The real-world benefits of direct-acting antiviral (DAA)-induced sustained virologic response (SVR) on the de novo occurrence and progression of esophageal varices (EV) remain unclear in patients with hepatitis C virus (HCV)-related liver cirrhosis (LC). This is a retrospective cohort study evaluating all patients with Child-Pugh class A HCV-related LC during 2013 to 2020 in the Chang Gung Medical System. A total of 215 patients fit the inclusion criteria and were enrolled. Of them, 132 (61.4%) patients achieved DAA induced-SVR and 83 (38.6%) did not receive anti-viral treatment. During a median follow-up of 18.4 (interquartile range, 10.1–30.9) months, the 2-year incidence of de novo EV occurrence was 8 (7.0%) in the SVR group and 7 (12.7%) in the treatment-naïve group. Compared to the treatment-naïve group, the SVR group was associated with a significantly lower incidence of EV occurrence (adjusted hazard ratio [aHR]: 0.47, p = 0.030) and a significantly lower incidence of EV progression (aHR: 0.55, p = 0.033). The risk of EV progression was strongly correlated with the presence of baseline EV (p < 0.001). To the best of our knowledge, this is the first study to demonstrate that DAA-induced SVR is associated with decreased risk of de novo EV occurrence and progression in the real world.

Background/Objectives: Chronic hepatitis C virus (HCV) remains a major public health concern in Taiwan, particularly in southern regions with high endemicity. While HCV elimination is a national priority, resources are often limited. Relying solely on broad, township-level prevalence rates is inefficient, as the true disease burden can vary dramatically at the village level. Therefore, identifying local hotspots through fine-scale mapping is critical for efficient resource allocation and targeted intervention. This study aimed to validate village-level prevalence estimates and evaluate the efficiency of a community-based, targeted screening approach utilizing this detailed prevalence data in Chiayi County. Methods: We integrated data from the Chiayi Health Bureau and Chiayi Chang Gung Memorial Hospital (2000–2015) to generate village-level risk maps for five townships: Lioujiao (LJ), Yijhu (YH), Dongshih (DS), Taibao (TB), and Lucao (LC). Between 2018 and 2021, we conducted door-to-door community screening using anti-HCV testing with reflex HCV antigen (Ag) testing. Anti-HCV/HCV Ag prevalence, number needed to test (NNT), and linkage-to-care rates were calculated to validate prevalence estimates and assess screening efficiency. Results: Among 3910 participants, anti-HCV prevalence ranged from 5.4% (TB) to 8.7% (DS). Estimated and observed village-level prevalence showed moderate-to-strong correlation (r = 0.696–0.830, p < 0.001). Screening efficiency was highest in DS (NNT = 21) and lowest in TB (NNT = 42). Of 132 antigen-positive individuals, 131 (99.2%) initiated direct-acting antiviral therapy. Conclusions: The village-level risk maps accurately predicted local HCV burden, enabling targeted screening with high diagnostic yield and near-complete treatment uptake. This approach maximizes resource efficiency and may serve as a scalable model for advancing Taiwan and the WHO’s 2030 HCV elimination goals.

Background: The albumin–bilirubin (ALBI) grade provides an objective assessment of hepatic reserve, but the need for calculation by means of a formula has hampered its use at the bedside. This study aimed to develop simple cut-off values for ALBI grade and validate its performance in a large multi-center real-world cohort. Methods: A mathematical simulation evaluated every possible ALBI pair that falls within the Child–Pugh classification (CP) A range, discretized to 0.1 increments. Cut points for patient stratification without equation-based calculation were derived. Validation was conducted with the Chang Gung Research Database (CGRD), which contains data from 10 hospitals in Taiwan. Patients with same-day albumin and bilirubin measurements in 2024 were included. Results: Mathematical modeling identified clinically applicable cutoffs—albumin ≥ 4.4 g/dL or ≤3.5 g/dL and bilirubin ≥ 2.4 mg/dL—with further refinement at albumin 4.0 g/dL and bilirubin ≥ 1.0 mg/dL. Among 7583 CP-A patients, 82% were directly classifiable without computation, with consistent applicability across chronic liver disease and hepatocellular carcinoma (HCC) subgroups. Equation dependence increased only slightly in the HCC group, confirming robustness across disease severities. Conclusions: Simplified cutoff rules derived from mathematical modeling and validated in a multi-center cohort enable rapid recognition of ALBI grade in most CP-A patients. This approach enhances the clinical usability of ALBI and supports its integration into patient care, clinical trials, and treatment allocation.