Endemic Worldwide Research Articles

Herpetic keratitis: Herpes simplex virus versus host

AbstractHerpes simplex virus type 1 (HSV‐1) is an endemic virus worldwide that causes ocular disease in a limited but significant number of infected persons. Corneal HSV‐1 infection is clinically classified into herpetic epithelial keratitis (HEK) and herpetic stromal keratitis (HSK). HEK is an acute inflammation and results from viral toxicity of infected corneal epithelial cells. In contrast, HSK is characterized as a chronic immunopathogenic disease in which tissue injury and eventually blindness is due to the complex interplay between cells of the innate and adoptive immune response to viral antigens expressed in the corneal tissue. Studies performed on the experimental HSK mouse model greatly improved our understanding of the pathogenesis of HSK. This talk will recapitulate current insights on the virus‐host interactions involved in the initiation and perpetuation of herpetic keratitis in mice and men.

HIV/AIDS-associated visceral leishmaniasis in patients from an endemic area in Central-west Brazil

An increase in morbidity associated with visceral leishmaniasis (VL) in human immunodeficiency virus (HIV)/AIDS patients has been described in Africa and the Mediterranean. Despite the high endemicity of VL and HIV-1/AIDS in Brazil, this association has not been thoroughly investigated. Our aim was to evaluate the epidemiologic and clinical characteristics of VL-HIV-1/AIDS cases from Central-west [Mato Grosso do Sul (MS)] Brazil. Medical records of 23 VL-HIV-1/AIDS patients were reviewed. Patients were predominantly adult males (87%) and 34.8% of the patients were intravenous drug users (IVDU). Leishmaniasis was the first opportunistic infection in 60% of the HIV-1 patients. Fever occurred in all patients, although splenomegaly and hepatomegaly were absent in 21.7% of the cases. CD4+ T-cell counts were below 200 cells/mm(3) in 80% of the cases and the counts did not increase after clinical remission despite antiretroviral therapy. The first drug chosen to treat the cases was antimonial, but the therapeutic regimen was altered to amphotericin B in 12 of 17 cases due to side effects. Relapses were reported in 56.5% of the patients. IVDU may constitute an important risk factor for the transmission of both diseases in MS. VL-HIV-1/AIDS patients in MS share similar clinical characteristics as those from other endemic regions worldwide. Thus, these findings are critical for improving the surveillance of VL-HIV/AIDS patients.

Cryptosporidiosis: environmental, therapeutic, and preventive challenges.

Cryptosporidium spp. are responsible for endemic and epidemic disease worldwide. Clinical manifestations may include acute, persistent, or chronic diarrhea, biliary, and pulmonary disease. Disease severity ranges from asymptomatic or mild to severe, intractable diarrhea with wasting depending on immune status, nutrition, and age. Transmission is fecal-oral with both human and animal reservoirs. Disease is often self limited in healthy individuals, but therapy remains a challenge in the immune-compromised. Prevention currently depends on appropriate hygiene and proper water management and treatment.

Neospora caninum and coxiella burnetii seropositivity are related to endocrine pattern changes during gestation in lactating dairy cows

Q fever is a zoonotic infection caused by Coxiella burnetii that is endemic worldwide. Domestic ruminants are a source of infection for humans. Given the suggestion that the bacterium recrudesces during pregnancy in cattle, this study was designed to determine whether C. burnetii infection affects hormonal patterns, such as progesterone, cortisol, pregnancy associated glycoproteins (PAG), and prolactin during gestation in lactating cows. Possible interactions with Neospora caninum were also explored. The study was performed on 58 gestating non-aborting cows. Blood samples for hormone determinations were collected on Days 40, 90, 120, 150, 180, and 210 of gestation. For antibody determinations, blood was collected at day 40 postinsemination and postpartum. By GLM repeated measures analysis of variance, we established the effects of production and reproductive variables as well as Coxiella and Neospora seropositivity related to changes on cortisol, PAG, progesterone, and prolactin levels. Coxiella antibody levels were significantly related to cortisol, PAG, and plasma progesterone concentrations, whereas Neospora seropositivity was linked to plasma progesterone concentrations. The interaction between Coxiella and Neospora seropositivity was correlated with cortisol and plasma progesterone levels, whereas the interaction seropositivity against C. burnetii-plasma cortisol concentration was related to plasma PAG levels. Finally, an effect of lactation number only was observed on plasma prolactin. Our findings suggest that both the N. caninum and C. burnetii infection or the presence of both modify endocrine patterns throughout gestation. Cows seropositive to both, Neospora and Coxiella, showed higher plasma progesterone levels than the remaining animals examined. Seropositivity to C. burnetii was associated with placental damage and diminishing PAG levels throughout the second half of gestation, along with increased plasma cortisol levels on Day 180 of gestation.

