anti-HCV Positive Patients Research Articles

English

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

Low cross-neutralization of hepatitis C correlates with liver disease in immunocompromized patients.

Chronic hepatitis C virus (HCV) infection causes severe liver disease in HIV-infected patients and liver transplant recipients. The impact of serum and immunoglobulin on viral entry was analysed in these patients. Sera from 60 anti-HCV positive patients, including 30 who were also anti-HIV positive, were tested with HCVpp from different genotypes (1a, 1b, 3 and 4) and with HCVcc (H77/JFH1). Seventeen HIV-seropositive and 13 HIV-seronegative patients with decompensated liver disease were studied before and after liver transplant. Serum neutralization was markedly lower after liver transplant and in HIV patients than in mono-infected immune-competent individuals. This effect was due to low antibody-mediated neutralization. In HIV patients, low neutralization was correlated with low lymphocyte T CD4 cell counts and the severity of liver disease. To characterize neutralization, we tested HCVpp lacking hypervariable region (HVR1) and SR-BI receptor cholesterol transfer inhibition by BLT-4. These experiments showed that neutralization was strongly dependent on the HVR1 and the SR-BI receptor. HVR1 sequences showed that selective pressures were low in immune-compromised patients and highly correlated to HCV neutralization after liver transplant. Neutralization experiments were reproduced with HCV strain JFH1. Serum neutralization in HIV-coinfected patients and HCV-infected liver transplant recipients is poor enhancing HCV entry through HVR1/SR-BI interplay. This may contribute to the severity of hepatitis C in these settings.

Liver Enzymes in Children with beta-Thalassemia Major: Correlation with Iron Overload and Viral Hepatitis

BACKGROUND:Beta Thalassemia is the most common chronic hemolytic anemia in Egypt (85.1%) with an estimated carrier rate of 9-10.2%. Injury to the liver, whether acute or chronic, eventually results in an increase in serum concentrations of Alanine transaminase (ALT) and Aspartate transaminase (AST).AIM:Evaluating the potentiating effect of iron overload & viral hepatitis infection on the liver enzymes.PATIENTS AND METHODS:Eighty (80) thalassemia major patients were studied with respect to liver enzymes, ferritin, transferrin saturation, HBsAg, anti-HCV antibody and HCV-PCR for anti-HCV positive patients.RESULTS:Fifty % of the patients were anti-HCV positive and 55% of them were HCV-PCR positive. Patients with elevated ALT and AST levels had significantly higher mean serum ferritin than those with normal levels. Anti-HCV positive patients had higher mean serum ferritin, serum ALT, AST and GGT levels and higher age and duration of blood transfusion than the negative group. HCV-PCR positive patients had higher mean serum ferritin and serum ALT and also higher age and duration of blood transfusion than the negative group.CONCLUSION:Iron overload is a main leading cause of elevated liver enzymes, and presence of HCV infection is significantly related to the increased iron overload.

Occult hepatitis B virus infection among chronic hemodialysis patients in Alexandria, Egypt.

The prevalence of end-stage renal disease has increased dramatically in developing countries. Hepatitis B virus (HBV) infection is a global health problem that represents a significant co-morbidity event that has led to outbreaks of hepatitis B. There are inadequate data concerning occult HBV infection among Egyptian chronic hemodialysis patients. This study aimed to detect occult HBV infection among chronic hemodialysis patients in Alexandria, Egypt. A cross-sectional study was performed on 100 patients with end-stage renal disease that received maintenance hemodialysis and had tested negative for HBV surface antigen. Blood samples were collected before the initiation of hemodialysis. Sera were tested for hepatitis C virus (HCV) and hepatitis B core (HBc) antibodies using ELISA, and HBV DNA was detected by SYBR Green real-time PCR using specific primers for the s and c genes and by nested PCR using pol gene-specific primers. The serum activity of alanine and aspartate aminotransferase (ALT and AST) were also measured. Anti-HCV and anti-HBc antibodies were detected in 34% and 48% of patients, respectively, and 70.6% of anti-HCV positive patients were also positive for anti-HBc antibodies. This association was statistically significant (p=0.001). HBV DNA was detected in 32% of the hemodialysis patients. A significant association was determined between the presence of HBV DNA and anti-HCV positivity (p=0.021). Aminotransferases were elevated in 21% of the studied patients, more often in patients with positive anti-HCV profiles than in patients negative for anti-HCV (p<0.05). In conclusion, the serological markers of HBV infection should be verified with molecular tests to investigate possible occult infections, especially among anti-HBc-positive hemodialysis patients, to improve our understanding of their clinical, laboratory, and epidemiological characteristics.

