anti-HCV Positive Patients Research Articles

Electronic Clinical Decision Support (eCDS) Intervention to Increase Hepatitis C Virus (HCV) Screening and Linkage to Care among Baby Boomers in Urban Safety-Net Health System

Objective: An estimated 3.5 million Americans are living with hepatitis C virus (HCV) infection and the majority is unaware of their infection. HCV causes significant morbidity and mortality and is one of the leading causes of hepatocellular carcinoma (HCC) and other liver complications. Baby boomers (born between 1945 and 1965) account for approximately 75% of people chronically infected with HCV. The CDC and USPSTF recommend universal one-time screening of all Baby Boomers. Methods: Cook County Health (CCH) implemented an electronic clinical decision support (eCDS) tool in September 2016 to increase HCV screening among baby boomers throughout its outpatient clinic network. We evaluated the impact of the eCDS tool on screening and the successive stages of the care continuum by analyzing the proportion of patients who completed 1) anti-HCV screening, 2) HCV RNA confirmatory testing, 3) HCV RNA detectable result, 4) liver staging, and 5) treatment in the 12-month periods pre- and post-implementation. Results: The number of baby boomers newly tested system-wide each month increased by 344% over the 24-month evaluation period. Of 15,630 patients tested for anti-HCV, 844 (5.4%) tested positive. Patients with anti-HCV positive results were predominantly male (59%), between the ages of 52 and 64 (70%), Black/African American (71%) and Non-Hispanic (86%). 605 (72%) of anti-HCV positive patients completed HCV ribonucleic acid (RNA) testing; of those patients, 347 (58%) had confirmed HCV infection. Of 347 patients with confirmed HCV infection, 198 completed liver staging and 68 initiated treatment. Conclusions: Implementation of eCDS tools across large urban safety-net health systems is an effective strategy for ensuring adherence to national guidelines for HCV screening among baby boomers. The high prevalence of HCV infection in this primarily male, Black/African American baby boomer population highlights the urgency of universal screening programs at similar institutions.

Existence of Occult Hepatitis C virus Infection in Local Haemodialysis Setting

Introduction: Among chronic hepatitis C patients, the viral agent is well known to replicate in the hepatocytes and extrahepatic cells. Previous studies have demonstrated a new form of hepatitis C called 'Occult HCV Infection' (OCI). It is defined as the presence of HCV RNA in the hepatocytes but undetectable HCV RNA in the serum or plasma. The exact natural history, epidemiology, pathogenesis and clinical importance of OCI are unknown. Several studies have been carried out worldwide, but none from Malaysia. This study investigated OCI among local patients undergoing routine hemodialysis at a referral hospital in Pahang, Malaysia. Materials and Methods: Blood was collected from both anti-HCV positive (n=10) and anti-HCV negative (n=18) patients. Inclusion criteria for the seronegative patients included elevated liver enzymes. Results: 10 chronic hepatitis C patients were recruited in this study. All had viral RNA detected in both serum and peripheral blood mononuclear cells (PBMC). Viral quasispecies was common in this group of patients. Meanwhile, out of 18 seronegative patients, 3 patients (16%) showed active viral replication in PBMC. Conclusion: This study proved the existence of OCI in local haemodialysis setting. Further investigation is needed to get the actual prevalence of OCI.

Distribution of hepatitis C virus genotypes and subtypes in Croatia: 2008-2015.

Hepatitis C virus (HCV) genotyping is an important part of pre-treatment diagnostic algorithms as it guides the choice of therapeutic regimens. The aim of this study was to analyse the distribution of HCV genotypes in patients with chronic hepatitis C from Croatia in the period 2008-2015. The study enrolled 3,655 anti-HCV positive patients with available results of HCV genotyping from the three largest national HCV genotyping laboratories. The majority of HCV-infected individuals enrolled in the study were male (70.7%). Analysis of age distribution in a subset of 2,164 individuals showed a mean age of 40.9 years (SD 11.77 years). Croatian patients were mostly infected with HCV genotype 1 (56.6%), followed by genotype 3 (37.3%), genotype 4 (4.2%) and genotype 2 (1.8%). Genotype 1 subtyping in a subset of 1,488 patients showed 54% (803/1,488) of 1b infections and 46% (685/1,488) of 1a infections. Percentages of genotype 1 were the highest in Central/Northwestern and Eastern Croatia and the lowest in the Central/Southern Adriatic Region. Genotype 3 was most frequently found in the Central/Southern Adriatic Region (49.1%) but represented only 17.5% of infections in Eastern Croatia (p < 0.001). The results of this nine-year retrospective analysis on the distribution of HCV genotypes and subtypes in 3,655 HCV-infected individuals from Croatia showed that the majority of infections can be attributed to genotypes 1 and 3 with absence of major changes in the molecular epidemiology of the two most frequent HCV genotypes infection in Croatia in the past 20 years.