Can hip fracture prediction in women be estimated beyond bone mineral density measurement alone?

The etiology of hip fractures is multifactorial and includes bone and fall-related factors. Low bone mineral density (BMD) and BMD-related and BMD-independent geometric components of bone strength, evaluated by hip strength analysis (HSA) and finite element analysis analyses on dual-energy X-ray absorptiometry (DXA) images, and ultrasound parameters are related to the presence and incidence of hip fracture. In addition, clinical risk factors contribute to the risk of hip fractures, independent of BMD. They are included in the fracture risk assessment tool (FRAX) case finding algorithm to estimate in the individual patient the 10-year risk of hip fracture, with and without BMD. Fall risks are not included in FRAX, but are included in other case finding tools, such as the Garvan algorithm, to predict the 5- and 10-year hip fracture risk. Hormones, cytokines, growth factors, markers of bone resorption and genetic background have been related to hip fracture risk. Vitamin D deficiency is endemic worldwide and low serum levels of 25-hydroxyvitamin D [25(OH)D] predict hip fracture risk. In the context of hip fracture prevention calculation of absolute fracture risk using clinical risks, BMD, bone geometry and fall-related risks is feasible, but needs further refinement by integrating bone and fall-related risk factors into a single case finding algorithm for clinical use.

Cours du Professeur B. Harrap

1. Applying epidemiological principles to clinical trials – lessons in stroke and diabetes Cardiovascular disease is now endemic worldwide and no longer limited to economically developed countries . In developed countries, cardiovascular disease accounts for about 35% of all deaths. Similar rates, but among younger age groups, are now being seen in developing countries such as Tanzania and India. Strategies to combat this growing burden are logically directed at cardiovascular risk factors, i...

The epidemiology of meningococcal disease and the impact of vaccines

Neisseria meningitidis causes endemic meningococcal disease worldwide. Serogroups B and C are responsible for the majority of cases of meningococcal disease in Europe, serogroups B, C and Y cause most disease in the Americas, and serogroups A, C and W135 predominate in Asia and Africa. Polysaccharide vaccines against meningococcal serogroups A, C, Y and W135 have been available for several decades, but have been little used due to poor immunogenicity in young children and minimal effects on nasopharyngeal carriage. Conversely, the introduction of the conjugate serogroup C meningococcal vaccine has dramatically changed the epidemiology of the disease in industrialized nations, showing potential for broader control with A, C, Y and W135 conjugates, and leaving serogroup B as the predominant cause of disease. Development of vaccines for prevention of serogroup B disease in industrialized nations and serogroup A conjugate vaccines for Africa could lead to global control of meningococcal disease.

Update on pertussis in children

Pertussis (or whooping cough) is a frequent and important infectious disease of the respiratory tract, mainly caused by the Gram-negative rod bacterium Bordetella pertussis. Although it is frequently believed that pertussis is exclusively a ‘childhood disease’, in reality it occurs at any age but is most serious in young infants. Adults are the main reservoir for B. pertussis today and pertussis remains an endemic disease worldwide despite the availability of comprehensive immunization programs that primarily target the pediatric population. There are many reasons for these, and these include incomplete immunity following natural infection as well as immunization and waning immunity over time. Manifestations of B. pertussis infections vary by magnitude of the bacterial inoculum, age, immune status and probably further yet unidentified individual factors. They can range from asymptomatic, apnea and uncharacteristic cough to typical coughing spells with posttussive phlegm and/or vomiting, and duration also varies between a few days and several months. Since antibacterial treatment of pertussis is generally ineffective as it usually sets in too late, the main focus should be on the prevention of pertussis by immunization. This apparently requires more than immunization of children – that is, expanding routine immunization into adolescence and adulthood.

