anti-HCV Test Research Articles

Preference, acceptability and implications of the rapid hepatitis C screening test among high-risk young people who inject drugs.

BackgroundPeople who inject drugs (PWID) are at highest risk for hepatitis C virus (HCV) infection, yet many remain unaware of their infection status. New anti-HCV rapid testing has high potential to impact this.MethodsYoung adult (<30 years) active PWID were offered either the rapid OraQuick® or standard anti-HCV test involving phlebotomy, then asked to complete a short questionnaire about testing perceptions and preferences. Sample characteristics, service utilization, and injection risk exposures are assessed with the HCV testing choice as the outcome, testing preferences, and reasons for preference.ResultsOf 129 participants: 82.9% (n = 107) chose the rapid test. There were no significant differences between those who chose rapid vs. standard testing. A majority (60.2%) chose the rapid test for quick results; most (60.9%) felt the rapid test was accurate, and less painful (53.3%) than the tests involving venipuncture.ConclusionsOraQuick® anti-HCV rapid test was widely accepted among young PWID. Our results substantiate the valuable potential of anti-HCV rapid testing for HCV screening in this high risk population.

HCV and pregnancy: prevalence, risk factors, and pregnancy outcome in north Indian population: a case-control study.

The study was carried out to investigate the prevalence, risk factors, and Pregnancy outcome in anti-HCV-positives pregnant women admitted for delivery in the Department of Obstetrics & Gynecology of Guru Gobind Singh Medical College and Hospital, Faridkot between January 2010 and January 2013. Department of obstetrics and Gynaecology of GGS Medical College and Hospital, Faridkot. A case-control study design was selected for the study. A total of 1412 pregnant women presenting in the labor room of our hospital between January 2010 and January 2013 were subjected to anti-HCV testing by third generation ELISA. Age, parity, and gestational age-matched controls were taken from the women delivering during the same time frame who tested negative for hepatitis C. All the subjects and controls were non-reactive for HIV and HBsAg as well. Risk factors and pregnancy outcome were compared with the control group. Approval was taken from ethic committee of the institute. The women who consented to participate in the study were evaluated on the basis of a questionnaire for the presence of risk factors of hepatitis C and pregnancy outcome. Women with the known previous liver disease were excluded from the study. Data were analyzed using SPSS for Windows version 16.0. p<0.05 was considered significant. Forty patients tested positive for anti-HCV antibodies among 1,412 patients subjected to anti-HCV testing during study period. 40 patients were taken as controls, who were negative for anti-HCV antibodies. Prevalence of HCV during pregnancy was 2.8% in our study. Among the risk factors studied, previous surgery and blood transfusion were the statistically significant risk factors. There was history of previous major surgery in 16 cases versus 4 controls and was statistically significant (p value 0.002) at p<0.05. History of blood transfusion was present in 4 versus 2 among cases and controls, respectively, and statistically significant (p value 0.004) at p<0.05. Sexual transmission was not the risk factor as none of the spouse of the pregnant women was positive for HCV antibodies. Neonatal outcome was similar in both groups. Pregnancy complications i.e., Pregnancy-induced hypertension and antepartum hemorrhage were significantly higher in study group compared to control group. Incidence of hepatitis C virus infection in pregnancy is 2.8%. Surgical procedures, blood transfusion, are the major risk factors for transmission. There are no identifiable risk factors in 35% of cases. Pregnancy complications like Pregnancy-induced hypertension and antepartum hemorrhage are more common in HCV-positive mothers. Neonatal outcome is not affected. Universal screening of all pregnant women should be done for HCV as many patients may not have any risk factor.

