HCV-related Chronic Disease Research Articles

Impact of HCV infection and ethnicity on incident type 2 diabetes: findings from a large population-based cohort in British Columbia

IntroductionIncreasing evidence indicates that chronic hepatitis C virus (HCV) infection is associated with higher risk of diabetes. Previous studies showed ethnic disparities in the disease burden of diabetes, with increased...

Direct-acting antiviral agents and risk of hepatocellular carcinoma: is it still a clinical dilemma?

Direct-acting antivirals (DAAs) revolutionised the treatment of chronic HCV-related disease achieving high rates of sustained virological response (SVR), also in more advanced patients, with a good safety profile and a proven positive effect on the reduction of risk of HCC occurrence. Nevertheless, patients with an history of successfully treated early HCC were initially excluded from pivotal trials. Although some initial retrospective studies, affected by several methodological issues, raised concerns regarding a possible harmful effect on the risk of HCC recurrence after antiviral therapy, more recent prospective studies and meta-analyses provided evidence that risk of HCC recurrence after DAA therapy is similar, or even lower, than that observed in patients treated with interferon or in DAA-untreated controls. In the future, a meta-analyses of individual patient data would be necessary to definitively close this clinical debate, as well as prospective studies assessing ‘true endpoints’, such as overall survival.

Su1401 Treatment of HCV Using Combination DAAs Can Be Successfully Managed by Trained Healthcare Extenders

Introduction: Chronic HCV related disease is one of the commonest ailment in pakistani community and genotype 3 is the common subtype. Iodine polymers like Renessans have long been used in central asian states for the management of chronic HCV. No clinical data is available to prove this claim. This study has been conducted to evaluate the safety and efficacy of Renessans in HCV related CAH. Material and Methods : In this randomized, active controlled study we have divided patients in three groups. Group I recieved only Renessans, Group II a recieved interferon+ribavirin+renessans and group II b received interferon + ribavirin.. 30 patients for each arm have been randomized in response guided therapy by checking the RVR, EVR and SVR. Results: SVR Achieved in 86.6 %in Group II And 76.9 % Patients in group II b while niether of the patient in group I achieved SVR. Four patients had serious adverse events which was managed and had uneventful recovery. Conclusion : It is concluded that iodine complex Renessans is safe and has beneficial role when added to standard of care therapy for patients suffering from HCV related disease.

Su1400 An Open Labelled, Active Controlled Study If Safety and Efficacy of Iodine Complex Renessans in Chronic HCV Patients

Introduction: Chronic HCV related disease is one of the commonest ailment in pakistani community and genotype 3 is the common subtype. Iodine polymers like Renessans have long been used in central asian states for the management of chronic HCV. No clinical data is available to prove this claim. This study has been conducted to evaluate the safety and efficacy of Renessans in HCV related CAH. Material and Methods : In this randomized, active controlled study we have divided patients in three groups. Group I recieved only Renessans, Group II a recieved interferon+ribavirin+renessans and group II b received interferon + ribavirin.. 30 patients for each arm have been randomized in response guided therapy by checking the RVR, EVR and SVR. Results: SVR Achieved in 86.6 %in Group II And 76.9 % Patients in group II b while niether of the patient in group I achieved SVR. Four patients had serious adverse events which was managed and had uneventful recovery. Conclusion : It is concluded that iodine complex Renessans is safe and has beneficial role when added to standard of care therapy for patients suffering from HCV related disease.