Conservation of oceanic island floras: Present and future global challenges

Abstract Current threats to the planet's biodiversity are unprecedented, and they particularly imperil insular floras. In this investigation, we use the threat factors identified by the Millennium Ecosystem Assessment as the main drivers of biodiversity loss on islands to define and rank 13 current, continuing threats to the plant diversity of nine focal archipelagos where volcanic origin (or in the Seychelles a prolonged isolation after a continental origin) has produced a high degree of endemicity and fragility in the face of habitat alteration. We also conduct a global endangerment assessment based on the numbers of insular endemic plants in the endangered (EN) and critically endangered (CR) IUCN categories for 53 island groups with an estimated 9951 endemic plant species, providing a representative sample of the world's insular systems and their floristic richness. Our analyses indicate that isolation does not significantly influence endangerment, but plant endemics from very small islands are more often critically endangered. We estimate that between 3500 and 6800 of the estimated 70,000 insular endemic plant species worldwide might be highly threatened (CR+EN) and between ca. 2000 and 2800 of them in critical danger of extinction (CR). Based on these analyses, and on a worldwide literature review of the biological threat factors considered, we identify challenging questions for conservation research, asking (i) what are the most urgent priorities for the conservation of insular species and floras, and (ii) with the knowledge and assets available, how can we improve the impact of conservation science and practice on the preservation of island biodiversity? Our analysis indicates that the synergistic action of many threat factors can induce major ecological disturbances, leading to multiple extinctions. We review weaknesses and strengths in conservation research and management in the nine focal archipelagos, and highlight the urgent need for conservation scientists to share knowledge and expertise, identify and discuss common challenges, and formulate multi-disciplinary conservation objectives for insular plant endemics worldwide. To our knowledge, this is the most up-to-date and comprehensive survey yet to review the threat factors to native plants on oceanic islands and define priority research questions.

Diabetic dyslipidemia is a well-known issue, but what about lipoprotein a levels in Type 2 diabetics?

Type 2 DM is a worldwide endemic disease. Dyslipidemia is also a frequent disorder associated with diabetic patients. Lipid profiles can vary in distinct ethnic groups and population. There have been few trials about lipoprotein a (Lpa) levels in type 2 diabetic patients. We investigated serum lipid profiles, Lpa levels and metabolic syndrome findings in type 2 diabetic patients. In this prospective trial, 709 type 2 diabetic patients (407 F; 302 M) and 157 healthy control subjects (91F; 66M) living in the same geographic region were included. The mean age of patients was 53.4 ± 9.2 years. After 12-h overnight fasting, blood samples were obtained for analyzing the serum lipids. The serum total cholesterol, HDL, LDL, and triglycerides levels were measured by glucose enzymatic calorimetric method and apo-B, lipoprotein (a) levels by electrochemiluminescence Immunoassay. All patients were also evaluated for metabolic syndrome by NCEP ATP III criteria.Type 2 diabetic patients had higher serum total cholesterol, LDL cholesterol, triglyceride and apo-B levels and lesser HDL-cholesterol, compared with the control group (p<0.001). The serum Lpa was found to be similar in both type 2 diabetic and control subjects (p=0.519). Of the 709 diabetic patients, 516 (72.9%) had metabolic syndrome. In conclusion, as expected, dyslipidemia and metabolic syndrome was found to be higher in diabetic patients with respect to healthy controls, however, serum Lpa levels were not different in both groups.

Mite‐Transmitted Dermatoses and Infectious Diseases in Returning Travelers

Mites are among the smallest arthropods with most barely visible without magnification. 1 Mites are closely related to ticks, but they are tissue‐juice feeders, not blood‐feeders, and do not transmit as broad a variety of infectious microbial diseases. 1 In fact, the only infectious diseases transmitted by mites are rickettsialpox and scrub typhus. 1 The most common ectoparasitic dermatoses caused by mites are chiggers and scabies. 1 Travelers are uniquely predisposed to contracting several mite‐transmitted dermatoses and infectious diseases including: (1) scabies mites from close personal contacts; (2) zoonotic scabies from domestic or wild animals and pets; (3) rickettsialpox from sleeping in or visiting mice‐infested dwellings; and (4) chiggers and scrub typhus after stumbling onto trombiculid larvae‐infested “mite islands” in endemic regions worldwide. This review will describe the epidemiology, clinical manifestations, and management of the most common mite‐transmitted dermatoses and infectious diseases in returning travelers. A MEDLINE search, 1966 to 2008, of the world's scientific literature of case reports, case series, original articles, reviews, and observational and longitudinal studies was conducted to determine the epidemiology, outcomes, clinical manifestations, preferred diagnostic interventions, and management for mite‐transmitted dermatoses and infectious diseases in returning travelers. In addition, a clinical classification of mite‐transmitted infestations and infections was developed to assist clinicians in assessing potential mite‐transmitted skin and systemic infectious diseases in travelers. ### Classification of Mites and Disease Ecology of Mite‐Transmitted Dermatoses and Infectious Diseases Mite infestations and infections were classified into the following distinct clinical and etiological categories: (1) the mite‐transmitted dermatoses caused by human mites: scabies and follicle mite infestations (also known as demodecidosis or demodicosis); (2) the mite‐transmitted dermatoses caused by non‐human mites: chiggers, zoonotic scabies, animal and plant and plant insect mite infestations, and dust mite allergies; and (3) the mite‐transmitted systemic infectious diseases: scrub typhus and rickettsialpox (Table 1). Only two non‐human, animal mites may transmit infectious diseases: (1) chiggers or trombiculid … Corresponding Author: James H. Diaz, MD, MPH&TM, Dr PH, Schools of Medicine and Public Health, Louisiana State University Health Sciences Center (LSUHSC), 1615 Poydras Street, Suite 1400, New Orleans, LA 70112, USA.E‐mail: jdiaz{at}lsuhsc.edu