IFNL3 polymorphisms and HCV infection in patients with beta thalassemia

Background and relationale for the study. Genome-wide association studies have identified host genetic variation to be critical for spontaneous clearance and treatment response in patients infected with hepatitis C virus. Recently, the role of the IFNL3 polymorphisms in influencing the spontaneous clearance of HCV, the response to interferon and the progression of liver fibrosis, was also demonstrated in patients with thalassemia major infected by genotype 1b. In the present study we retrospectively analyzed 368 anti-HCV positive patients with beta-thalassemia at two Italian major centers in Cagliari and Torino.Results. C/C variant of polymorphism rs12979860 was related to response to interferon treatment and, above all, to spontaneous clearance of the virus. However, the positive predictive power was stronger for viral persistence than spontaneous clearance and in such respect the TT allele was more predictive than CC. The methylation associated polymorphism rs4803221 had independent effects with respect to rs12979860 and the haplotype tagged by SNP rs12979860 and rs4803221 significantly could improve the viral clearance prediction in infected patients. Neither necroinflammation or bilirubin values in the chronic phase of the hepatitis C were related to IFNL3 polymorphisms. No relation among IFNL3 polymorphisms and fibrosis stage directly shown by the liver biopsy was found.Conclusions. Also in thalassemia the SNPs on chromosome 19q13 closely associates with spontaneous and treatment-induced HCV clearance. The viral clearance prediction is significantly improved by the haplotype tagged by SNP rs12979860 and rs4803221. Neither necroinflammation, bilirubin values or fibrosis stage seem to be related to IFNL3 polymorphisms.

The Usefulness of Anti-HCV Signal to Cut-off Ratio in Predicting Viremia in Anti-HCV in Patients With Hepatitis C Virus Infection.

Background:Hepatitis C Virus (HCV) infection is diagnosed by antibody and RNA based methods. Patients with anti-HCV sample rate/cutoff rate (S/CO) ratios > 1 are reported as anti-HCV positive. RNA based methods are introduced to confirm positivity in seropositive samples.Objectives:The current study aimed to assess relationship between S/CO rates and HCV-RNA levels in the laboratory to identify HCV viremia in patients with a positive anti-HCV.Patients and Methods:All serum samples were assayed for anti-HCV by ELISA method. A total of 265 anti-HCV positive patients were tested for HCV-RNA testing by quantitative method using Artus HCV RG Real-time Polymerase Chain Reaction (RT- PCR) kit. Statistical analysis was done by SPSS version 16.Results:Of the 265 patients with HCV infection, 204 (77%) were male and the mean age was 43.53 ± 13.17 years, ranging 1 - 81 years. No correlation was found between S/CO ratios and HCV-RNA levels. There was significant difference in S/CO ratio between viremic and non-viremic subjects. The sensitivity, specificity, negative predictive value, and positive predictive value were 100%, 81.4%, 100%, and 77.2%, respectively in the S/CO ratio of 2.7.Conclusions:The present study indicated that anti-HCV S/Co ratio is useful to predict non-viremic patients. A cut-off value of 2.7 can determine the usefulness of HCV-RNA testing. Patients with S/CO < 2.7 are not viremic; therefore, HCV-RNA testing is not recommended. It is suggested that laboratories report S/CO ratio along with anti-HCV results to manage HCV infection better, especially in countries that quantitative HCV testing is expensive or not available.