Screening of hepatitis C virus infection in adult general population in Spain.

The aim was to estimate seroprevalence and prevalence of hepatitis C virus (HCV) infection in a small health area of the Valencian Community, Spain. This is a descriptive cross-sectional study aimed at estimation of HCV infection prevalence in the whole adult population (25-70 years old), that is, a pilot study for an eventual population-based screening program. A total of 5849 participants aged 25-70 years (51% male) were invited to participate by regular mail. Overall, 143 letters were returned owing to errors in the addresses. Of 5706 participants, 2637 (46.2%) participated in the study. Rapid test of anti-HCV antibody detection was positive in 30 cases (HCV seroprevalence 1.14%, 95% confidence intervals: 0.73-1.55%). Of those, seven were not aware of their condition. Participants who had a positive result in the rapid test of anti-HCV detection were given a confirmatory test by enzyme immune assay, and all had a positive result. RNA-HCV determination by quantitative PCR in positive anti-HCV patients showed positive viremia in 13 (43.3%) cases, of which five were not aware of the disease. Of the 17 patients who had negative viremia, two were unaware of their HCV status, one was a carrier of anti-HCV and was already aware of his condition, and 14 had been previously treated with satisfactory results. Regarding fibrosis, of the seven patients who were unaware of HCV infection, none of them had significant fibrosis. Moreover, 26 (86.7%) anti-HCV positive patients were reported to have one or more risk factors for HCV infection. HCV screening strategies applied to the general population are good means to diagnose and treat patients who are not aware of their infection, avoiding new transmissions as well as disease progression.

Efficacy of Direct Acting Antiviral Agents in Dialysis Patients with Chronic Hepatitis C Virus Infection on the Kidney Transplant Waiting List

Introduction The incidence of hepatitis C virus (HCV) infection in chronic kidney disease (CKD) is higher than in the healthy population. Disadvantages such as side effects and inadequate response prevent the effective use of interferon and/or ribavirin treatments in dialysis patients. The risk of complications related to chronic HCV infection, incompatibility with conventional treatments, and prolonged waiting periods in the list are important problems for transplant candidates. Newly developed direct acting anti-viral agents (DAA) promise good results. In this study, we aimed to investigate the efficacy of DAA in HCV-RNA positive dialysis patients on kidney transplant waiting list in our center. Method A total 405 adult dialysis patients (mean age 49.9±13.8 years; 53.1% male) were listed on the national kidney transplant waiting list at our center. Among 26 anti-HCV positive patients on the list, 12 had HCV-RNA positivity. They were treated with DAA. The results at the end of the 12 week treatment, the frequency of adverse events and laboratory changes were assessed. Results The mean waiting time of 405 patients on the waiting list was 42.7±33.9 months. Anti-HCV positive candidates had longer waiting times than negative candidates (85.3±38.8 vs. 39.7±31.6 months, p<0.001). Fifteen transplant recipients had experience of interferon and/or ribavirin, and 7 could not complete the treatment for various reasons. In 9 patients who responded to treatment, HCV was reactivated in the follow-ups and sustained virologic response (SVR) could not be obtained. The DAA protocol (viekirax-exviera in 7, viekirax-exviera-ribavirin in 4, ledipasvir-sofosubvir in 1) was applied in 12 patients with HCV-RNA positive (genotype 1 1a in 4, genotype 1 1b in 8). Viekirax-exviera-ribavirin and viekirax-exviera were given for 12 weeks, ledipasvir-sofosuvir for 6 months. Two patient had cirrhosis. Three patients were treatment-naive, and 9 patients were treatment-experienced. The mean follow-up period of the patients was 6.33±1.96 months. HCV-RNA became negative in 10 of 12 patients after 12 weeks (Table 1). One patient was unable to complete the treatment with the cause of bleeding diathesis, and 1 patient dropped out from follow-up. There were no significant side effects associated with treatment in any patient. Conclusion HCV infection is an important cause of morbidity and mortality before and after kidney transplantation in CKD. It is recommended to obtain SVR before kidney transplantation. In our study HCV-RNA was negative in 83% of patients after 12 weeks. Our study supports that dialysis patients on the kidney waiting list should be treated with protocols that include DAA, which provides high SVR rates. However, long-term studies with more participants are required.