Hepatitis C Virus Testing Perspectives Among Primary Care Physicians in Four Large Primary Care Settings

In 1998, the Centers for Disease Control and Prevention (CDC) published Recommendations for Prevention and Control of Hepatitis C Virus (HCV) Infection and HCV-Related Chronic Disease, recommending HCV testing for populations most likely to be infected with HCV. However, the implementation of risk-based screening has not been widely adopted in health care settings, and 45% to 85% of infected U.S. adults remain unidentified. To develop a better understanding of why CDC's 1998 recommendations have had limited success in identifying persons with HCV infection and provide information about how CDC's 2012 Recommendations for the Identification of Chronic Hepatitis C Virus Infection Among Persons Born During 1945-1965 may be implemented more effectively. Qualitative data were collected and analyzed from a multidisciplinary team as part of the Birth Cohort Evaluation to Advance Screening and Testing for Hepatitis C project. Nineteen providers were asked open-ended questions to identify current perspectives, practices, facilitators, and barriers to HCV screening and testing. Providers were affiliated with Henry Ford Hospital, Mount Sinai Hospital, the University of Alabama, and the University of Texas Health Science Center. Respondents reported the complexity of the 1998 recommendations, and numerous indicated risk factors were major barriers to effective implementation. Other hindrances to hepatitis C testing included physician discomfort in asking questions about socially undesirable behaviors and physician uncertainty about patient insurance coverage. Implementation of the CDC's 2012 recommendations could be more successful than the 1998 recommendations due to their relative simplicity; however, effective strategies need to be used for dissemination and implementation for full success.

Recommendations for Prevention and Control of Hepatitis C Virus (HCV) Infection and HCV-Related Chronic Disease

Hepatitis C virus is the main cause of chronic liver disease and cirrhosis, and also liver cancer. According to global health importance of hepatitis C, decreasing the burden of HCV infection and HCV-related disease is so important. It need to design and implement preventive activity against HCV infection by introducing primary and secondary prevention activities. Hepatitis C has no effective vaccine. Considering counseling and education of people to avoid risk factors, such as IV drug abusing and having multiple sex partners, are important primary prevention activities.Public health surveillance is an effective strategy to detect new cases, risk factors and burden of disease. Early diagnosis and prompt treatment by expert specialists can decrease hepatitis C and HCV- related diseases prevalence, disease sequel and burden of hepatitis C. Monitoring and assessment of preventive programs is required to identify the strength and weakness of program and to re-establish newer one.

Impact of Immunogenetic IL28B Polymorphism on Natural Outcome of HCV Infection

With the aim of investigating whether interleukin 28B gene (IL28B) rs1297860 polymorphism is associated with different hepatitis C (HCV) infection statuses, we compared IL28B allelic distribution in an Italian case series of 1050 patients with chronic infection and different outcomes, 47 individuals who spontaneously cleared HCV, and 178 blood donors. Furthermore, we compared IL28B variants among 3882 Caucasian patients with chronic infection, 397 with spontaneous clearance, and 1366 blood donors reported in PubMed. Overall data confirmed a relation between IL28B C allele and HCV spontaneous clearance. Furthermore, we found that IL28B T allele had a weak relation with chronic HCV progression to hepatocellular carcinoma. Study findings are in accordance with the hepatocellular carcinogenic model where IL28B TT genotype, by promoting a persistent chronic hepatitis which leads to both hepatocyte injury and chronic inflammation, could facilitate HCC development. Conversely, patients with lymphoproliferative disorders had not any significantly different IL28B rs1297860 allelic distribution than those with chronic HCV, but, like all chronic HCV-related diseases, they showed a lower CC frequency than patients who spontaneously cleared HCV. Study results confirmed the model of persistent HCV infection as a risk factor for the pathogenesis of both liver and lymphoproliferative disorders.