Evaluation of the HCV RNA Results in Anti HCV Positive Patients

Evaluation of the HCV RNA Results in Anti HCV Positive Patients

Prevalence of risk factors for liver disease in a random population sample in southern Germany.

Chronic liver disease leads to fibrosis and cirrhosis of the liver. This may, in turn, result in chronic liver failure or the development of hepatocellular carcinoma (HCC). Main risk factors for chronic liver disease are viral hepatitis and alcoholism. The present study assessed a randomly selected population in southern Germany for risk factors for chronic liver disease such as fatty liver disease, viral hepatis infection and life-style factors. In addition, the potential association with elevated liver enzymes was investigated. A total of 2256 subjects (1182 females, 1074 males), aged 18 - 65 years, participated in the study. Each subject underwent a standardized ultrasound examination, and anthropometric and biochemical assessments. Test subjects were randomly selected from the general population of a town in southwestern Germany. Data were acquired from November to December 2002 without further follow-up. Several factors were found to be associated with chronic liver disease in the study population. Alcohol consumption >20 g/d was seen in 18.1% (n=409). Metabolic syndrome was diagnosed in 5.9% (n=132). The number of people with a BMI greater than 25 kg/m(2) was 45.1% (n=1017). The prevalence of subjects with chronic hepatitis B was 0.7% (n=15), that of anti-HCV positive patients, 0.6%(n=15). Elevated gGT was seen in 10.4% (n=14) of the patients. Prevalence of hepatic steatosis was 25.0% (n=564). Many cases of chronic liver disease could be prevented by healthy nutrition, optimized medical treatment of associated disorders, and prevention strategies such as routine vaccination, in particular, against hepatitis B virus (HBV).

THU0281 Use of Anti-Tumor Necrosis Factor Alpha Therapy in Patients with Inflammatory Arthritis and Concurrent History of Hepatitis B or Hepatitis C Infection: A Retrospective Analysis of 44 Patients

BackgroundThe safety of tumor necrosis factor (TNF) inhibitors in the setting of HBV and HCV infections is controversial since it has been associated with an increased risk of reactivation of...

Prevalence of hepatitis B and C infections in rheumatoid arthritis and ankylosing spondylitis: A multicenter countrywide study.

Immunosuppressive therapies, especially tumor necrosis factor-α inhibitors, are frequently used in treatment of rheumatoid arthritis (RA) and ankylosing spondylitis (AS). These therapies can induce viral reactivation in concurrent hepatitis B virus (HBV)- or hepatitis C virus (HCV)-positive patients. On the other hand, the prevalence of HBV and HCV infections is not exactly known in RA and AS patients. The aim of this study was to investigate the prevalence of HBV and HCV infections in RA and AS patients. A group of 1517 RA and 886 AS consecutive patients followed by six different rheumatology outpatient clinics of Turkey were recruited in this study. The prevalence of HBV surface antigen (HBsAg) and HCV antibody (anti-HCV) were retrospectively investigated. The mean age was 49.0±13.2 years in RA and 37.3±10.5 years in AS patients. HBsAg prevalence was 35 (2.3%) in RA and 27 (3%) in AS patients. Anti-HCV prevalence was 17 (1.1%) and 10 (1.1%), respectively. In the RA group, both HBsAg and anti-HCV positive patients were older than negative ones (p<0.05), and the highest prevalence was found in those 60-69 years (p<0.05). In previous national data, the prevalence of HBsAg has been reported as 3.99% and shown to increase with age. In this study we have found a lower HBV infection prevalence in both RA and AS patients according to Turkish national data. This result may explain by being younger age of our patients. In another conclusion, lower prevalence could be related to, joint complaints may less consulted to Rheumatologist in HBV positive.

Phylogenetic analysis of hepatitis C virus strains and risk factors associated with infection and viral subtypes among Iranian patients.