Effect of duration of fluoride exposure on the reproductive system in male rabbits

BACKGROUND AND OBJECTIVES:Fluorosis has become an endemic problem worldwide. Fluoride has its effect on various organs, including the reproductive system, although there are controversial reports over it. Thus, the present study was designed to study the effect of sodium fluoride (NaF) exposure for different durations.MATERIALS AND METHODS:30 healthy rabbits were divided into three equal groups. Group I was fed on a standard diet for 30 days, Group II was fed on sodium fluoride (20 mg/kg body weight) for 30 days and Group III was fed on sodium fluoride (20 mg/kg body weight) for 60 days. Sperm count, motility, progressive motility and weight of testis and epididymis were measured and compared with the control group.RESULTS:We observed that in the group exposed to NaF for 30 days (Group II), there was a significant decrease in all the parameters except the testicular weight and in the group on exposure of 60 days (Group III), there was a significant decrease in all the parameters when compared with the control group (Group I). On applying the Tukey post-hoc test between Groups II and III, we observed that there was a significant decrease in the sperm count while the other parameters showed a non-significant decrease. Testicular histology was confirmatory for the above findings.CONCLUSION:The present study demonstrates that fluoride hampers the reproductive functions of male rabbits and is proportional to the duration of fluoride exposure.

Phylogeographic analysis reveals association of tick-borne pathogen, Anaplasma marginale, MSP1a sequences with ecological traits affecting tick vector performance

BackgroundThe tick-borne pathogen Anaplasma marginale, which is endemic worldwide, is the type species of the genus Anaplasma (Rickettsiales: Anaplasmataceae). Rhipicephalus (Boophilus) microplus is the most important tick vector of A. marginale in tropical and subtropical regions of the world. Despite extensive characterization of the genetic diversity in A. marginale geographic strains using major surface protein sequences, little is known about the biogeography and evolution of A. marginale and other Anaplasma species. For A. marginale, MSP1a was shown to be involved in vector-pathogen and host-pathogen interactions and to have evolved under positive selection pressure. The MSP1a of A. marginale strains differs in molecular weight because of a variable number of tandem 23-31 amino acid repeats and has proven to be a stable marker of strain identity. While phylogenetic studies of MSP1a repeat sequences have shown evidence of A. marginale-tick co-evolution, these studies have not provided phylogeographic information on a global scale because of the high level of MSP1a genetic diversity among geographic strains.ResultsIn this study we showed that the phylogeography of A. marginale MSP1a sequences is associated with world ecological regions (ecoregions) resulting in different evolutionary pressures and thence MSP1a sequences. The results demonstrated that the MSP1a first (R1) and last (RL) repeats and microsatellite sequences were associated with world ecoregion clusters with specific and different environmental envelopes. The evolution of R1 repeat sequences was found to be under positive selection. It is hypothesized that the driving environmental factors regulating tick populations could act on the selection of different A. marginale MSP1a sequence lineages, associated to each ecoregion.ConclusionThe results reported herein provided the first evidence that the evolution of A. marginale was linked to ecological traits affecting tick vector performance. These results suggested that some A. marginale strains have evolved under conditions that support pathogen biological transmission by R. microplus, under different ecological traits which affect performance of R. microplus populations. The evolution of other A. marginale strains may be linked to transmission by other tick species or to mechanical transmission in regions where R. microplus is currently eradicated. The information derived from this study is fundamental toward understanding the evolution of other vector-borne pathogens.