Evaluation of HBsAg, Anti-HCV, Anti-HIV and Syphilis Test Results among the Blood Donors Admitted to the Near East University Hospital in Turkish Republic of Northern Cyprus

Evaluation of HBsAg, Anti-HCV, Anti-HIV and Syphilis Test Results among the Blood Donors Admitted to the Near East University Hospital in Turkish Republic of Northern Cyprus

The diagnosis of hepatitis C virus infection

The successful therapy of hepatitis C viral infection requires that the illness is diagnosed before the development of structural changes of the liver. Testing is stepwise consisting of screening, diagnosis, and anti-viral therapy follow-up. For these steps there are different biochemical, serological, histological and molecular biological methods available. For screening, alanine aminotransferase and anti-HCV tests are used. The diagnosis of infection is confirmed using real-time polymerase chain reaction of the viral nucleic acid. Before initiation of the therapy liver biopsy is recommended to determine the level of structural changes in the liver. Alternatively, transient elastography or blood biomarkers may be also used for this purpose. Differential diagnosis should exclude the co-existence of other viral infections and chronic hepatitis due to other origin, with special attention to the presence of autoantibodies. The outcome of the antiviral therapy and the length of treatment are mainly determined by the viral genotype. In Hungary, most patients are infected with genotype 1, subtype b. The polymorphism type that occurs in the single nucleotide located next to the interleukin 28B region in chromosome 19 and the viral polymorphism type Q80K for infection with HCV 1a serve as predictive therapeutic markers. The follow-up of therapy is based on the quantitative determination of viral nucleic acid according to national and international protocols and should use the same method and laboratory throughout the treatment of an individual patient.

Evaluation of Parasite Density, Plasma Total Bile Acids, Alanine Transaminase, Lactate Dehydrogenase and CD4 in Plasmodium Infected Patients Treated with Morinda lucida (Oowo)

<i>Morinda Lucida</i> has been tested to have antimalarial and antidibetic effect among other health benefits. It is commonly used for the treatment of malaria infection in Oke-Ogun and its environs. Despite the health usefulness of this extract little has been reported about its biochemical alterations. This work was therefore designed to evaluate the parasite density, plasma total bile acids, Alanine transaminase, Lactate dehydrogenase and CD4 in Plasmodium infected patients treated with <i>Morinda Lucida</i><b> (Oowo)</b>. Sixty four(64) HIV, HBsAg and anti-HCV seronagative Plasmodium infected patients visiting traditional hoimes in Oke-Ogun the Nothern part of Oyo state Nigeria for traditional malaria cure aged 5 to 73 years classified into Female (n=34) and Male (n=30) were investigated. Hepatitis B surface antigen (HBsAg) and anti-HCV tests were carried out by Enzyme Linked Immunozorbent Assay (ELIZA). HIV screening and confirmation were carried out by immuno-chromatographic and Immunobloting (Western blot) assays respectively. Fasting Plasma Total Bile Acids (TBA), Lactate Dehydrogenase (LDH) and Alanine aminotransferase (ALT) were carried out biochemically by spectrophotometry while CD4 cell count was carried out by cytoflowmetry using Partec Cyflow machine and reagent. The tests were carried out in the control and test subjects before and after the treatment with the raw liquid extract of the leaf of <i>Morinda Lucida</i>. The result obtained showed a significantly higher mean values of falciparum parasite density and plasma ALT in the plasmodium infected test subjects than the values of the parameters obtained in plasmodium non-infected control subjects before and after treatment of the plasmodium infected subjects with the raw liquid extract of <i>Morinda lucida</i> with p<0.05. There was also a higher significant difference in the value of plasma LDH in the plasmodium infected test subjects before the administration of the extract than the result obtained in the plasmodium non-infected control subjects with p<0.05. A significantly higher value of plasma LDH was obtained in the test subjects before the treatment compared to the value of this parameter obtained in the test subjects after treatment (p<0.05). There was also a significantly higher mean value of TBA in the test subjects compared with the control after treatment (p<0.05). There was no significant alteration in the mean values of the CD4 cell count in the subjects before and after treatment and also in test compared with the control subjects. This recent work showed significant alterations in the mean values of the plasmodium parasite density, ALT, LDH, TBA in the test subjects studied due to plasmodium infection and the effectiveness of the raw liquid extract of the leaf of <i>Morinda Lucida </i>in the treatment of malaria<i>. </i>Estimation of plasmodium parasite density, plasma ALT, LDH, and TBA should be considered in the treatment of malaria using the raw liquid extract of the leaf of <i>Morinda Lucida</i>.

Prevalence of hepatitis C virus antibody among undergraduates in ogbomoso, southwestern Nigeria.