Hepatitis C virus (HCV) has infected approximately 170 million people worldwide. While the seroprevalence of anti-HCV antibody among Iranian blood donors is 0.13%, HCV infection is prevalent in 59-80% of Iranian injecting drug users. One hundred seventy-eight anti-HCV positive patients were referred to the Gastroenterology Department at the Taleghani Hospital (Tehran, Iran) between June 2007 and June 2012. Out of 178 samples, 142 were positive for HCV-RNA. HCV subtypes were determined using phylogenetic analysis of the NS5B or 5'UTR/core regions. Of 142 viremic patients, 71 (50%) were infected with HCV subtype 1a, 43 (30.3%) with subtype 3a, 20 (14.1%) with subtype 1b, 3 (2.1%) with subtype 4d, 2 (1.4%) with subtype 4a, 1 (0.7%) with subtype 2b, and 1 (0.7%) with subtype 6a. Interestingly, genetic analysis of a sub-genomic fragment from one patient identified a non-subtypeable HCV genotype-3 strain. There was a significant association between HCV subtype and a history of injecting drug use (P = 0.003). Subtype 3a was predominant among patients with such a history. Injecting drug use was associated with younger age (P < 0.001). HCV subtype was also significantly associated with a history of upper gastrointestinal endoscopy (P = 0.02). Subtype 1a was more frequent among patients with such a history. In addition, history of upper gastrointestinal endoscopy was significantly associated with older age (P = 0.002). In conclusion, while HCV subtype 1a is predominant among infected Iranian individuals, subtype 3a is predominant among Iranian injecting drug users.

Frequency of active HCV infection among anti-HCV positive patients in selected districts of Khyber Pakhtunkhwa, Pakistan

Objective: The objective of this study was to determine frequency of active HCV infection among confirmed anti-HCV positive subjects of KPK in order to help the infected subjects decide about anti-viral treatment options. Methods: Blood samples (3075 samples) were collected from patients in selected districts of KPK and were transported to Centre of Biotechnology and Microbiology, Diagnostic laboratory, University of Peshawar. These patients were already screened for anti-HCV by ICT (Immuno Chromatographic Technique) and ELISA (Enzyme Linked Immunosorbant Assay) in the local laboratories of the concern districts. Subsequently, viral RNA was isolated from serum sample and subjected to Real-time PCR. The frequency of the results was calculated for the HCV-RNA positive and negative samples. Results: Out of 3075 confirmed anti-HCV samples, HCV-RNA positive and negative samples were 2055 (66.6%) and 1020 (33.3%) respectively. The frequency of male and female HCV-RNA positive samples was 57.6% and 42.4% respectively. Rate of false anti-HCV positivity was 33.3%. Moreover, rate of active HCV infection was found more in district Bunir followed by districts Dir and Mardan. Comparatively less positive percent frequency of active HCV infection was found in districts Swabi, Peshawar and Kohat, respectively. Conclusion: It is concluded that viremia is present in more than 50% of confirmed anti-HCV positive patients. Anti-HCV positive, but HCV-RNA negative samples represent either false- positivity of anti-HCV or a spontaneous clearance of HCV. J Microbiol Infect Dis 2013;3(4): 199-202

A study of changing trends of prevalence and genotypic distribution of hepatitis C virus among high risk groups in North India