The efficacy of direct anti-HCV drugs improves early post-liver transplant survival and induces significant changes in waiting list composition

The efficacy of direct-acting antivirals (DAAs) has dramatically changed the prognosis of patients with chronic hepatitis C. We aimed to evaluate the impact of DAA therapy on the composition of the liver transplant (LT) waiting list and the early post-transplant survival. We evaluated all patients admitted to the waiting list for a primary LT between 1st January 2008 and 31st of December 2016 in Catalonia, Spain. Time span was divided into two periods according to the availability of different antiviral therapies: 2008-2013 (interferon-based therapies) and 2014-2016 (DAA). Changes in the indications of LT and the aetiology of liver disease, as well as post-LT patient survival, were evaluated according to the year of inclusion and transplantation, respectively. We included 1,483 patients. Admissions in the waiting list for hepatitis C virus (HCV)-related liver disease decreased significantly, from 47% in 2008-2013 to 35% in 2014-2016 (p <0.001), particularly because of a reduction in patients with decompensated cirrhosis. In contrast, NASH-related inclusions increased from 4% to 7% (p = 0.003). Three-year post-LT patient survival increased significantly in the second period in the whole cohort (82% vs. 91%, p = 0.002), because of better survival in anti-HCV positive patients (76% vs. 91%, p = 0.001), but not in anti-HCV negative patients (88% vs. 91% p = 0.359). Anti-HCV positive serology, the time period of 2008-2013 and higher donor age were independently associated with post-LT mortality in the whole cohort; while time period and donor age were independently associated with post-LT mortality in anti-HCV positive recipients. The high efficacy of DAAs is associated with significant changes in the composition of the LT waiting list and, more importantly, results in improved post-transplant survival. The efficacy of the new direct-acting antivirals is associated with a significant improvement in survival of patients undergoing liver transplantation because of hepatitis C virus-related liver disease. In addition, it has decreased the number of patients with hepatitis C that need a liver transplant.

A hiddenly high hepatitis C virus related liver disease burden among Chinese patients with non-liver disease complaints: A hospital based study from 2013 to 2017

Objective: To determine the frequency of anti-HCV antibody positivity in patients with non-liver disease complaints, to explore whether anti-HCV positive patients had been properly advised and visited hepatologists for further assessments, and to investigate their clinical characteristics as well as the HCV treatment status. Methods: A hospital based survey of non-liver disease patients with anti-HCV positive and their attending physicians was conducted to determine: 1. were the patients adequately advised of the implication of anti-HCV positive finding; 2. to what extent the patients were aware of potential chronic liver disease associated with HCV infection and whether they sought for further assessments and care of hepatologists. Results: A total of 295 294 non-liver disease patients were tested for anti-HCV antibody, and 2 778 of them were found to be positive (0.94%). However, only 45.10% (1 253/2 778) of the anti-HCV antibody (+) patients were referred to hepatologists and received HCV RNA test. In addition, 34.10% (312/915) and 1.42% (13/915) of them had already advanced to cirrhosis and hepatocellular carcinoma (HCC), respectively. Further analysis showed that the patients who declined antiviral therapy were older, with lower education and lower income, possessed poorer knowledge on the risk of chronic hepatitis C, and had more severe liver diseases. Surprisingly, 65% of the surveyed physicians did not know the genotype-guided treatment duration suggested by the guidelines. Alarmingly, 22% of the surveyed physicians did not know the standard assays for the diagnosis of HCV infection. Conclusions: Our findings highlight the challenge and hidden enormous burden of chronic HCV infection among patients with non-liver disease complaints in China.