This study was conducted to determine the prevalence of hepatitis C virus antibody (anti-HCV), among a healthy university undergraduate population in south-western Nigeria. Relevant medical information of students who underwent the post-admission screening exercise for the year 2012, at the Ladoke Akintola University of Technology (LAUTECH), Health Center, Ogbomoso were extracted from the laboratory log book. All tests were done using rapid anti-HCV test kit by Health - Chem diagnostics, USA. A total of 1,572 students were included in the study. The mean age was 19.61 (± 2.75) years while the age range was 15-50 years. A total of 821 (52.20%), of the subjects were males while 751 (47.80%) were females. More than ninety nine percent (99.90%) of the subjects were aged 15-30 years, whereas those aged ≥31 years were comparatively few (0.60%). Of the 1572 students, 6 tested positive, giving an overall prevalence of 0.40%. Three (0.37%) of the 821 male subjects tested positive while 3(0.40%) also of the 751 female subjects tested positive. Age-group 21-30 years had the highest prevalence of anti -HCV (0.50%), followed by age-groups ≤ 20 years with 0.30% prevalence. None of the subjects in age-groups 31-40 and ≥ 41 years tested positive. These observed differences were not statistically significant. The prevalence of Hepatitis C Virus is low among the young healthy undergraduate population in the south - western region of Nigeria.

Performance of rapid hepatitis C virus antibody assays among high- and low-risk populations

BackgroundRapid tests for the detection of antibodies to hepatitis C virus (anti-HCV) can facilitate access to diagnosis. ObjectivesThis study aimed to evaluate the performance of rapid tests for anti-HCV detection in the sera, whole blood, and oral fluid samples from individuals with different endemicity profiles and risk behaviors. Study designThree groups donated biological samples that were tested using three anti-HCV rapid tests (WAMA, Bioeasy and OraSure): (I) suspected cases of hepatitis C, (II) individuals who were living in remote areas in Brazil and (III) crack users and beauty professionals. Reproducibility, repeatability and cross-reactivity to other infectious agents (dengue, HIV, malaria, and syphilis) were also evaluated. ResultsIn group I, specificities varied from 93.75% to 100% and sensitivities varied from 76.03% to 93.84% according to the EIA results. When anti-HCV/HCV RNA-reactive sera samples were considered true-positive HCV cases, the sensitivities and specificities varied from 86.3% to 99.09% and 93.75% to 100%, respectively. In group II, the OraSure rapid test presented the best performance. In group III, the Bioeasy assay performed best using saliva and whole blood and the OraSure assay performed best using oral fluid samples. The reproducibility and repeatability of the WAMA and Bioeasy tests were excellent. The level of concordance between the HCV EIAs and the rapid tests using samples that were reactive for other infectious agents varied from 82.35% to 100% for the WAMA assay and 94.11% to 100% for the Bioeasy assay. ConclusionAll of the rapid tests could be used to identify active HCV infection among individuals with different endemicity profiles and risk behaviors.

A New Stochastic Model for Subgenomic Hepatitis C Virus Replication Considers Drug Resistant Mutants

As an RNA virus, hepatitis C virus (HCV) is able to rapidly acquire drug resistance, and for this reason the design of effective anti-HCV drugs is a real challenge. The HCV subgenomic replicon-containing cells are widely used for experimental studies of the HCV genome replication mechanisms, for drug testing in vitro and in studies of HCV drug resistance. The NS3/4A protease is essential for virus replication and, therefore, it is one of the most attractive targets for developing specific antiviral agents against HCV. We have developed a stochastic model of subgenomic HCV replicon replication, in which the emergence and selection of drug resistant mutant viral RNAs in replicon cells is taken into account. Incorporation into the model of key NS3 protease mutations leading to resistance to BILN-2061 (A156T, D168V, R155Q), VX-950 (A156S, A156T, T54A) and SCH 503034 (A156T, A156S, T54A) inhibitors allows us to describe the long term dynamics of the viral RNA suppression for various inhibitor concentrations. We theoretically showed that the observable difference between the viral RNA kinetics for different inhibitor concentrations can be explained by differences in the replication rate and inhibitor sensitivity of the mutant RNAs. The pre-existing mutants of the NS3 protease contribute more significantly to appearance of new resistant mutants during treatment with inhibitors than wild-type replicon. The model can be used to interpret the results of anti-HCV drug testing on replicon systems, as well as to estimate the efficacy of potential drugs and predict optimal schemes of their usage.