Environmental toxins, a potential risk factor for diabetes among canadian aborginals

Objectives. To review the current literature to determine if there is a case for examining the presence of toxins in traditional foods and the environment as a possible risk factor for type 2 diabetes in Canadian Aboriginal populations.Study design. Literature review.Methods. The scientific literature on possible causes of type 2 diabetes in Aboriginal populations in Canada was reviewed. Potential exposure through food and water to environmental toxins such as methylmercury, arsenic, persistent organic pollutants (POPs), including bisphenol A and phthalates, as well as Aboriginal lifestyle and composition of the traditional diet is discussed.Results. There is growing evidence to suggest that environmental toxins may be associated with noninsulin-dependent diabetes mellitus (type 2 diabetes), which many consider to be endemic worldwide. In Canada, diabetes has reached epidemic proportions, especially among Aboriginal populations. Based on both molecular and pathological findings, some toxins found in the environment interfere with the functioning of the pancreas’ islets of Langerhans cells, and consequently they affect insulin production. In addition, there is new evidence suggesting that obesity may be linked to endocrine disruptors, thus increasing the likelihood that obesity in itself may not be a chief risk factor for diabetes.Conclusions. Diabetes prevalence rates among First Nations, Inuit and Métis populations are 3–5 times higher than the general population. Accepted risk factors such as diet, lifestyle and genetics do not fully explain this phenomenon. However, as many environmental toxins bioaccumulate in the food chain and are found in wild game and fish traditionally harvested and consumed by Aboriginal peoples, these chemicals could present health risks not yet fully explored. As there is not enough evidence to rule out this possibility, further studies are suggested. If correct, such environmental risk factors, especially if they are encountered early in life, would have implications on Aboriginal public health.

Genetic differentiation of Echinostoma revolutum and Hypodereaum conoideum from domestic ducks in Thailand by multilocus enzyme electrophoresis

Echinostomes are common intestinal parasites causing zoonotic disease, which are endemic worldwide. Of the four species of medically important echinostomes reported in Thailand, two species, Echinostoma revolutum and Hypodereaum conoideum, have been detected in poultry. These two parasites are morphologically similar and are sometimes difficult to distinguish. In the present study, multilocus enzyme electrophoresis was used to differentiate E. revolutum from H. conoideum collected from domestic ducks in Thailand. The parasites were compared using 22 enzymes with 30 presumptive enzyme loci. The two species of echinostome could be distinguished at 17 of the 30 enzyme loci. Several loci were polymorphic within each species, suggesting that these can be used to examine their population genetics.

Chromoblastomycosis: clinical presentation and management

Chromoblastomycosis is an important subcutaneous mycotic infection that is endemic worldwide but more common in the tropics. It is caused by the traumatic inoculation of the skin with pigmented saprophytic moulds, and the principal infective species are Fonsecaea pedrosoi and Cladophialophora carrionii. Although chromoblastomycosis is not known to be fatal, it is characteristically chronic, and can be complicated by lymphatic damage and neoplastic transformation. It is one of the more difficult-to-treat mycoses, and a variety of antifungal regimens often combined with various physical treatments can be used.

Infectivity of pestivirus following persistence of acute infection

Bovine viral diarrhoea virus (BVDV) is an endemic pathogen worldwide and eradication strategies focus on the identification and removal of persistently infected (PI) animals arising after in utero infection. Despite this, acute infections with BVDV can persist for months or years after the removal of the PI source despite repeated screening for PIs and tight biosecurity measures. Recent evidence for a prolonged duration of viraemia in the testicles of bulls following acute BVDV infection suggests the possibility of a form of chronic persistence that may more closely resemble the persistence strategies of hepatitis C virus (HCV). To investigate the potential for virus transmission from infected and recovered cattle to virus naïve hosts we established an acute infection of 5 BVDV-naïve calves and monitored animals over 129 days. Infectious BVDV was detected in white blood cells between days 3 and 7 post-challenge. The animals seroconverted by day 21 post-infection and subsequently were apparently immune and free from infectious virus and viral antigen. Animals were further monitored and purified white blood cells were stimulated in vitro with phytohaemagglutinin A (PHA) during which time BVDV RNA was detected intermittently. Ninety-eight days following challenge, blood was transferred from these apparently virus-free and actively immune animals to a further group of 5 BVDV-naïve calves and transmission of infection was achieved. This indicates that BVDV-infected, recovered and immune animals have the potential to remain infectious for BVDV-naïve cohorts for longer than previously demonstrated.

