anti-HCV Positive Subjects Research Articles

Towards SDG30: Fighting HCV with a screening program in Lombardy

Abstract Background The third Sustainable Development Goal, specifically in target 3.3, identifies fighting HCV as a priority. It is estimated that in Italy more than 200.000 patients eligible for HCV treatment are not being treated and 20% are not aware of the infection. Lombardy region to promptly identify and treat patients affected, developed a screening program to be offered to all patients born between 1969 and 1989. Healthcare facilities were divided into first and second-level centers and the campaign was designed in 2 phases: at the first level centres patients were screened with blood tests, if positive they were contacted by second level structures to get a diagnostic test and if confirmed positive to start the therapeutic approach. Methods The screening program started in June 2022 and consisted of an opportunistic offer of free testing for serum anti-HCV antibodies in the context of any healthcare performance offered to eligible patients. Data were uploaded and collected on a web database from which second-level centers could obtain data of positive patients to contact them and set appointment for confirmation tests. Results As of 31st December 2022 120,193 individuals underwent HCV screening in 75 screening centers in Lombardy. The mean age was 44 years, 65.2% were females, and 83.7% were tested at outpatient blood collection centers. 604 (0.50%) patients tested positive with mean age 47 (±5). HCV-RNA was detectable in 125 out of 441 (28.3%) anti-HCV positive subjects with available HCV-RNA. Patients with active HCV infection were aged 46 (±6) and were mostly males (56.8%). Overall, the prevalence of active infection in the general population was 0.10% and was higher in elderly. Conclusions The prevalence of active HCV infection in the general population born between 1969 and 1989 in Lombardy was low. Considering the higher prevalence of active infection in the elderly population, an extension of the screening offer to patients born between 1949-70 could be evaluated. Key messages • Prevalence of active HCV infection in screened population is low. • Extending the screening offer may result in higher number of positive results and more people directed towards treatment.

The Low Incidence of Viral Hepatitis Reactivation Among Subjects on Immunotherapy Reduces the Impact of Suboptimal Screening Rate

Background and AimsImmunotherapy with immune checkpoint inhibitors (ICIs) is a pillar of many advanced tumors. However, there is scarce data concerning the rate of viral hepatitis screening in this population or the risk of viral reactivation.MethodsRetrospective–prospective study that includes all patients who began ICIs between January/2019 and December/2020 in a University Hospital. Data on viral hepatitis screening prior to the beginning of ICIs were collected. In subjects lacking information, serological tests were requested prospectively. Among HBsAg, anti-HBc, or anti-HCV positive subjects, reactivation was prospectively assessed.ResultsDuring the 2-year period of study, 595 subjects received ICIs (61.2% male, mean age 63 years). The most prevalent cancers found were 35.5% lung cancer, 12.1% melanoma, and 8.2% head and neck; ICIs schemes were mainly anti-PD1 (65.7%), followed by anti-PD-L1 (19.2%), and combined therapy (13.6%). Prior to immunotherapy, anti-HCV screening was performed in 462 (77.6%) subjects, HBsAg in 462 (77.6%), anti-HBc in 335 (56.3%), and the complete screening in 328 (55.1%). The anti-HBc screening was more frequently ordered among patients treated with concomitant systemic therapy (p = 0.003), especially in the case of chemotherapy (p = 0.015), though HCV screening was more commonly performed in concomitant therapies different from chemotherapy (p = 0.001). Serological tests were completed prospectively in those alive, leading to an overall prevalence for anti-HCV of 3.5%, HBsAg at 1.3%, and anti-HBc of 15.2%. HCV-RNA was detected in 2/19 (both patients with hepatocellular carcinoma), HBV-DNA in 4/7 HBsAg positive, and in 1/75 anti-HBc positive subject. Five out of the 7 HBsAg carriers and 1/75 anti-HBc+ subjects (due to concomitant antiretroviral therapy) received antiviral prophylaxis. Neither cases of HBV reactivation nor changes in HCV viral load were observed.DiscussionHBV and HCV screening prior to immunotherapy is suboptimal. Though the rate of viral hepatitis reactivation seems extremely low, efforts should be made to optimize viral hepatitis screening prior to immunotherapy for the selection of candidates for either antiviral prophylaxis or periodical follow-up.