Hepatitis C virus antibodies in outpatients with chronic kidney disease.

Aim of the studyTo determine the seroprevalence of hepatitis C virus (HCV) in outpatients with chronic kidney disease (CKD) attending a nephrology clinic.Material and methodsProspective observational study on consecutive outpatients attending a nephrology clinic. Inclusion criteria were age > 18 years, CKD, informed consent. There were no exclusion criterias. Recorded variables were age, gender, CKD grade and etiology, anti-HCV antibodies (Ab). Patients with positive HCV Abs were tracked for HCV RNA detection. Study interval was from November 2015 to March 2016. The study has been approved by the Ethic committee of F.D. Roosevelt University Hospital. Funded by Restricted Grant of AbbVie Slovakia.ResultsOne hundred and thirty-four patients were enrolled, with median age 70 years (19.7-91), 52% women. CKD grades: G1/2 – 52 patients (39%), G3a – 34 patients (25%), G3b – 32 patients (24%), G4 – 8 patients (6%), G5 – 8 patients (6%); CKD etiology: tubulointerstitial nephritis (TIN) – 53 patients (40%), nephrosclerosis (NS) – 30 patients (22%), diabetic nephropathy (DN) – 23 patients (17%), glomerulonephritis (GN) – 23 patients (17%), others – 5 patients (4%). Anti-HCV antibodies were detected in 8 patients (6%). There were no significant differences in CKD grades between HCV+ and HCV– patients; Heymann nephritis and GN were significantly more frequent in HCV– patients, as was male gender. Of 8 HCV Ab positive patients, 5 were available for HCV RNA testing (2 died after completion of the study, 1 was lost to follow-up); of them, 1 patient tested positive.ConclusionsPrevalence of anti-HCV antibodies in CKD patients was 6%, which is 4 times higher than in the general population of Slovakia; HCV RNA was detected in 1 patient (12.5%) of anti-HCV positive patients. Based on this result, multicentric, a larger-scale study is considered to be warranted.

Hepatitis C Update

Page e6 The pace of Hepatitis C Virus (HCV) drug development in recent years has accelerated dramatically. But, for patients to benefit from these impressive advances, practitioners (i.e. “us”) need to know the most recent and accurate data on the diagnosis and treatment. In 2013, The American Association for Study of Liver Disease (AASLD) and the Infectious Disease Society of America (IDSA), put together web-based guidelines, which are frequently updated: www.hcvguidelines.org and www.aasld.org/practice-guidelines.1 The size of the problem: In the USA, the prevalence is 1.8% (4.1 million), 80% of them are viremic. It is the principal cause of death from liver disease. It is the leading indication for liver transplantation in the USA. Although, HCV is a curable disease, it is under-diagnosed and under-treated.2 Three quarters of individuals with HCV are unaware they are infected. 66-87% of patients diagnosed with HCV have not received antiviral treatment. Screening and diagnosis: 65-69% of anti-HCV positive patients were born between 1945 and 1964. Persons born between 1945 and 1964 had a 4.6 times higher prevalence of HCV than persons born prior to 1945 or after 1964 (3.7% vs. 0.73%).3 Treatment: Before treatment, you need to know: genotype and viral load, previous treatment, and presence of absence of cirrhosis.4 Generally speaking, 4 regimens are currently available. Ledipasvir/sofosbuvir × 12 weeks (8 weeks at discretion of practitioner), Paritaprevir/ritonavir/ombitasvir+dasabuvir + RBV × 12 weeks, Daclatasvir/sofosbuvir × 12 weeks and Sofusbuvir +Simeprevir±RBV × 12 weeks.5