How to Interpret Borderline HCV Antibody Test Results: A Comparative Study Investigating Four Different Anti-HCV Assays

Anti-HCV testing is the first step to diagnose hepatitis C. Although anti-HCV assay performance improved during the last 2 decades, very high sensitivity required for screening may lead to limitations in specificity. Thus, there remains an uncertainty how to interpret anti-HCV test results with a borderline signal-to-cut-off ratio. Comparison was made of concordance and performance of four licensed anti-HCV assays in samples with borderline signal-to-cut-off ratios. Out of 12,090 consecutive samples tested for anti-HCV with the Abbott Architect Anti-HCV assay over a period of 29 months, 95 plasma samples with a signal-to-cut-off ratio between 0.5 and 2 were selected for this study. All samples were re-tested with the Enzygnost Anti-HCV version 4.0, the Ortho anti-HCV version 3.0, and the Monolisa anti-HCV-Plus version 2 assays. Discordant samples were classified by additional immunoblot testing. Overall, only 52% of the Architect borderline samples gave similar results in all four assays. Inter-assay concordance ranged between 58% and 80%. The highest discordance was observed between the Architect and the Monolisa assay (42%). In contrast, a high level of concordance was found between the Enzygnost and Ortho assays (80%). The Monolisa was best to identify negative samples (100%), while the Enzygnost correctly classified most of the positive samples (96%). Anti-HCV antibody assays show significant variation in classifying samples with low signal-to-cut-off ratios. Different performances may have cost and management implications, as false-positive results are not infrequent. However, sensitivities were good for all assays if indeterminate results are not considered as negative.

Risk factors for hepatitis C virus sero-positivity among haemodialysis patients receiving care at kidney centre in a tertiary health facility in Maiduguri, Nigeria.

Hepatitis C virus (HCV) is an important health care problem in haemodialysis. Hepatitis C virus is both a cause and complication of kidney diseases. Yet there are limited information on antibody against HCV in patients on haemodialysis. The purpose of this study was to determine the prevalence of anti-HCV and the risk factors associated with HCV infection in a cohort of 100 participants on haemodialysis. They were consecutively recruited into the study, anti-HCV testing was made by the 3rd-generation ELISA System (C-100, C-33c, C-22). The prevalence of HCV antibody was 15%, risk factors associated with HCV antibody were history of blood transfusion and duration of session of haemodialysis; the risk increased with increased with the number of blood transfusion and seasons of haemodialysis. The observed high prevalence of HCV antibody among patients on haemodialysis reflect the quality of healthcare services and the standards of infection control practices in our haemodialysis units. Routine screening for HCV should be done before blood transfusion using third generation ELISA assays with high sensitivity and specificity. Safety measures should be taken in our haemodialysis units to prevent cross infection among patients and staffs. These safety measures include; discarding syringes, needles, gloves, bloodlines and dialysers after single use, and the use of sterile dressings on each patient visit.

Hepatitis C virus core antigen testing: role in diagnosis, disease monitoring and treatment.

While hepatitis B virus (HBV) screening relies on hepatitis B surface antigen to confirm HBV infection since the early days of hepatitis B disease management, hepatitis C virus (HCV) infection screening is based on anti-HCV testing which does not discriminate active from past infection. Thus to confirm infection HCV RNA testing has been required; recently a HCV core antigen assay became widely commercially available which could serve to confirm infection. That assay is less sensitive than current HCV RNA assays, but as more than 50% of anti-HCV positive persons will be HCV core antigen positive, HCV core antigen testing can be a cost effective and reflex test to confirm HCV infection in anti-HCV positive individuals and will be easier as it can be applied on the same platform. For treatment monitoring, more data need to be generated, but the early data available at present suggest that HCV core antigen may be an alternative to HCV RNA monitoring. With direct antivirals, HCV core antigen could even be superior to HCV RNA testing, as direct antivirals might already prevent virus formation when HCV core antigen is still produced and thereby correlates better with eventual viral clearance.

