life10120359"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"100442","DOI":"10.1016\/j.epidem.2021.100442","article-title":"Estimated prevalence of undiagnosed HCV infected individuals in Italy: A mathematical model by route of transmission and fibrosis progression","volume":"34","author":"Kondili","year":"2021","journal-title":"Epidemics"},{"key":"ref_53","unstructured":"(2023, October 23). Registri AIFA per il Monitoraggio dei Farmaci Anti-HCV, Available online: https:\/\/www.aifa.gov.it\/en\/aggiornamento-epatite-c."},{"key":"ref_54","unstructured":"(2023, July 07). Linee di Indirizzo AISF\u2014HCV. Available online: https:\/\/www.webaisf.org\/wp-content\/uploads\/2020\/12\/DOCUMENTO-HCV-14_12_20.pdf."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1016\/j.jhep.2020.10.016","article-title":"HCC surveillance after SVR in patients with F3\/F4 fibrosis","volume":"74","author":"Ioannou","year":"2021","journal-title":"J. Hepatol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1053\/j.gastro.2016.09.009","article-title":"Eradication of Hepatitis C Virus Infection in Patients With Cirrhosis Reduces Risk of Liver and Non-Liver Complications","volume":"152","author":"Nahon","year":"2017","journal-title":"Gastroenterology"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"4603","DOI":"10.3748\/wjg.v27.i28.4603","article-title":"Viral hepatitis: Milestones, unresolved issues, and future goals","volume":"27","author":"Torre","year":"2021","journal-title":"World J. Gastroenterol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1038\/s41575-023-00759-2","article-title":"Global epidemiology of cirrhosis\u2014Aetiology, trends and predictions","volume":"20","author":"Huang","year":"2023","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"2060","DOI":"10.1111\/liv.13743","article-title":"Prevalence and severity of nonalcoholic fatty liver disease by transient elastography: Genetic and metabolic risk factors in a general population","volume":"38","author":"Petta","year":"2018","journal-title":"Liver Int."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"9151820","DOI":"10.1155\/2018\/9151820","article-title":"Characteristics and Changes over Time of Alcohol-Related Chronic Liver Diseases in Italy","volume":"2018","author":"Stroffolini","year":"2018","journal-title":"Can. J. Gastroenterol. Hepatol."}],"container-title":["Viruses"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1999-4915\/15\/11\/2199\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:15:17Z","timestamp":1760130917000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1999-4915\/15\/11\/2199"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,31]]},"references-count":60,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2023,11]]}},"alternative-id":["v15112199"],"URL":"https:\/\/doi.org\/10.3390\/v15112199","relation":{},"ISSN":["1999-4915"],"issn-type":[{"value":"1999-4915","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10,31]]}}}