Hepatitis C and Its Metabolic Complications in Kidney Disease

IntroductionEvidence has been accumulated during the last decade showing that HCV infection plays an important activity at hepatic and extra-hepatic level. Chronic HCV is associated with a large spectrum of extra-hepatic manifestations including lympho-pro-liferative diseases and metabolic abnormalities (such as insulin resistance and fatty liver disease). Material and methodsWe have performed an extensive review of the medical literature regarding the increased risk of cardiovascular and kidney disease that has been observed in various groups of HCV-infected patients. The potential link between such increased risk and the metabolic consequences of chronic HCV infection has been explored. ResultsAccording to a systematic review with a meta-analysis of longitudinal studies (n = 9 clinical observational studies; n = 1,947,034 unique patients), we found a strong relationship between positive anti-HCV serologic status and increased incidence of chronic kidney disease in the adult general population, the summary estimate for adjusted hazard ratio was 1.43 (95% confidence intervals, 1.23; 1.63, P = 0.0001) (random-effects model) in anti-HCV positive patients. In another meta-analysis of clinical observational studies (n = 145,608 unique patients on long term dialysis; n = 14 observational studies), anti-HCV sero-positive status was an independent and significant risk factor for death in patients on maintenance dialysis. The summary estimate for adjusted relative risk (all-cause mortality) was 1.35 with a 95% confidence interval (CI) of 1.25; 1.47 (P < 0.01) in anti-HCV positive patients on maintenance dialysis. An updated and stratified analysis (n = 4 studies, n = 91,916 patients on maintenance dialysis) resulted in an adjusted HR for cardiovascular mortality among anti-HCV positive patients of 1.21 (95% CI, 1.06; 1.39) (P < 0.01); the homogeneity assumption was not rejected. The mechanisms underlying such relationships remain unclear; it has been suggested that HCV promotes atherogenesis through direct and indirect mechanisms. ConclusionsClinical trials are under way to assess whether the clearance of HCV RNA from serum by direct-acting antiviral drugs reduces all-cause or disease-specific (cardiovascular) mortality among patients on maintenance dialysis.

Hepatitis C Virus (HCV) genotypes distribution among hepatocellular carcinoma patients in Southern Italy: a three year retrospective study

BackgroundHepatocellular carcinoma (HCC) is one of the major cause for cancer in the world. Aim of this case-control study was to investigate the distribution pattern of HCV genotypes among HCC patients and suggest whether infection with specific subtypes may be associated with an increased risk of progression to cancer.Methods152 HCC anti-HCV positive patients, fulfilling the criteria from the Barcelona 2000 EASL conference, and 568 patients HCV chronically infected but without HCC as control group were included in the study. Serum of each patient was evaluated for viral load estimation and genotyping.ResultsMales with HCC significantly showed to have quite 2 times higher risk of exposure to HCV infection (OR = 1.72; 95% CI = 1.15–2.58). Moreover, HCC was significantly associated with older age. In fact, > 50 years older patients showed to have a higher risk of developing HCC (OR = 17.4; 95% CI = 4.24 to 71.36) compared to younger patients.HCV RNA rate was significantly higher (83.7%) among HCC patients than in the control group (61.4%, p < 0.001) and the most prevalent genotype was 1b (68.0% in HCC vs 54.4% in the control group, p < 0.005). HCC patients significantly have a risk of exposure to HCV 1b infection almost 2 times greater than the control group (OR = 1.8; 95% CI = 1.11–2.82). The multivariate-adjusted OR (95% CI) of developing HCC for HCV 1b comparing to non-1b was 1.65 (1.16–2.33).ConclusionsOur study detected a significantly higher rate of HCV RNA positivity and a higher rate of HCV 1b infection in HCC patients, suggesting the strict association between subtype 1b infection and HCC. A prospective study with larger number of samples would be needed to confirm our results.

Characterization of Occult Hepatitis C Virus (Hcv) Infection among Hemodialysis Patient

Introduction: The existence of new entity called occult hepatitis C virus (HCV) has become a raising and escalating concern among healthcare professionals worldwide. It is defined by the presence of viral RNA in liver and/or peripheral blood mononuclear cells (PBMCs) within non HCV-infected patients. Previous study had shown the occult HCV is infectious and capable of transmitting the virus to another host. Till today, HCV infection remains common among hemodialysis patients despite having the best preventive plans. Because of this, there is a significant concern about the source of viral transmission. The aim of the study was to identify and characterize occult HCV infection in PBMC sample of hemodialysis patients. This was an observational and cross sectional study. Materials and method: PBMCs were isolated from the whole blood using Ficoll-gradient centrifugation technique. The PBMCs were then subjected for cell counting and stored in -70O C until further used. HCV RNA were extracted from these cells and viral RNA were subjected for molecular assays, immune cells analysis and cells culture. Results: PBMCs were isolated from eleven (11) study patients and five (5) anti-HCV positive (control) patients. By using automated flow cytometry, PBMCs of each sample were counted and the average number of cells obtained range from 2x104 to 5x106 cells/ ml. Viral RNAs were extracted and quantitatively measured by using NanoDrop Spectrophotometers. The viral RNAs concentration obtained were between 24.7 and 258.9 ng/ml. The RNAs would be subjected for purification (ethanol precipitation) and further assays. Conclusion: The final findings might contribute to the clinical management of dialysis patients.