Mastitis in dairy production: Estimation of sensitivity, specificity and disease prevalence in the absence of a gold standard

Mastitis, a worldwide endemic disease of dairy cows, is an important cause of decreased efficiency in milk production. Early medical treatment can reduce the nonreversible losses in milk production caused by this infection. Various diagnostic tests for mastitis are available, including a test measuring the electrical conductivity of milk (MEC test), the industry standard of somatic cell counting (SCC test), a bacteriological test, and a recently developed test measuring mammary associated amyloid A (MAA test). None of these tests is considered a gold standard, however. The aim of the present study was to determine which of these tests provides the best results, and at what cost, to improve the efficiency of milk production. For this study, 25 cows were tested at all four quarters of the udder with each of the aforementioned mastitis diagnostic tests. Based on the data, the disease prevalence as well as the sensitivity and the specificity of the four tests were estimated with a Bayesian approach by extending the Hui and Walter model with two independent tests and two populations to a model with four partially dependent tests and one population. This model was further combined with a receiver operating characteristics analysis to estimate the overall test accuracy.

Sinefungin-PLGA Nanoparticles: Drug Loading, Characterization, &lt;I&gt;In Vitro&lt;/I&gt; Drug Release and &lt;I&gt;In Vivo&lt;/I&gt; Studies

Cryptosporidiosis, the leading cause of endemic and epidemic diarrhoeal disease worldwide is due to Cryptosporidium parvum, a spore-forming protozoan. Anticryptosporidial pharmacological and/or immunological agents were initially tested in immunodeficient models of cryptosporidiosis, and sinefungin exhibited a significant dose dependent curative and preventive activity. Shedding relapses observed after discontinuation of sinefungin therapy lead to identify the bile ducts as a protected reservoir that may sustain chronic infection. The MIC50 of the sinefungin observed in vitro studies is 14.5 microg/ml. It is a hydrophilic drug lowly absorbed when orally administered and nephrotoxic after IV injection. To avoid this toxic effect, Neal's team prepared sinefungin loaded microspheres and proved that encapsulated sinefungin was 10 times more effective than free sinefungin. This optimistic result led us to study the nanoparticles as drug carrier for sinefungin. In this study, we prepared optimal sinefungin loaded PLGA nanoparticles. Physico-chemical characterization, in vitro drug release and in vivo studies were assessed. Negative surface-charged (-56.1 mV) sinefungin loaded PLGA nanoparticles were prepared with a homogenous size of 200 nm. Optimal formulation led to a drug content of 9.18% w/w (4.59 mg) and a drug entrapment of 15.16%. Dilution technique was used to study the release of sinefungin in vitro. 93.03% of sinefungin were released from dilution 1:5 to 1:20. This burst effect could probably due to the adsorption of the drug on the surface of the nanoparticles. A second step with a lower release was observed from dilution 1:20 to 1:100 which may correspond to the diffusion out of the drug solution from the nanoparticles into the bulk release medium. Investigations in rats showed that only 1.23 mg of sinefungin loaded in PLGA nanoparticles led to a decrease of sinefungin in the urine (0.23 mg vs. 4.27 mg for IV administration of free sinefungin) and to an increase of sinefungin concentration in the bile (6.63 microg/ml vs. 3.89 microg/ml for IV administration of free sinefungin). But the biliary concentration of encapsulated sinefungin (6.63 microg/ml) is still nearly 2 times lower than the MIC50.

When to treat and the benefits of treating hepatitis C in patients with haemophilia

Chronic hepatitis C (CHC), a curable infection, remains endemic worldwide. More than 90% of individuals with haemophilia have been infected with hepatitis C virus (HCV) mostly caused by transfusion with non-virucidally treated clotting factor concentrates. Relevant to haemophilics, the risk of cirrhosis with CHC infection is greatest in males, those who have been infected for a long time, consume alcohol regularly, and/or are co-infected with HIV. The cure rate, using the current standard therapy for CHC with pegylated-interferon-alpha given weekly and ribavirin daily, ranges from 43% to 65% in those infected with genotype 1 and 50-90% with genotype 2 and 3 infections. Eradication of hepatitis C in those co-infected with HIV is less in part because full dose therapy is poorly tolerated. Achieving a sustained virological response (SVR) prevents progression to cirrhosis and in those with established cirrhosis prevents liver failure, and reduces the risk if hepatocellular carcinoma, and the need for liver transplant. Novel treatment options now in development are predominantly focused on inhibitors of HCV-specific enzymes. The treatment paradigm for haemophilics infected with hepatitis C is that all should be assessed for treatment once a diagnosis of chronic hepatitis C is made in order to achieve the highest chance of an SVR, i.e. cure.