Innovative procedures for micro-elimination of HCV infection in persons who use drugs.

People who use drugs are a key population in global HCV control. We evaluated the efficacy of an innovative model to eliminate HCV infection in a high-risk population of PWUD in a service for substance use disorder (SUD). Between January 2018 and December 2018, we conducted a prospective, interventional, before and after study, based on audits performed by Infectious Diseases physicians in a SUD facility in Piedimonte Matese, in southern Italy, to improve the knowledge about HCV infection; a shared protocol for screening and linkage to care of patients was implemented. The pre-intervention period was defined as January-December 2017 and the post-intervention period as January-December 2018. The subjects followed up at SUD facility in the pre-intervention and post-intervention periods were 318 and 275, respectively. Compared with the pre-intervention period, the number of anti-HCV-positive subjects tested for HCV RNA was higher in the post-intervention period (91% vs 27%, P<.0001), as was the number who started directly acting antivirals (DAAs). Of the 18 HCV RNA-positive subjects in the pre-intervention period, only 3 (16.6%) started DAA, a percentage decisively lower than that observed after the start of the programme, 63 (84%) of 75 subjects (P<.0001), and all obtained SVR. The data were similar for people who inject drugs (PWID) and non-PWID sub-populations. The use of our innovative model with close interaction between the Infectious Disease Unit and the SUD facility determined a significant increase in HCV RNA testing, linkage to care and the start of DAA in the PWUD population.

Significant decrease in the prevalence of hepatitis C infection after the introduction of direct acting antivirals.

Accurate information on the epidemiology of hepatitis C and B infection is mandatory to establish a national/regional plan. We aim to update the prevalence of hepatitis C and B infection in Catalonia using point-of-care tests to analyze the risk factors related and to implement a linkage-to-care circuit. This is a community-based study. A random list of adult individuals was retrieved from censuses of primary care centers. Point-of-care tests for anti-hepatitis C virus (HCV) and HBV surface antigen (HBsAg) and a questionnaire for risk factor assessment were performed. Positive results were validated and a circuit for linkage-to-care was established. A total of 3328 individuals were included. The anti-HCV and HBsAg overall prevalence were lower than expected [1.02%, 95% confidence interval (CI) 0.65-1.39; and 0.52%, 95% CI 0.26-0.77, respectively]. Anti-HCV positive subjects were mostly (88%) autochthonous. The prevalence increased with age; only 12% were under age 40. The associated risk factors were drug use, blood transfusion, relative with HCV, and diabetes. Notably, the prevalence of active infection was only 0.49% (95% CI 0.23-0.74), 40% less than previously reported, reflecting the impact of direct acting antiviral therapy. Differently, HBsAg positive subjects were mostly foreign migrants (53%) with no other risk factors. Despite the implementation of a linkage-to-care circuit, one third of HBsAg positive subjects were lost. The prevalence of HCV infection was lower than previously reported, showing a strong impact of direct acting antiviral therapy in the last years. Because of hepatitis B universal vaccination, HBV infection in Catalonia is mainly associated with migrant population. Linkage-to-care in patients with hepatitis B was challenging and warrants additional efforts.