13C-Aminopyrine breath test accurately predicts long-term outcome of chronic hepatitis C

Although numerous non-invasive tests are currently available to explore liver function and disease activity in patients with HCV-related chronic diseases, none of these indicate the likelihood of disease progression in the individual patient. We aimed at assessing the prognostic ability of (13)C(2)-aminopyrine breath test ((13)C-ABT) in the prediction of liver fibrosis progression in patients with HCV chronic hepatitis who prospectively entered a long-term follow-up. Fifty patients with HCV-related chronic disease who underwent paired liver biopsy (at baseline and after a mean period of 86 months) were included in the study. (13)C-ABT was carried out at baseline and every 3 years. Histological progression was defined as increase of at least 2 fibrosis units according to Ishak score. Fourteen patients progressed of at least 2 fibrosis units during the follow-up. These patients were more frequently infected with a HCV-1b genotype and had, at baseline, a significantly older age, higher BMI, AST levels, and AST to platelet ratio index (APRI). (13)C-ABT was altered in 57% of cases at baseline and in 100% of the cases at 3-year follow-up. In the univariate analysis, age (p=0.005), BMI (p=0.006), platelet count (p=0.03), AST (p=0.012) and ALT (p=0.04) levels, APRI (p=0.03), and baseline (13)C-ABT results (p<0.0001) were all independently associated with progression of liver fibrosis. By Cox's multiple regression analysis, the (13)C-ABT was the only covariate that significantly predicted liver fibrosis progression (HR 6.7; 95% CI 2.3-20.1; p<0.001). (13)C-ABT accurately predicts the risk of disease progression in patients with HCV-related chronic hepatitis.

Letter

Back to table of contents Previous article Next article LetterFull AccessLetterMuhamad Aly Rifai M.D.Muhamad Aly Rifai M.D.Search for more papers by this authorPublished Online:1 Mar 2010https://doi.org/10.1176/ps.2010.61.3.325aAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To Screen or Not to Screen for Hepatitis C Infection?To the Editor: The report by Kakisi and colleagues ( 1 ) in the September 2009 issue on the high prevalence of hepatitis C virus (HCV) infection among patients with psychiatric disorders is in line with other reports of increased rates of HCV infection in patient populations with psychiatric disorders (three to ten times the rates in the general population) ( 1 , 2 ). Kakisi and colleagues concluded that routine screening for HCV should be implemented for patients with psychiatric disorders. I contend that the evidence for such recommendation is equivocal at best and needs to be examined closely and evaluated cautiously ( 3 ). Recommendations of the Centers for Disease Control and Prevention support screening for HCV infection among patients who have psychiatric disorders with a history of intravenous drug use. Routine HCV screening has been implemented for patients at Department of Veterans Affairs hospitals (prevalence around 6%) and for incarcerated individuals (prevalence as high as 20%). However, the U.S. Preventive Services Task Force (USPSTF), a nonfederal group of health experts that makes recommendations about preventive health care, found insufficient evidence to recommend for or against routine screening for HCV infection among high-risk asymptomatic adults ( 4 ). The USPSTF made its recommendation because it found no studies proving that screening for HCV infection leads to better long-term clinical outcomes—specifically, to fewer cases of HCV-related chronic disease and fewer deaths that are attributable to actions taken as a result of screening (for example, counseling and treatment) ( 4 ). An argument can be made that adult patients with psychiatric disorders should be screened for HCV because they are a unique population by virtue of their psychiatric symptomatology and because of the increased morbidity and mortality associated with the combination of HCV infection and psychiatric disorders ( 2 , 3 ). Nonetheless, my study of outcomes of HCV screening for patients with psychiatric disorders showed that only a minority of those who screened positive for HCV infection were considered for treatment and an even smaller minority actually received HCV antiviral treatment ( 2 ). Freudenreich and colleagues ( 5 ) reported that after two years of HCV screening of patients enrolled in a clozapine clinic, none who screened positive were referred for evaluation or received HCV antiviral treatments. Where does this body of conflicting evidence leave us? HCV is a viral liver infection associated with increased morbidity and mortality in psychiatric populations. HCV treatments, however, have not been proven to reduce morbidity or mortality. This calls for an individualized approach to screening for HCV in psychiatric populations. Questions that may help target screening include these: What are the risk factors (for example, intravenous drug use or other high-risk practices)? Is a patient in a high-risk group or symptomatic (that is, elevated liver transaminases, fatigue, or cognitive issues)? Will the patient benefit from screening in terms of counseling to modify behavior or reduce and eliminate alcohol intake? Evidence that new HCV antiviral medications improve treatment and reduce morbidity and mortality from HCV infection will make a stronger case for routine HCV screening for patients with psychiatric disorders.Dr. Rifai is medical director, Department of Psychiatry, Lehigh Valley Health Network, Bethlehem, Pennsylvania, and associate professor of medicine and psychiatry, Penn State College of Medicine, Hershey.