Purpose: Hepatitis C virus (HCV) has emerged as a leading cause of chronic hepatitis, liver cirrhosis and hepatocellular carcinoma. There is a great variability in HCV’s geographical presence, transmission routes, genotypic distribution etc., in studied populations. We undertook this study in a North Indian hospital on patients of chronic liver disease to observe any emerging trend in risk groups, transmission patterns, genotypic distribution of the virus in this geographical region and its correlation with viral load. Materials and Methods: There were 54 anti-HCV positive patients including 31 HCV Ribonucleic acid (RNA) positive patients were included in the study. HCV genotyping was carried out by restriction fragment length polymorphism (RFLP) followed by direct sequencing of the core region. Viral load estimation was carried out by Taqman real time polymerase chain reaction system. Results: In 45/54 (83.3%) anti-HCV positive patients, iatrogenic procedures were responsible for transmission with blood transfusion alone responsible in 36/54 (67%). Genotype 3 was observed to be the commonest type found in all risk groups followed by type 1 and 2. Subtype 3b (35.5%) was found more prevalent than subtype 3a. A higher frequency of subtype 1b (19.4%) was also seen. Genotype 1 was associated with a significantly higher viral load compared to genotypes 3 and 2. No significant difference was observed in the biochemical profile among the three genotypes except for the levels of the enzyme, aspartate aminotransferase (AST). Conclusions: Iatrogenic procedures, especially contaminated blood transfusion etc., still contributes significantly to the pool of HCV infection. Genotype 3 is the predominant genotype in North India, though the subtype distribution within genotype 3 may be changing. The association of severe liver disease is significantly more with genotype 1 as evidenced by higher viral load and deranged AST levels.

P3: Unexpected high prevalence of hepatitis C in a densly populated metropolitan area of Germany

PURPOSE OF THE STUDY: Recent studies have identified a seroprevalence of hepatitis C of 1.6% in the United States and 0.7% in Germany. A significant variation has, however, been detected between rural and metropolitan areas. Identification of hepatitis C virus (HCV)-positive persons for appropriate counseling and management is the major focus of national prevention programs. Currently, routine testing is recommended for persons most likely to have HCV infection. Our aim was to assess the prevalence of hepatitis C in the German Ruhr region, which is one of the largest and most densely populated metropolitan areas in Europe. METHODS: Between 06/2009 and 07/2010 8435 consecutive patients (46.4% male, 53.6% female) who were admitted to the emergency unit of a tertiary care center (St. Josef Hospital, Ruhr-University Bochum, Germany) were investigated. Tests included analysis of antibodies to HCV (anti-HCV), ASTand ALT-levels and HCV RNA, if applicable. Thirty patients with known replicative hepatitis C infection served as internal control. SUMMARY OF RESULTS: The seroprevalence of anti-HCV was 3.45% (291/8435 patients). 194/291 (66.67%) seropositive individuals were amendable for further evaluation. Viral replication was detected in 70.62% of these patients (137/194) equating to a prevalence of replicative and chronic hepatitis C of 1.62% in this population. Age and sex distribution did not differ between anti-HCV positive patients and negative controls. Following analysis of liver transaminases, significant differences in AST levels between anti-HCV positive patients and negative controls (AST antiHCV positive = 60.8 4.2 U/L; AST controls = 37.7 4.5 U/L; p 0.05). CONCLUSIONS: The prevalence of hepatitis C in densely populated metropolitan areas seems to be higher than previously expected (3.45% versus 0.4–0.7%). Revisiting the risk stratification and a more extensive screening might contribute to more effective prevention programs. The mere evaluation of transaminases is not suitable for predicting either seroprevalence of anti-HCV antibodies or chronic hepatitis C. Furthermore, the pre-clinical identification of HCV-positive individuals might significantly reduce the risk of accidental hepatitis C transmission among healthcare workers and would lead to an increase of the early hepatitis C diagnosis targeting to an early lead-in of the antiviral therapy avoiding late complications.

CHRONIC HEPATITIS “C”;