Geospatial epidemiology of hepatitis C infection in Egypt 2017 by governorate

BackgroundGeographic Information Systems (GIS) and spatial epidemiological methods may provide a basis for disease investigation through which hotspots and disease determinants can be identified. Applying these methods for hepatitis C virus (HCV) in Egypt would support a more effective strategy to control its transmission. Therefore, this study used GIS software to draw one of the first HCV maps in Egypt elucidating and analyzing geographical and epidemiological differences in HCV distribution within the country. MethodsA cross-sectional survey of 21 governorates (n = 12169, 8080 rural, 3733 urban and 356 slums areas) was completed. All participants were interviewed regarding potential exposures to HCV. Third generation ELISA was used to test serum for HCV antibody. Quantitative real-time RT-PCR was used to test anti-HCV positive subjects for HCV-RNA. ResultsThe participants ranged in age from 14-90 years. Overall, anti-HCV sero-prevalence was 14.8%. The prevalence of HCV-RNA, was 9.5%. Proportionally, 65.8% of anti-HCV positives were positive for HCV-RNA. The map of Egyptian governorates highlighted the darkest spot of HCV infection in Menoufeya (37.8%) followed by Beni Suef (29.2%) and Minya (28.6%). Anti-HCV prevalence was higher among males and logistic regression models revealed a strong independent association with increasing age, rural residence and parenteral anti-schistosomal therapy. ConclusionsRural residences and HCV hotspots should be prioritized for HCV prevention programs. The unique age distribution first shown in this study shows that the older age groups (≥60 years old) constitutes a considerable reservoir of infection and must not be neglected.

High prevalence of non-alcoholic fatty liver disease among healthy male blood donors of urban India.

BackgroundThere is limited data on the community prevalence of non‐alcoholic fatty liver disease (NAFLD). The present study evaluated the prevalence of NAFLD in a large number of healthy male blood donors of urban north India.MethodologyIn a prospective study performed over 18 months, voluntary blood donors fulfilling the requisite blood donation criteria and consenting to participate in the study were evaluated. The study received the approval of the institute's ethics committee. Diagnosis of NAFLD was made by excluding significant alcohol intake, ultrasound showing hepatic steatosis, and exclusion of transfusion associated infections. Subjects were also evaluated for various metabolic risk factors and the presence of metabolic syndrome.ResultsOf 1388 subjects who consented for participation, 386 did not come for evaluation. Three females, nine (0.9%) HBsAg‐positive, and four (0.4%) anti‐HCV positive subjects were excluded. Of the 986 males evaluated with hepatobiliary ultrasound, 543(55.1%) had fatty liver on ultrasonography [15 (1.5%) alcoholic fatty liver and 528 (53.5%) NAFLD]. Among those with NAFLD, 469 (88.8%), 54 (10.2%), and 5 (0.9%) had mild, moderate, and severe hepatic steatosis, respectively. Subjects with NAFLD, when compared to those without NAFLD, had significantly higher age, BMI, waist circumference, blood pressure, total cholesterol and triglycerides, low‐density lipoprotein, and fasting plasma glucose. Multivariate regression analysis demonstrated age, BMI, waist circumference, systolic blood pressure, total cholesterol, and number of metabolic syndrome criteria as independent predictors of NAFLD.ConclusionsUrban Indian healthy male blood donors have a high prevalence of NAFLD.

Prevalence and risk factors of HCV infection in a metropolitan area in southern Italy: Tail of a cohort infected in past decades.

Data on the prevalence of HCV infection in Italy are often outdated and from non-urban populations. This study assessed the prevalence and risk factors for HCV infection in a large metropolitan area in southern Italy. A random 1:3 systematic sample of the adult general population of Naples was selected from three general practitioner patient registers in three different city districts. Socioeconomic indicators and risk factors for HCV infection were collected. Anti-HCV and HCV-RNA assays were performed. Logistic regression analysis was used to identify independent predictors of HCV infection. Of 1,500 randomly selected subjects, 1,315 (87.7%) participated in the study. Forty subjects (3.0%; 95%CI: 2.1-4.0) were anti-HCV-positive, with HCV-RNA detected by PCR in 31 (77.5%) of these. Anti-HCV prevalence increased with age, peaking (8.2%) in people born during the years 1945-1955. It was 1.7% in people residing in the better socioeconomic districts; but 5.7% in those residing in the district with lower socioeconomic status (P < 0.01). In multivariate analysis, age ≥60 years (OR 2.8, 95%CI: 1.3-6.1) and lower educational level (OR 3.6; 95%CI: 1.4-9.3), which is a proxy of low socioeconomic status, were the only independent predictors of the likelihood of anti-HCV positivity. Overall, 22.5% of anti-HCV positive subjects were previously unaware of their status. In the large city of Naples, infection with HCV is most common in people aged older than 60 years. Differences in socioeconomic conditions have played an important role in the spread of this infection. HCV positive subjects born during the years 1945-1955 are those who may benefit, to a greater extent, to be identified in order to receive the new effective therapy. J. Med. Virol. 89:291-297, 2017. © 2016 Wiley Periodicals, Inc.