Brain Microstructural Correlates of Cognitive Dysfunction in Clinically and Biochemically Normal Hepatitis C Virus Infection

This study examined correlates of the brain's neurocognitive performance among clinically and biochemically normal adult patient with hepatitis C virus (HCV). We hypothesized that anti-HCV positive individuals would demonstrate structural brain abnormalities and neurocognitive dysfunction as well as the changes in cell component and extracellular space in the white matter regions of brain in asymptomatic HCV infection by using diffusion tensor tractrography (DTT) metrics. Anti-HCV positive patient (n=40), and healthy controls (n=31), fulfilling inclusion criteria (incidentally detected anti-HCV positive) and able to provide informed consent were screened and recruited for the study. All these subjects and controls underwent subjective assessment of their quality of life related symptoms, neuropsychometric tests (NPT) and magnetic resonance imaging. The patients were subjected to neuroimaging as well as psychological testing. There was no significant difference in basic laboratory parameters in these two groups. Independent t-test reveals significantly lower neuropsychological functioning as compared to healthy control. A significantly decreased FA values and myoinsitol were observed in HCV subjects on sensory, inferior longitudinal fascicules, and STR fiber bundles as compared to healthy control. Bivariate correlation analysis reveals that neuropsychological scores are significantly positive. Our result show that HCV positive individuals would demonstrate structural brain abnormalities and neurocognitive dysfunction as well as the changes in cell component and extracellular space in the white matter regions of brain in asymptomatic HCV infection by using DTT metrics.

Anti-hepatitis C virus seroprevalence in the working age population in Poland, 2004 to 2014.

Hepatitis C virus (HCV) infection is considered by the World Health Organization (WHO) to be a serious public health concern and one of the major public health priorities. In 2005, it was estimated that there are 185 million anti-HCV positive people in the world, which constitutes 2.8% of the global population. Our study estimates the anti-HCV seroprevalence in the working age population (15–64 years-old), mostly urban and suburban residents, in Poland from 2004 to 2014. The studied group consisted of 61,805 working-age population representatives whose data were obtained from electronic medical records of an outpatient clinic network operating on a countrywide level. Positive anti-HCV test results were obtained in 957 patients, representing 1.5% of the whole population studied throughout the analysed period. The average age of all anti-HCV positive patients was 36.8 years. Analysis of the data suggests that the proportion of anti-HCV positive patients decreased over the study period (mean positive anti-HCV = -0.0017 × year + 3.3715; R2 = 0.7558). In 2004, positive results were noted among 3.2% of patients undergoing HCV antibody tests, but in 2014, the percentage of patients with a positive result stood at 1.1%. The apparent decrease affected men and women similarly. Our study also provides evidence that screening people born before 1965 could be beneficial.

FRI-182 - Linkage to care of HBsAg and anti-HCV positive patients after a systematic screening approach in the German primary care setting

FRI-182 - Linkage to care of HBsAg and anti-HCV positive patients after a systematic screening approach in the German primary care setting

Putting "sticky notes" on the electronic medical record to promote intra-hospital referral of hepatitis B and C virus-positive patients to hepatology specialists: an exploratory study.