Increased liver mast cell recruitment in patients with chronic C virus‐related hepatitis and histologically documented steatosis

Hepatitis C virus (HCV) is still one of the major causes of chronic viral infection worldwide, and hepatic steatosis is a frequent pathological finding in patients with chronic HCV-related diseases. It is unclear whether the steatosis is associated with host factors or the virus itself, although a consistent relationship has been found between steatosis and a necro-inflammatory reaction with the increased secretion of immuno-regulators. A primary sources of inflammatory mediators are mast cells (MCs) bone marrow-derived cells that are detected in both normal and diseased livers. We determined MC density and correlated it with the fibrosis, inflammatory reaction and steatosis observed in the liver biopsies of patients affected by HCV with or without steatosis. All the histological features were assessed using a computer-aided image analysis system. There was a statistically significant difference in MC density between the HCV-infected patients with and without steatosis, with the lower mean value being detected in those without (P < 0.02). Furthermore, a nonstatistically significant difference in fibrosis and inflammation between the two patient groups was found. In conclusion, this is the first study showing a significant increase in MC density in the tissues of patients with chronic HCV infection and histologically documented steatosis.

Testing for Hepatitis C Virus Infection Should Be Routine for Persons at Increased Risk for Infection

In the United States, chronic hepatitis C virus (HCV) infection affects an estimated 3 million persons, most younger than 50 years of age. It is one of the leading causes of chronic liver disease morbidity and mortality and the most common indication for liver transplantation. Effective treatment can eradicate the virus and eliminate or reduce liver inflammation and fibrosis, and counseling and immunization can modify or prevent the adverse effect of cofactors (for example, alcohol consumption or co-infections) on disease progression. However, controversy surrounds the need to routinely identify asymptomatic HCV-infected persons. Because no data currently demonstrate that treatment or other interventions will reduce future cases of HCV-related chronic disease and deaths, the U.S. Preventive Services Task Force found insufficient evidence to recommend for or against routine screening for HCV infection in adults at high risk. Chronic hepatitis C would require many years of follow-up to determine the incidence of complication after treatment of or other interventions in asymptomatic persons. It seems inappropriate to wait several decades to measure the impact of early identification of this viral infection when current data support a positive therapeutic effect that points to long-term benefits. In addition, treatment and other interventions must be provided before cirrhosis or liver failure occurs. Therefore, medical and public health professionals should continue the practice of screening persons for risk factors; offering testing to those at increased risk for HCV infection; and providing infected persons with appropriate counseling, medical evaluation, and treatment.

Hepatitis C

This chapter discusses the epidemiology of hepatitis C. The hepatitis C virus (HCV) is a blood-borne pathogen that appears to be endemic in most areas of the world. Differences in virus- and host-specific factors are likely responsible for the individual differences observed in the natural history of HCV-related chronic disease and in responses to antiviral therapy. Differences in the frequency and extent to which various risk factors contribute to the transmission of HCV are responsible for temporal and geographic differences that have been observed in the epidemiology of hepatitis C. It is suggested to prevent new infections, public health programs should focus on ensuring a safe blood supply, implementing appropriate infection control practices, and preventing initiation of high-risk drug and sexual behaviors. In addition, we need to better define the risk for HCV transmission in selected settings, develop more effective therapies for treatment of persons with chronic hepatitis C, and design approaches for treating current or former injecting drug users.