OBJECTIVE: To find spectrum of various dermatological manifestations during hepatitis “C” virus infection in localpopulation of hyderabad. METHODS: This descriptive study was conducted in medicine department of Isra University HospitalHyderabad from January 2011 to June 2012. A total of 325 anti-HCV positive patients were enrolled. All patients were subjected todetailed history, careful clinical examination of skin by a dermatologist to diagnose skin disease. All data was analyzed using statisticalpackage SPSS 14.0. RESULTS: A total of 325 HCV positive patients (61% males and 39% females) were enrolled in this study. Mean agewas 43 (SD+10 years), ranging from 15 to 78 years. About 41% had one or more dermatologic manifestations. Pruritis was the leadingmanifestation found in 11% , lichen planus (oral and cutaneous) was next to be found in 6.7% patients and hyperpigmentation in 5.2%patients. Urticaria (acute &amp; chronic) was next counting in 5.23%. Jaundice, alopecia and vitiligo were seen in 4.9% each. Dry skin andinterferon injection site erythema were observed in 4.6% patients each. Cutaneous vasculitis was noticed in 3.6% each, whilephotosensitivity, psoriasis and Raynaud's phenomenon were seen in 1.8%, 2.5%, 1.5% patients respectively. CONCLUSION:Dermatological manifestations are very common in patients with chronic HCV infection and when confronted with a suspected skinlesion, patient should be screened for it. Epidemiological studies are essential to determine the real prevalence of other dermatoses duringcourse of HCV infection.

Occupational exposure to blood borne viruses among healthcare workers in a tertiary care referral hospital in tehran.

Dear Editor, Occupational exposure to blood-borne viruses (BBVs) is a major concern in the health care setting. The BBVs of primary concern are the human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV). Health care workers (HCWs) can be exposed to these viruses through needle-stick and other injuries through contaminated material with blood and other infectious body fluids. Nurses, health technicians, cleaning personnel and physicians are potentially targets for such accidents. The Center for Disease Control and Prevention (CDC) estimates that hospital-based healthcare personnel sustain an estimated 385,000 percutaneous injuries (needle-sticks and other sharp-devices) (1) annually. In Iran, the annual incidence of occupational exposure to BBVs is unknown due to the limited data in this area. The World Health Organization (WHO) estimates that more than two million injuries causes about 66,000 HBV, 16,000 HCV and about 1,000 HIV infections among 35 million HCWs each year (2). The key in reducing accidental exposure to BBVs is through promoting educational awareness of health care staff on suitability of HBV vaccination, in house training courses concerning preventive measures of such accidents and implementing proper postexposure prophylaxis (PEP) and following-up. Here, we reviewed case notes of 193 HCWs accidently exposed to BBVs over four-years, from January 2009 to January 2013. The data were reviewed in Labbafinejad hospital, which is a specialized 231 bed public tertiary care referral hospital with a total number of 915 HCWs who are potentially at accidental risk of acquiring BBVs. The study was approved by the ethics committee in the hospital. The reviewed HCWs cases (193) were classified into 75 nurses, 39 medical doctors, 35 cleaning personnel, 30 medical technicians (17 surgical operation technicians, 10 lab technicians and 3 radiology technicians), 13 nursing students and 1 medical student. In this study, the nurses were in top list of accidental exposure, which is in line with other studies (3, 4). Injuries were categorized as follows; 150 had needle-stick injuries, 22 cases had sharp cuts like scalpel and broken glasses and 21 cases had blood splashes on their eyes. Among these 193 cases, 132 HCWs were exposed to known serologically tested HIV, HBV and HCV negative patients, 24 had exposure to HBsAg positive patient, 5 had exposure to anti-HCV positive patients and two were exposed to HIV seropositive patient (one was co-infected with HCV infection). A total of 30 HCWs had occupational exposures to unknown sero-status patients. Anti-HBs antibody titer of the 24 HCWs, who had HBV exposure, was higher than 200 mIU/mL. Therefore, no intervention was done for them expect one who, despite being vaccinated had low anti-HBs titer. Thus, he was treated with hepatitis B immunoglobulin (HBIG) with another full course of hepatitis B vaccine, as routine schedule. Six patients were exposed to HCV seropositive patients; they underwent lab investigations, the result of that was normal for everyone. In these patients, follow up 2 weeks RT-PCR was negative. Thereafter, 1, 3, 6 months lab investigations were repeated and results were negative. One HCW was exposed to seropositive HIV patient, as the result of which he received PEP for HIV infection and underwent follow up and the result was negative. Another HCW was exposed to seropositive HIV coinfected with HCV. He also received PEP for HIV and underwent follow up lab investigation for HCV infection and lab results were negative. Hence, no further action was advised. PEP therapy has been shown to reduce the risk of transmission of HIV following accidental exposure by 80% (5). In conclusion, avoiding accidental occupational exposure to BBVs is an important safety issue, which can be achieved to some extent by health awareness of the problem and further by strengthening health control measures and providing a safe hospital work environment.