Detection of hepatitis C virus antibody in the saliva of children and adolescents with b-thalassemia

Introduction Children with b-thalassemia (BTM) are at risk of acquiring hepatitis C virus (HCV) infections because of their need for multiple blood transfusions. The aim of this study was to evaluate the new rapid antibody test (OraQuick) for detection of HCV antibody in the saliva of BTM major and intermedia patients with known and unknown anti-HCV antibody status. Patients and methods The present study included 150 children and adolescents suffering from BTM enrolled from the Hematology and Oncology Clinic of the Children's Hospital of Ain Shams University. A full medical history, clinical examination, salivary swab detection of anti-HCV in saliva, blood sampling for complete blood count, and liver enzyme assessment were performed. Anti-HCV testing by enzyme-linked immunosorbent assay and HCV RNA testing by PCR were carried out in those studied patients who had not undergone such tests earlier. Results There was significant correlation between HCV status and the total number of blood transfusions. A significant fall in the incidence of HCV infection after 2004 was proven. The sensitivity and specificity of both, the OraQuick test and the enzyme-linked immunosorbent assay test, were the same (97.8 and 100%, respectively). Conclusion The OraQuick HCV Rapid Antibody Test using saliva proved to have a high sensitivity and specificity. Therefore, it could be considered a noninvasive, easy, rapid, and reliable test for screening of patients suspected to have HCV infection.

Effect of HLA on hepatitis C virus clearance and persistence in anti-HCV-positive end-stage renal disease patients

Background/Aims:The efficacy of immune response against hepatitis C virus (HCV) is determined by human leukocyte antigen (HLA) molecules of the host which present HCV antigens to CD4 + and CD8 + T lymphocytes. In this study, we aimed to investigate the possible relationship between the frequencies of certain HLA class I–II alleles and the natural history of HCV in patients with end-stage renal disease (ESRD).Settings and Design:This is a retrospective cohort study conducted in a university hospital.Patients and Methods:The present study comprised 189 ESRD patients (candidates for renal transplantation) who had positive anti-HCV antibody test. The results concerning HCV and HLA status were gathered from patients’ files. The viral persistence was compared between the groups that were determined by HLA sub-typing.Statistical Analysis:Statistical evaluation was performed using Mann–Whitney U-test, Chi-square test, and Fisher's exact test. Level of error was set at 0.05 for all statistical evaluations, and P values < 0.05 were considered statistically significant.Results:We found possible association between the course of HCV infection and specific HLA alleles. HLA class I Cw*6 and HLA class II DRB*10 alleles were observed more frequently in the viral clearance group (P < 0.05). The HLA class I B*38 allele group was more prone to develop chronic hepatitis C (P < 0.01).Conclusions:These findings suggest that HLA class I Cw*6 and HLA class II DRB*10 alleles may be associated with immunological elimination of HCV in Turkish patients on hemodialysis. HLA sub-typing could help predict the prognosis of HCV infection.

Targeted hepatitis C screening among ex‐injection drug users in the community

Chronic hepatitis C virus (HCV) infection is one of the leading causes of cirrhosis and hepatocellular carcinoma worldwide. It is highly prevalent among injection drug users (IDUs) but is often undiagnosed because they represent an underprivileged group that faces multiple barriers to medical care. Here, we report the results of the New Life New Liver Project, which provides targeted HCV screening and education for ex-IDUs in the community. Patients were recruited through the social worker networks and referrals by fellow ex-IDUs, and rapid diagnosis was based on point-of-care anti-HCV testing at rehabilitation centers. From 2009 to 2012, we served 234 subjects. One hundred thirty (56%) subjects were anti-HCV positive. The number needed to screen to detect one patient with positive anti-HCV was 1.8 (95% confidence interval, 1.6-2.0). However, only 69 (53%) HCV patients attended subsequent follow-up at regional hospitals, and 26 (20%) received antiviral therapy. Patients who attended follow-up were older, had higher education level and more active disease as evidenced by higher alanine aminotransferase, HCV RNA, and liver stiffness measurement by transient elastography. Targeted screening in ex-IDUs is effective in identifying patients with HCV infection in the community. Improvement in the referral system and introduction of interferon-free regimens are needed to increase treatment uptake.