BackgroundCurrently, no system for appropriate intra-hospital collaboration regarding hepatitis virus positive individuals exists, even in medical institutions with hepatologists among their staff. The main objective of this study was to explore a simple alert system to promote the referral of patients with hepatitis B surface antigen (HBsAg)- or anti-hepatitis C virus (HCV) antibodies positivity to hepatologists through electronic medical records.MethodsSince April 2014 at Osaka City Juso Hospital, “sticky notes” have been put on the electronic medical records of patients newly diagnosed with HBsAg- or anti-HCV- antibodies positivity to recommend intra-hospital referral of those patients to specialists. In this study, we investigated the number of referrals to hepatologists before vs. after the introduction of this system (that is, in fiscal years 2013 [Period 1] and 2014 [Period 2], respectively), and the subsequent clinical courses of the patients.ResultsThe proportions of patients with HBsAg and anti-HCV antibody positivity did not show statistically significant differences between Period 1 and Period 2 (1.6 % [43/2,757] vs. 1.3 % [39/2,891], p = 0.58; and 5.8 % [156/2,674] vs. 5.3 % [147/2,790], p = 0.39, respectively). However, the referral proportions for patients with HBsAg- and anti-HCV antibody positivity were significantly higher in Period 2 (73 % [11/15] and 65 % [41/63], respectively) than in Period 1 (28 % [5/18] and 17 % [9/54]) (p = 0.009 and p < 0.001, respectively). Among patients who were referred to hepatologists, 2 HBsAg-positive and 4 anti-HCV antibody positive patients initiated antiviral treatment.ConclusionOur simple electronic medical record based alert system effectively promoted intra-hospital referral of hepatitis virus-positive patients, who have been detected by screening tests, to hepatologists.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1765-y) contains supplementary material, which is available to authorized users.

Hepatitis C Virus Infection in Patients on Hemodialysis in Tertiary Care Hospital

Background and Aim: Hepatitis C virus is a major problem with an estimated global prevalence of 3%. The prevalence of HCV infection among dialysis patients is generally much higher than healthy blood donors and general population. Studies held in dialysis centers from different countries revealed that prevalence ranges from 1 to 84.6%. There is particular concern because it causes significant morbidity and mortality among hemodialysis (HD) patients. The aim of the study was to study the prevalence of HCV infection and its genotype in HD patients, HCV viremia by PCR, demographic profile and risk factors of HCV infection. Methods: This is a prospective cross-sectional study conducted in 225 patients undergoing HD at Gandhi Hospital, Secunderabad. Patients were subjected to screening for Anti-HCV antibody using ELISA, HCV RNA using RT PCR technique and genotyping. Further comparison was done with healthy control population and blood donor group. Statistical analysis of the data was done by Chi-square test using EPIINFO 2000 software with P < 0.001 highly significant and P > 0.05 insignificant. Results: Out of 225 hemodialysis patients 38 (16.8%) patients were anti HCV positive. Duration of dialysis was significantly longer in anti-HCV antibodies positive group with dialysis duration more than 2 years. Seropositivity is more in HD patients having dialysis more than one center. HCV RNA was detected in randomly selected 13/25 (52%) anti HCV positive patients. The genotype distribution was as 3a (7) 2a (2), 2b (1), mixed genotypes (3). Conclusion: Duration of dialysis, getting dialysis at more than one center is important association for anti-HCV antibodies positivity. Genotype 3 was predominant (61.11%). Detection of genotypes helps in initiation of therapy and prediction of prognosis in patients of chronic renal failure on hemodialysis. The authors have none to declare.

HBsAg and anti-HCV screening in elderly hospitalized patients of a German tertiary referral centre.

Elderly patients are under-represented in hepatitis B and C screening approaches, but may be at increased risk for advanced liver disease. We therefore screened a hospitalized elderly population. 6011 admissions to the department of internal medicine and neurology within one year were screened for HBsAg and anti-HCV (Elecsys(®)-HBsAg and -anti-HCV). Positive anti-HCV results were confirmed with the INNO-LIA™ assay. HCV-RNA was analyzed by real-time PCR in the case of confirmed positive anti-HCV results, HBV-DNA in the confirmed HBsAg positive individuals. Patient´s mean age (62.4 years) was 19 years above that of the average German population. The confirmed HBsAg prevalence was 0.6 %. 34 % (n = 12/35) of HBsAg positive cases were newly diagnosed, three of them presented with HBV-DNA levels > 2000 IU/mL. The confirmed anti-HCV prevalence was 0.9 %. 14 % (n = 8/56) of anti-HCV positive patients were previously undiagnosed. HCV-RNA was positive in three of them. In newly diagnosed individuals cirrhosis was present in 1/12 of the HBsAg and in 3/8 of the anti-HCV positive individuals. Compared to non-infected controls, the following risk factors were significantly more frequent in infected patients: (i) HBsAg: sexual exposure (20 % vs. 2 %), blood transfusion before 1992 (13 % vs. 6 %), referrals from nursing homes (10 % vs. 1 %). (ii) Anti-HCV: blood transfusion before 1992 (41 % vs. 6 %), IVDU (25 % vs. 0.5 %), organ transplantation (20 % vs. 5 %), hemodialysis (11 % vs. 3 %). HBsAg and anti-HCV were underdiagnosed in a senescent population, however, only few cases presented with advanced liver disease. Referrals from nursing homes were at increased risk for HBV infection.