Patient-to-Patient Transmission of Hepatitis C at Iranian Thalassemia Centers Shown by Genetic Characterization of Viral Strains

BackgroundHepatitis C is prevalent among thalassemia patients in Iran. It is mainly transfusion mediated, in particular among patients treated before 1996 when blood screening was introduced.ObjectivesThe current study aimed to investigate why patients still seroconvert to anti-HCV in Iranian thalassemia centers.Patients and MethodsDuring 2006-2007 sera were sampled from 217 anti-HCV positive thalassemia patients at nine thalassemia centers in Tehran and Amol city, where 34 (16%) patients had been infected after 1996. The HCV subtype could be determined by sequencing and phylogenetic analysis of partial NS5B and/or 5׳NCR-core region in 130 strains.Results1a (53%) was predominant followed by 3a (30%), 1b (15%), and one strain each of 2k, 3k and 4a. Phylogenetic analysis revealed 19 clades with up to five strains diverging with less than six nucleotides from each other within subtypes 1a and 3a. Strains in seven clades were from nine patients infected between 1999 and 2005 and similar to strains from eight patients infected before 1996, indicating ongoing transmission at the centers. Further epidemiological investigation revealed that 28 patients infected with strains within the same clade had frequently been transfused at the same shift sitting on the same bed. An additional eight patients with related strains had frequently been transfused simultaneously in the same room.ConclusionsThe results suggest nosocomial transmission at these thalassemia centers both before and after the introduction of blood screening. Further training of staff and strict adherence to preventive measures are thus essential to reduce the incidence of new HCV infections.

Conventional Interferon Therapy Response among Chronic HCV Patients in Khyber Pakhtunkhwa

As Hepatitis C infection is the cause of hundreds of thousands of deaths worldwide including Pakistan. Different regions have different infection rates in Pakistan and hence different mortality. Khyber Pakhtunkhwa (KPK) is one of the main affected provinces of the country. Since Interferon (IFN) based therapy is used to eradicate the infection from the bodies of infected individuals. However information regarding treatment response in different population groups in case of chronic HCV patients is lacking. So it is aimed to investigate response rates of IFN and Ribavirin combination therapy in different districts of KPK. A total of 198 anti-HCV and PCR positive patients were selected from district Swabi, 54 from Kohat and 89 from Bunir for conventional IFN therapy keeping in mind therapy exclusive criteria for patients. All the patients were given 3MIU thrice a week and 300-400 mg thrice a day, dose of conventional IFN and Ribavirin respectively. Therapy was continued for six months with repeated investigations of CBCs and LFTs during and at the end of course. PCR test was also repeated during (3 months) and at the end of treatment (6 months). Out of total 341, selected patients for standard IFN- based therapy, 288 (81%) showed ETR while 53 (19%) did not show response. In different districts of KPK, the ETR rates were, 92% in district Swabi, 71% in Bunir and 80% in district Kohat. All these patients having positive ETR were negative for HCV RNA at the end of six months of conventional IFN therapy. IFN therapy response varies among different population groups of KPK but the average response rate is good enough against HCV infection. This high response may be attributed to responsive genotypes prevalent in KPK.