Seroprevalence of Hepatitis B and C markers at the population level in the municipality of Caxias do Sul, southern Brazil

Chronic viral hepatitis are main public health problems worldwide. Data about the seroprevalence to Hepatitis B and C viruses (HBV e HCV) at the population level are scarce on Brazil and especially for the Southern region of the country. The seroprevalence to HBV and HBC antigens was evaluated on a large portion of the population of the municipality of Caxias do Sul (427,858 inhabitants), Brazil. A total of 60,604 individual serum samples collected from 2008 to 2011 were screened for HBV surface antigen (HBsAg) and for antibodies against HBsAg; anti HCV antibodies were measured by ELISA (Enzyme Linked Immunosorbent Assay). Overall, 1.63% of the individuals were positive for HBsAg and 1.43% showed seropositivity to HCV. From the total, 31,749 samples were analyzed for HBsAg and 28,855 for HCV. For HBsAg, 519 samples showed positive (1.63%) while the results for 37 patients (0.12%) remained inconclusive. For the anti-HCV test, 412 individuals (1.43%) showed positive. From the positive samples for HBsAg 216 (50.6%) were from male individuals whereas for anti-HCV the seroprevalence was slightly higher for females 216 (52.4%). The higher prevalence for both hepatitis viruses were found among individuals at the age group of 40 to 59 years and the lower levels of positivity for both HBV and HBC were among children and teenagers.

The Correlation Of Hepatic Iron Loading Determined By Magnetic Resonance Image and Serum Ferritin In Patients With Beta-Thalassemia Intermedia

BackgroundCurrent practice of starting iron chelation when ferritin values reach 1,000 mcg/l has been given to patients with thalassemia disease. The body iron load in patients with thalassemia intemedia can be different from other severe thalassemia disease due to the increased intestinal iron absorption. ObjectiveThe correlation of hepatic iron loading determined by magnetic resonance image study (MRI) and various parameters was calculated. Materials and MethodsMRI study, using CRMtool to determine the myocardial and hepatic iron loading, was performed in pediatric patients with beta-thalassemia intermedia. The amount of blood transfusion and duration of iron chelation were recorded. The levels of serum ferritin as well as the transfusion-transmitted diseases were checked twice yearly. ResultsIn all, 40 patients (19 males, 23 females) manifested as beta-thalassemia intermedia were enrolled in the study. They included beta thalassemia/HbE disease (n=37) and beta thalassemia major (n=3) with the mean age of 14.9±3.6 years. Three patients with beta-thalassemia major behaved as beta-thalassemia intermedia since two patients carried the combination of beta-thalassemia0 and beta-thalassemia+ genes while another patient had an additional alpha-thalassemia gene. The remaining patients possessed the combination of beta-thalassemia genes at codon 41/42 (4 base pair deletion) and HbE gene at codon 26 (GAG>AAG). All patients received routine hepatitis B vaccination. None had positive serological testing for HBsAg, antiHCV or antiHIV. They required regular transfusion to maintain their pre-transfusion hematocrit at 24% starting at the mean age of 4.1±3.3 years with the mean duration of 10.1±4.6 years. Nineteen were splenectomized at the mean age of 8.0±3.1 years. They all received iron chelation of 10-12 hours of desferrioxamine subcutaneous injection, oral deferiprone ingestion or the combination of desferrioxamine and deferiprone starting at the mean age of 9.1±3.8 years with the mean duration of 6.2 ±4.3 years. At the mean age of 14.9±3.6 years, they underwent MRI study and revealed that the mean T2* of myocardium was 38.6±8.1 milliseconds (ms) and mean T2* of liver was 3.2±2.0 ms. Neither patients had myocardial iron loading while 36 patients had hepatic iron loading varying from severe degree of <1.4 ms (iron >10 mg/g dry weight, n=4), moderate degree of >1.4-2.7 ms (iron >5-10 mg/g dry weight, n=16) and mild degree of >2.7-6.3 ms (iron 2-5 mg/g dry weight, n=16). The results revealed no correlation of the hepatic T2* and the duration of blood transfusion (p=0.157), duration of iron chelation (p=0.071), total blood transfusion and total iron loading from transfusion (p=0.471) one-year blood transfusion and one-year iron loading from transfusion (p=0.321) except for the serum ferritin (p=0.001). The geographic mean of ferritin was 1584.9 mcg/l. The hepatic iron loading by MRI was shown in the equation of T2*(ms) = 4.663-0.001ferritin (mcg/l) (r=-0.503, p=0.001). Patients with serum ferritin ≥1,000 mcg/l risked hepatic iron loading (T2*<2.7 ms, iron 5-10 mcg/g dry weight) with an odds ratio of 5.07 (95% CI 1.09-23.44). Therefore, patients with beta-thalassemia intermedia were at risk of hepatic iron overloading if the initiation of iron chelation started at the serum ferritin of 1,000 mcg/l. ConclusionThe current practice of starting iron chelation when ferritin values reach 1,000 mcg/l risks hepatic iron loading in patients with beta-thalassemia intermedia. Advanced technology for evaluating hepatic iron loading is suggested. Thus, where MRI study is not feasible, serum ferritin can be used to estimate the hepatic T2*. Disclosures:No relevant conflicts of interest to declare.