Recipient female gender is a risk factor for graft loss after liver transplantation for chronic hepatitis C: Evidence from the prospective Liver Match cohort

BackgroundFemale gender has been reported to be a risk factor for graft loss after liver transplantation for hepatitis C virus (HCV)-related cirrhosis but evidence is limited to retrospective studies. AimsTo investigate the impact of recipient gender and donor/recipient gender mismatch on graft outcome. MethodsWe performed a survival analysis of a cohort of 1530 first adult transplants enrolled consecutively in Italy between 2007 and 2009 and followed prospectively. After excluding possible confounding factors (fulminant hepatitis, human immunodeficiency virus co-infection, non-viremic anti-HCV positive subjects), a total of 1394 transplant recipients (604 HCV-positive and 790 HCV-negative) were included. ResultsFive-year graft survival was significantly reduced in HCV-positive patients (64% vs 76%, p=0.0002); Cox analysis identified recipient female gender (HR=1.44, 95% CI 1.03–2.00, p=0.0319), Mayo clinic End stage Liver Disease score (every 10 units, HR=1.25, 95% CI 1.03–1.50; p=0.022), portal thrombosis (HR=2.40, 95% CI 1.20–4.79, p=0.0134) and donor age (every 10 years, HR=1.14, 95% CI 1.05–1.24, p=0.0024) as independent determinants of graft loss. All additional mortality observed among female recipients was attributable to severe HCV recurrence. Conclusions. This study unequivocally shows that recipient female gender unfavourably affects the outcome of HCV-infected liver grafts.

Spectrum of Incidentally Detected Hepatitis C Virus Infection in Southern India- A Prospective Study

Purpose/Aims: The relationship between viral replication, genotypes, host biochemical characteristics, clinical outcomes and mode of transmission in Indian subjects with incidental detection of hepatitis C virus (HCV) infection is yet to attain. We evaluated the above parameters in incidentally detected asymptomatic subjects seropositive for HCV antibody (anti-HCV). Methods: Incidentally detected 96 anti-HCV positive subjects were evaluated by clinical, endoscopic, ultrasound and demographic parameters. Blood samples were assessed for biochemical and serological markers. Serum HCV RNA and genotypes were assessed by real time PCR and line probe assay respectively. Results: Majority (57%) of the subjects had non specific symptoms followed by detection during pre surgical checkup (20%) and blood donation (16%). Previous history of dental procedures (41.3%), surgical procedures (33.7%) and blood transfusions (25%) were identified as major risk factors. Genotype 3 was predominant (47%), followed by 1 (37%) 4 (15%) respectively while genotype 5 was identified in a single cirrhotic subject. Type 2 diabetes and esophageal varices were observed in 22% and 18% subjects respectively. Significant alterations of serum albumin, platelets count, AST and INR were evident in older subjects (＞50 years). Cirrhotic features were observed in a number of subjects having both low and high viral load. Conclusion: The probable risk factors for acquisition of HCV infection identified in almost all study subjects of which one fifth were though apparently asymptomatic had cirrhosis. The predominant HCV genotype was 3.Genotype 5 has been identified for the first time from southern India.