Characteristics of Seropositive Hepatitis B and C Thalassemia Major Patients in South-East of Iran

Background: Hepatitis is a serious blood born infection in patients with β-thalassemia major (β-TM). There was no previous report on hepatitis prevalence in patients with β-TM in Zabol, Iran. Objectives: The current study aimed to evaluate characteristics of hepatitis in patients with ᵝ-TM visiting Imam Khomeini Hospital of Zabol, in Sistan and Baluchistan province of Iran. Patients and Methods: There were 90 patients with ᵝ-TM. General demographic and laboratory results were obtained by interviews and reviewing clinical and laboratory histories. Data for anti-HCV, HBs antigen and anti-HBs were extracted from latest archived records, and analyzed using SPSS ver. 19. Results: Males and females comprised 51% and 49% of the patients, respectively. Mean age of the patients was 14.8±7.4 years old. Anti-HCV and HBs antigen were detected in 10% and 3.3% of the patients, respectively. Significant difference was found between the mean age of anti-HCV positive (20.1 ± 3.6, 95% CI: 17.3 - 22.9) and negative (14.2 ± 7.5, 95% CI: 12.5 - 15.9) patients (P = 0.02). Mean ferritin value was measured 4702 ± 2743 ng/mL. A significant correlation was observed between serum ferritin level and age (r = 0.3, P = 0.01). Hepatic enzymes, aspartate aminotransferase (AST) and alanine aminotransferase (ALT) had mean levels of 51.8 ± 32.8 IU/L and 58.8 ± 59 IU/L, respectively. No significant association was identified between hepatitis status and either ferritin or hepatic enzymes levels. Conclusions: Results demonstrated the relatively high prevalence of HCV infection in the patients. Applying sensitive methods to screen blood units is recommended to minimize the risk of transfusion associated hepatitis. Keywords: β-Thalassemia Major, Anti-HCV, HBs Antigen, Anti-HBs, Ferritin

H.PYLORI INFECTION

Objectives: To study the frequency of H. pylori infection and its association as acause of upper G.I bleeding in cirrhosis. Study Design: Cross Sectional Study. Setting: MedicalUnit III, JPMC Karachi. Period: January 2014 to December 2014. Methods: 100 patients ofestablished cirrhosis with upper G.I bleeding were included in this study. These patients wereevaluated for viral etiology of cirrhosis. An upper G.I Endoscopy was performed in all patientsand antral biopsies were taken. Rapid urease test was performed on biopsy specimen fordetection of H.pylori infection. Results: Out of 100 patients 71 were males and 29 were femaleswith age ranging between 14 to 70 years. Among them 53% patients turned out to be positivefor H.Pylori infection with rapid urease test. H.pylori infection was detected in 68.7% of HBsAgpositive patients and in 50% of Anti HCV positive patients. On upper G.I endoscopy 96 patientshad PHG and among them 50 (52%) were positive for H.pylori. 4 patients did not have PHGand among them 3 (75%) were positive for H.pylori. Gastric ulcer was present in 17 patientsand amongst them H.pylori was detected in 10 (58.8%) cases. Duodenal ulcer was present in 5patients and among them 2 (40%) were positive for H.pylori. Gastritis was present in 17 casesamong them 11 (64%) were positive for H.pylori. Duodenitis was present in 13 cases amongthem 11 (84.6%) patients were positive for H.pylori infection. Conclusion: The frequency ofH.pylori infection was low in cirrhotic patients. No association was seen in H.pylori infectionand causes of upper G.I bleeding in cirrhosis including PHG, gastric ulcer and duodenal ulcer