Low Yield From Hepatitis C Virus (HCV) Lookback At a Large Cancer Center

While chronic hepatitis due to HCV is a major health problem in the USA, blood transfusions pose a low risk of transmission. The federally mandated lookback process is initiated when a blood donor, previously negative or untested for HCV, now has a positive test. The process serves to identify any possible transmission during the “window period.” While there have been publications on lookback series from single institutions and countries, to date there has not been data presented solely from a cancer center. Moffitt Cancer Center (MCC), a large NCI-designated comprehensive cancer center, has had 291 HCV lookback investigations. Although the average age at time of transfusion was 51, this failed to include a number of patients on whom an electronic medical record was not created. Most of the transfusion recipients had advanced age or were ill from their cancer and had died prior to the investigation, accounting for 234 (80.4%) of the cases. Five of the cases were blood components that had expired and were never transfused. Six cases identified blood components that were never received and were actually transfused at other facilities. One case had no documentation of the recipient of the fresh frozen plasma unit. Eight cases were from patients who were alive but not tested either due to patient decision or inability to get in contact with them. Out of the 37 patients that were subsequently tested, 35 (94.5%) of them tested negative for HCV by either anti-HCV enzyme immunoassays (EIA) or nucleic acid amplification tests (NAT), or both. Only 2 patients (or 0.7% of all cases investigated) tested HCV seropositive (EIA and RIBA confirmed). Both transfusion recipients were elderly women who were asymptomatic for chronic hepatitis and who posed no current or past risk for transmission via their blood or body fluids. In our case series, 80.4% of recipients were deceased at the time of the investigation. The seroprevalence rate in our case series, among the 37 recipients tested for HCV and transfused between 1988 and 2012, was 5.4%. In the USA, HCV prevalence continues to be low with current estimates &lt;1.5%. The CDC has recently expanded the recommendations for HCV testing to any persons born between 1945 and 1965, recipients of blood transfusions before July 1992, and patients with abnormal liver enzymes. Since the initiation of blood donor HCV EIA testing in 1990 and NAT testing in 1999, the risk of transfusion-transmitted HCV infection has plummeted. Given the improved public awareness of HCV, improved blood donor testing, and the low yield of the lookback process to both the recipient and society, discontinuation of the HCV lookback requirement should be considered. This case series also highlights that most transfusion recipients are either older or ill. As with HCV, several recent publications document the infrequency of transmitting human immunodeficiency virus (HIV) through modern transfusions; In England and Wales from October 1995 to December 2008, only 1 HIV positive recipient was identified with the lookback procedure. In conclusion, our large cancer center had almost 300 HCV lookback notifications and most transfusion recipients had advanced cancer and died prior to case investigation. The series found 94.5% of recipients tested had no evidence of HCV transmission. Consideration should be given to focusing HCV detection efforts on the general public and to eliminating the HCV lookback requirement in transfusion recipients. Disclosures: No relevant conflicts of interest to declare.