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

Liver fibrosis progression at autopsy in injecting drug users infected by hepatitis C: A longitudinal long-term cohort study

There is a paucity of unbiased data on the natural history of hepatitis C virus (HCV) infection in injecting drug users (IDUs). The purpose of this study was to assess the risk of developing advanced fibrosis associated with chronic hepatitis C (CHC) infection among injecting drug users (IDUs) who underwent an autopsy. A longitudinal cohort design was applied, in which the stage of liver fibrosis in anti-HCV positive IDUs with or without chronic HCV infection was assessed in liver tissue from autopsies performed up to 35 years after HCV exposure. The cohort originated from 864 IDUs consecutively admitted for drug abuse treatment 1970-1984. Stored sera, mostly drawn at the time of admission for drug treatment, were available in 635 subjects. 220 out of 523 anti-HCV positive subjects had died before 2009. Liver tissue from autopsies was available from 102/220 subjects, of which 61 were HCV RNA positive. Liver sections were classified according to METAVIR scores for fibrosis. Two pathologists, both blinded for serologic results, scored sections of liver tissue. Among HCV RNA positive subjects 16.4% (10/61) had septal fibrosis (F3) or cirrhosis (F4) compared to 2.4% (1/41) among anti HCV positive/HCV RNA negative subjects (p=0.026). Of 18 HCV RNA positive subjects autopsied <15 years after HCV exposure none had F3 or F4. Among subjects autopsied >25 years after exposure 35% (6/17) had F3-F4. Among IDUs chronically infected by HCV, 1/3 developed septal fibrosis or cirrhosis 25 years or more after exposure.

A nationwide seroepidemiology of hepatitis C virus infection in South Korea

The aim of this study was to reveal nationwide seroprevalence of HCV infection in South Korea by a large-scale survey. From January to December 2009, a total of 291314 adults underwent health check-up in 29 centres nationwide. The data concerning anti-HCV antibody and biochemical tests were obtained from all participants. Among subjects with positive anti-HCV, such data as HCV RNA, genotypes and treatment detail were additionally analysed. Using an estimated 2009 population of Korea, the age, sex and area-adjusted anti-HCV positive rate was 0.78%. Anti-HCV prevalence in female patients (0.83%) was higher than that in male patients (0.75%). Gradual increase in anti-HCV positivity was observed, from 0.34% in those aged 20-29years to 2.31% in those >70years. The age- and sex-adjusted anti-HCV prevalence varied in different areas, being higher in Busan and Jeonnam (1.53-2.07%), mid-level in Seoul and surrounding districts (0.50-0.61%) and lower in Jeju (0.23%). The comparative analysis of laboratory variables between anti-HCV (+) and anti-HCV (-) group revealed significantly higher levels of alanine aminotransferase and lower levels of serum lipids in anti-HCV (+) group. Among 1 718 anti-HCV positive subjects, serum HCV RNA was measured only in 478 people, of whom 268 (56.1%) patients had detectable HCV RNA in serum. Among 50 patients for whom assessment of response to antiviral therapy was feasible, overall sustained virological response was achieved in 84% of patients. The prevalence of HCV infection is low in South Korea. Studies to analyse risk factors are warranted to reduce HCV infection.

Prevalence and risk factors of hepatitis B and C virus infections among the general population and blood donors in Morocco

BackgroundViral hepatitis is a serious public health problem affecting billions of people globally. Limited information is available on this issue in Morocco. This cross-sectional study was undertaken with the aim of determining the seroprevalence and risk factors of hepatitis B virus (HBV) and hepatitis C virus (HCV) among the general population and among blood donors.MethodsBlood samples from volunteers, have been screened with ELISA tests for detecting the hepatitis-B surface antigen (HBsAg) and anti-HCV. Within the seroreactive patients for HCV in the general population, RT-PCR was performed by the Cobas Ampliprep/Cobas Amplicor.ResultsHCV and HBV-seropositivity was documented in 1.58% and 1.81% out of 41269 and 23578 participants respectively from the general population. Two patients were found to be co-infected. HCV-RNA was detected by PCR in 70.9% of the 195 anti-HCV positive subjects. The anti-HCV prevalence was not different among males and females (P = 0.3). It increased with age; the highest prevalence was observed among subjects with >50 years old (3.12%). Various risk factors for acquiring HCV infection were identified; age, dental treatment, use of glass syringes and surgical history. In addition to these factors, gender and sexual risk behaviors were found to be associated with higher prevalence of hepatitis B. The HBV positivity was significantly higher among males than females participants in all age groups (P < 0.01). The peak was noticed among males aged 30–49 years (2.4%). None of the 152 persons younger than 20 years had HBsAg or anti-HCV. The prevalence of anti-HCV and HBsAg among 169605 blood donors was 0.62% and 0.96% respectively.ConclusionsOur study provided much important information concerning hepatitis B and C prevalence and risk factors; it confirmed the intermediate endemicity for HCV infection and pointed to a decreasing trend of HBV incidence, which might reclassify Morocco in low HBV endemicity area. This could be attributed primarily to the universal HBV vaccination among infants and healthcare workers over the past 13 years. HCV and HBV infections in the present survey were mainly associated with nosocomial exposures. Prevention and control of HBV infection are needed to reduce HBV transmission between adults.