Hepatitis C Virus Antibodies in Patients with Hemoglobinopathies - Decreased Prevalence but Continued Transfusion-Related New Cases in Two New York City Hospitals

Purpose: There are no recent studies on hepatitis C virus (HCV) in patients with hemoglobinopathies who are also at risk for liver damage from iron overload after multiple blood transfusions. The aims of this study were to determine prevalence and incidence of HCV antibodies (anti-HCV) in patients with sickle cell diseases, and to assess how anti-HCV status impacts hospital attendance. Methods: Medical records of patients with sickle cell diseases who tested positive for anti-HCV and patients screened for anti-HCV after January 2009 in 2 New York City hospitals (Interfaith Medical Center and Kings County Hospital) were reviewed. Of 189 patients, there were 130 S/S, 36 S/C, 15 S/beta+ thalassemia, 6 S/beta0 thalassemia, 1 C/C and 1 A/A with 76% fetal hemoglobin. Transfusion history, drug use, liver function tests, HCV RNA status and hospital attendances on the year of the latest negative anti-HCV test and 2 years following the first documented positive anti-HCV test were recorded. Results: Anti-HCV was detected in 26/189 patients (13.8%). HCV RNA was detected in 10 of the 26 cases, negative in 7 cases and unknown in 9 cases. In 4 of the 26 anti-HCV positive patients, we were able to establish that anti-HCV had been non reactive before year 2000. HCV RNA was detected in one of these 4 patients, negative in the second and unknown in two cases. These four patients had no risk factors other than recent polytransfusion. None of the 23/189 patients who never received blood transfusion tested positive for anti-HCV. There was a significant difference in ALT (but not AST) between anti-HCV positive and anti-HCV negative patients (ALT 76.90± 155.80 IU/L and 59.06± 298.48 IU/L, respectively; Wilcoxon, p=0.01). The annual hospital attendance for anti-HCV positive patients was unchanged at 2 year follow-up, and there was no difference compared to anti-HCV negative patients (3.5 attendances for each group, p=0.78). Conclusion: The prevalence of anti-HCV in patients with hemoglobinopathies has decreased from 16.5% in 2002 to 13.8% presumably due to systematic screening of blood products (Richard S, Billett HH, 2002). New reactive anti-HCV cases with detectable HCV RNA occur in patients requiring a high number of transfusions and suggest that anti-HCV is not 100% sensitive in diagnosing HCV in blood donors and a more sensitive assay may be warranted. Although anti-HCV positive status does not appear to worsen the course of sickle cell disease, we suggest periodic testing and education of patients who test positive for anti-HCV on the importance of their assessment by a hepatologist.

Seronegative anti‐hepatitis C virus antibody in hemodialysis patients

Dear Editor, I read with interest the recently published article by El-Sherif et al. in your journal. The authors have reported a high prevalence of false-negative rate of antiHCV antibody among hemodialysis (HD) patients using molecular studies. I agree with the authors regarding the importance of nosocomial transmission of hepatitis C virus (HCV) infection among HD patients. I would like to emphasize that dedication of hemodialysis machines in HCV negative and positive patients by anti-HCV antibody screening cannot prevent the transmission efficiently. Furthermore, they found the HCV-RNA by reverse transcription polymerase chain reaction (RT-PCR) in 17.9% of anti-HCV-negative HD patients that grouped in falsenegative of anti-HCV antibody. I would like to add that one probability for this high rate may be related to contaminations during sampling, transferring, or processing for RT-PCR. The reason for that is the low rate of antiHCV seroconversion (21.4%) out of 14 false-negative anti-HCV patients. Phylogenetical analysis in any center among the patients can help us to better understand the similarities between the two HCV-RNA groups. Comparison between the anti-HCV positive and false antiHCV HD patients can help for better understanding the distribution of risk factors in the studied groups. Preor postdate transfusion of blood screening in Egypt is critical for any conclusion regarding the importance of this risk factor in the studied groups. In a published systematic review related to HCV infection in Eastern Mediterranean Regional Office of WHO, the prevalence rate of HCV infection in HD patients in Egypt was 48% and transfusion history was a risk factor. Finally, I would like to emphasize on the importance of HCV detection before renal transplantation; the infected HD patients have worse outcomes than HCV-negative HD patients after renal transplantation.