Hepatitis C Virus Serosorting in People Who Inject Drugs: Sorting Out the Details

Hepatitis C Virus Serosorting in People Who Inject Drugs: Sorting Out the Details

MULTIPLE TRANSFUSIONS;

Background: Multiple transfusions in patients of thalassemia who are conventionally treated by a regular transfusionregimen. Though regular blood transfusion improves the overall survival of patients with thalassemia, it carries a definite risk of infectionwith blood-borne viruses. The present study was carried out to estimate the real frequency of hepatitis C virus (HCV) among Pakistanithalassemic patients, and determine the infection-associated risk factors in these patients. Objective: To determine the frequency of anti-HCV in children with multiple transfusions. Setting: Shalimar Hospital, Lahore. The samples were collected from Children Hospital, MayoHospital and Fatimid Foundation; Lahore. Period: June 2012 to Nov 2012. Subjects &amp; Methods: One hundred blood samples werecollected from the children with multiple transfusions. Two to three ml of blood was taken from each multiply transfused child who hadreceived more than two blood transfusions. Serum was separated from each sample by centrifugation at 6000 rpm for 5 minutes. Afterserum separation, all the samples were stored at -80°C. The HCV antibody can be detected by anti-HCV Rapid Test but third or fourthgeneration enzyme linked immunosorbent assay (ELISA) is considered a better indicator of the seropositivity of this antibody. Results:The ages ranged from 6 months to &gt;12 years. The mean age of children in the study was 6.17±4.13 years. There were 70 were malesand 30 were females. Male to female ratio is 2.3:1. There are 58 thalassemic children, 27 different types of leukemia and 11 are aplasticanemia. Two children are with neuroblastoma while one each with thrombobasthenia and CDA-1. Conclusions: We concluded that a veryhigh HCV prevalence which calls for adoption of stricter donor selection criteria, rigid implementation of quality control measures and useof more sensitive and specific techniques for HCV testing.

Hepatitis C Screening: Are Primary Care Physicians Following the New CDC Guidelines?

Purpose: To establish the current hepatitis C virus (HCV) screening rate for patients born between 1945-1965 in the outpatient primary care clinics according to the new Center for Disease Control (CDC) guidelines released in 2012. Methods: We retrospectively reviewed the charts of patients born between January 1, 1945 - December 31, 1965, who presented to two outpatient primary care clinics in Dearborn, MI in the period from December 1, 2012 until April 30, 2013. Information obtained were date of birth, age at presentation, gender, and method of HCV screening (anti-HCV antibody or HCV RNA testing). Results: The total number of charts reviewed is 1,578. Males represented 36% (569) of the total population, and females represented 64% (1,009) of the total population. The mean age for all eligible patients was 56 years, with a standard deviation of 6 years. Two percent (31) of patients from our total enrolled patients were screened for HCV. A higher number of patients (1547) did not receive HCV screening, representing 98% of the toqtal eligible patients. The mean age for the screened group was 57 years, compared to 56 years in the non-screened (p=0.535). Among those who got screened, 68% (21) were males, and 32% (10) were females, compared to 35% (548) males and 65% (999) females in the non-screened group (p<0.001). Ninety-seven percent of the screened patients had anti-HCV antibody testing, and 3% had HCV RNA testing. Out of the 31 screened patients, four patients (13%) tested positive for HCV; these patients were referred to HCV specialists for further evaluation and treatment. Conclusion: Hepatitis C virus infection is the most common indication for liver transplantation in the United States, and is a leading cause of hepatocellular carcinoma. More than 3/4 of the newly diagnosed cases have been identified as baby boomers, verified by studies done by the CDC. The CDC has recently updated HCV screening guidelines to include patients who were born between 1945-1965, regardless of their risk factors. Our study shows the extremely low rates of HCV screening in the primary care setting. These findings support the need to increase awareness about hepatitis C screening. Adhering to these guidelines would result in early detection and referral of HCV positive patients for appropriate management. Future educational interventions should target both patients and primary care physicians, with frequent assessment and re-evaluation of these interventions.