The evolving Incidence of Hepatitis C Virus Infection in Italy

Dear Editor, The epidemiology of chronic liver diseases (CLD) in Italy is changing. This is due to the decreasing rate of viral hepatitis [1] and the increased number of steatosis and nonalcoholic steatohepatitis cases, which are emerging as a new epidemic with a wide spectrum of metabolic disorders [2]. This scenario reflects what has occurred in Italy over the last few decades, as the vaccination program against the Hepatitis B virus (HBV), mandatory since the 1991, has helped to achieve complete immunization of newborns, adolescents and young adults [3]. Simultaneously, the epidemiology of the Hepatitis C virus (HCV) has evolved, due to factors such as increased blood transfusion safety, improvements in healthcare conditions, continuing expansion of intravenous drug use (IDU) and immigration from endemic areas. The lack of a prophylactic vaccine or universally active therapy has made the prevention of this chronic infection extremely important. Identification of infected persons and of the risk factors associated with acquiring a HCV infection may allow the development of strategies to reduce its incidence and control the resulting epidemic [4]. The prevalence of the HCV in Europe is nearly 1%, but this varies geographically along a north-south gradient, ranging from approximately 0.5% in Northern countries to 2% in Mediterranean areas [5]. In Northern Italy, the Dionysos study collected data regarding 6,917 inhabitants of two towns (Campogalliano and Cormons). The overall prevalence of positivity to the HCV antibody was found to be 3.2%. When the prevalence was analysed according to different age groups, it was relatively low ( 70 years [8]. The incidence of HCV infection is very difficult to estimate accurately because many patients with acute HCV infection are asymptomatic, and thus, do not present themselves for diagnosis [4]. Data from the US suggests that the annual incidence of HCV infection fell from 230,000 new cases per year in the late 1980s to approximately 35,000 new cases per year in the 1990s [4]. In Northern Italy, Mazzeo et al. carried out a study on the ten year incidence of HCV infection in a representative cohort of 1,646 adults from the general population of two Apennine hill towns. The incidence was 50.3 cases per 100,000 inhabitants/year while 16.9% of anti-HCV positive subjects spontaneously cleared the virus while 7 out of 11 also lost HCV-RNA from both serum and leukocytes [9]. Although Italian scientific literature is rich with controversial epidemiological data obtained in limited populations, the pattern of HCV infection in the whole population overall is poorly defined. In a recent issue of Hepatitis Monthly, La Torre et al. estimated HCV infection trends in Italy during the years 1996-2006 [10]. To evaluate the incidence rates, the authors integrated specific ministerial data (Ministry of Health) with population data from the National Institute of Statistics (ISTAT), a public and independent research organization. A strong reduction was observed in the analyzed years (-12,45%), distributed equally among males (-12,23%) and females (-12,8%). Considering all age groups, the incidence rate decreased from 2.02 to 0.55 per 100,000. This reduction was significant in all age groups [10]. Reported prevalence and incidence rates of HCV infection in the community vary, not only depending on the specificity and sensitivity of the method used, but also according to the study design, geographical origin, and other characteristics of the included populations [4]. Many studies have been carried out in blood donors or in other specific populations (for example intravenous drug users). Scarce data is however available in the general population. The strengths of the study by La Torre et al. lie in the study design, which included the whole population over a long period of follow-up, and in the use of the joinpoint regression method. The latter is useful in determining the occurrence of changes during distinct periods of time in trend data. Thus, it identifies the calendar years in which statistically significant changes in the trends occur, and the annual percentage of change within the identified period. On the other hand, the potential limitations, as reported by the authors, are the poor quality of reporting. In conclusion, studies such as that of La Torre et al. [10], are crucial in increasing our knowledge of worldwide HCV infection rates and to plan health policy strategies.

New perspectives in occult hepatitis C virus infection

Occult hepatitis C virus (HCV) infection, defined as the presence of HCV RNA in liver and in peripheral blood mononuclear cells (PBMCs) in the absence of detectable viral RNA in serum by standard assays, can be found in anti-HCV positive patients with normal serum levels of liver enzymes and in anti-HCV negative patients with persistently elevated liver enzymes of unknown etiology. Occult HCV infection is distributed worldwide and all HCV genotypes seem to be involved in this infection. Occult hepatitis C has been found not only in anti-HCV positive subjects with normal values of liver enzymes or in chronic hepatitis of unknown origin but also in several groups at risk for HCV infection such as hemodialysis patients or family members of patients with occult HCV. This occult infection has been reported also in healthy populations without evidence of liver disease. Occult HCV infection seems to be less aggressive than chronic hepatitis C although patients affected by occult HCV may develop liver cirrhosis and even hepatocellular carcinoma. Thus, anti-HCV negative patients with occult HCV may benefit from antiviral therapy with pegylated-interferon plus ribavirin. The persistence of very low levels of HCV RNA in serum and in PBMCs, along with the maintenance of specific T-cell responses against HCV-antigens observed during a long-term follow-up of patients with occult hepatitis C, indicate that occult HCV is a persistent infection that is not spontaneously eradicated. This is an updated report on diagnosis, epidemiology and clinical implications of occult HCV with special emphasis on anti-HCV negative cases.

Sociodemographic Differences in the Distribution of Hepatitis C Virus Antibodies among Children with Sickle Cell Anaemia in Enugu, South East Nigeria

Background: Hepatitis C virus (HCV) has become an important cause of chronic liver disease and liver cancer worldwide. A study of the sociodemographic differences in the distribution of HCV antibodies (Anti-HCV) among those at risk will broaden knowledge of the problem among patients in this part of the country. Objective: To determine the sociodemographic differences in the distribution of HCV antibodies among transfused children with sickle cell anaemia (SCA) in Enugu and compare it with their non- transfused counterparts. Methodology: The study was conducted among two hundred and sixty-nine children with SCA attending the paediatrics sickle cell clinic at University of Nigeria Teaching Hospital (UNTH) Enugu, 136 transfused SCA patients as subjects and 133 age and sex matched non-transfused SCA as controls were studied. Results: There was no statistically significant difference in the age and sex distribution of the anti-HCV positive subjects and controls P > 0.05. Majority of the subjects (66.7%) and control (71.4%) who tested positive were in lower socio-economic class. Conclusion: HCV infection is not uncommon in children with SCA. There is no significant difference in the sociodemographic characteristics of the HCV positive subjects and controls.Keywords: Sociodemographic, Hepatitis C, Sickle cell anaemia

Current practice of hepatitis C treatment in Southern Italy

Background Only a small proportion of subjects referring to hospitals for hepatitis C virus (HCV) positivity receives antiviral therapy. Aim To evaluate the rate of antiviral treatment and the causes for no treatment in HCV-RNA positive subjects seen in hospital settings. Patients and methods A prospective study enrolling over a 6-month period (February–July 2009) all consecutive anti-HCV positive subjects initially referred (naïve patients) to 12 liver units in Southern Italy for HCV treatment. Results Out of 608 subjects evaluated, 74 (12.2%) had no detectable HCV-RNA in the serum and thus were excluded. Of the remaining 534 HCV-RNA positive subjects, 357 (66.9%) were not treated for the following reasons: 49.9% were older than 65 years of age (75% of them >70 years), 14.3% had normal liver enzymes, 13.2% had compensated/decompensated cirrhosis, 10.4% refused treatment, 9.8% had ongoing substance or alcohol abuse. Multivariate analysis showed that females (O.R. 2.27; C.I. 95% 1.05–4.90) and subjects with low educational level (O.R. 4.38; C.I. 95% 1.27–15.11) were more likely to decline therapy. Conclusions The majority of patients with HCV infection does not receive antiviral treatment. The effectiveness of the current standard therapy for HCV infection is low despite its good efficacy.

Anti-HCV antibody positivity of various sections of Pakistani patients.

To determine the anti-HCV antibody status of various sections of the Pakistani population and patients as reported in various Pakistani studies. A meta-analysis. Department of Medicine, Rawalpindi Medical College and Allied Hospitals, Rawalpindi, from July 2007 to July 2008. Data pertaining to anti-HCV antibody status of various sections of the Pakistani population and patients was collected from studies published till July 2008. To note anti-HCV antibody status, 15 groups of subjects like liver disease patients, general blood donors, adult screening, and community prevalence etc. were identified. The frequency of total and anti-HCV antibody positive subjects of each group was noted. Chi2 was used as test of significance for comparison wherever appropriate. Data from 183 studies was collected; 1004391 subjects anti-HCV antibody status was retrieved. 4.27% (n=42982) of these were anti-HCV antibody positive. Major bulk of patients with liver disease (56.9%), 2.71% of general and 10.39% of professional blood donors groups were positive, (p < 0.05). Positivity in community and adult screening was 11.52 and 6.29% respectively. According to the studies in consideration; 2.71% of Pakistani general blood donors and major bulk of liver disease patients are anti-HCV positive. Community based anti-HCV positivity is 11.52%.

Anti-HCV positivity in sexual partners and offspring of patient with chronic hepatitis C

We investigated the seroprevalence of HCV in stable sexual partners and offspring of chronic hepatitis C patients, and aimed to determine the risk factors involved. 191 anti-HCV and HCV RNA positive subjects who coinhabited with their spouse and/or offspring were included. Risk factors of index cases for disease transmission, liver biopsy results, anti-HCV and HCV-RNA in spouses and/or offspring were evaluated. Together with index cases, a total of 404 family members including 174 stable sexual partners and 230 offspring were included. The most common risk factors among index cases were dental procedures (73.8%), history of surgery (64.9%), and blood transfusions (24.1%). Anti-HCV positivity was established in 11 (2.7%) of the total 404 family contacts--6 sexual partners and 5 offspring. HCV seropositivity was significantly higher in the spouses of index cases with severe hepatitis C compared to those with mild to moderate hepatitis C (p=0.008), but there was no statistically significant correlation between the severity of liver disease in index cases and anti-HCV positivity in their offspring. In conclusion, anti-HCV seropositivity in the spouses and children of patients who are HCV-RNA positive HCV carriers does not appear to be higher than the HCV seroprevalence in our country.

Aflatoxin Exposure and Hepatitis C Virus in Advanced Liver Disease in a Hepatitis C Virus–Endemic Area in Taiwan

This community-based study evaluated the role of aflatoxin exposure in advanced liver disease in hepatitis C virus (HCV)-endemic townships. Preventive health examination was performed on 314 adults > or = 40 years of age recruited from HCV-endemic townships in Tainan, Taiwan. Aflatoxin-albumin in serum was quantified by a new enzyme-linked immunosorbent assay method. After adjusting serum albumin levels and platelet counts, aflatoxin-Bi albumin adducts was still an independent risk factor for advanced liver disease among all 314 residents (> 8 versus < or = 8 (AFBi)-albumin/albumin; OR = 2.29, 95% CI = 1.23-4.27, P = 0.009) and particularly in anti-HCV-positive subjects (OR = 2.09, 95% CI = 1.09-4.0, P = 0.026). Levels of AFB1-albumin/albumin were significantly related to ultrasonographic parenchyma scores (P < 0.001, one-way ANOVA) in all and anti-HCV-positive subjects. The findings indicated aflatoxin exposure may be associated with advanced liver disease in chronic hepatitis C patients in HCV-endemic regions in Taiwan.