HCV Cases Research Articles

The Massachusetts Hepatitis C Testing Cascade, 2014-2016.

Objectives:To characterize hepatitis C testing in Massachusetts and guide stakeholders in addressing the needs of people living with hepatitis C.Methods:All persons with a positive laboratory report for anti-hepatitis C virus (HCV) antibody, between 2014 and 2016, were included in the testing cascade. Outcomes were HCV tests received after a positive anti-HCV antibody test: nucleic acid test or genotype test. Logistic regression analyses were performed to determine factors associated with progression through the HCV testing cascade.Results:Among those reported anti-HCV antibody positive, a total of 13 194 (61%) cases had a subsequent RNA-based test, and 79% (10 374/13 194) were confirmed with current, active HCV infection. For confirmed HCV cases, 44% (4557/10 374) had a genotype identified. The median time from an antibody-positive test to a RNA-based test was 29 days (interquartile range [IQR] = 7-151). Differences in moving through the testing cascade were observed by birth cohort and race/ethnicity.Conclusions:Improved surveillance capture of demographic information is needed to help public health agencies ensure equity in HCV diagnosis and linkage to care.

Predictive Clinical Value of Rheumatoid Factor and Anti-Citrullinated Protein Antibodies as Diagnostic Tools in Cases with Non-Arthritic Chronic Hepatitis C Viral Disease

Background: Rheumatoid arthritis is a chronic immunological disease that causes destruction and deformity of joints. Chronic hepatitis C infection cases could develop rheumatic like clinical presenting profile. Raised rheumatoid factor in chronic HCV infection considerably reduces the diagnostic privilege of rheumatoid factor for rheumatoid arthritis coexisting with HCV infection. Aim of the work: To determine the value of anti-citrullinated protein antibody levels in cases having chronic HCV infection in comparison to rheumatoid factor. Methodology: The research team recruited 150 non-arthritic study subjects having chronic hepatitis C virus infection rheumatoid factor and anti-citrullinated protein antibody levels were assayed for all study subjects for statistical analysis. Results: Rheumatoid factor +ve study subjects had statistically significantly more frequent within female gender. (p value=0.027) Rheumatoid factor high +ve cases had statistically significantly had more frequent fatty liver and higher platelets than on high RF +ve cases. (P value =0.020, <0.038 consecutively) Conclusion: HCV cases with joint involvement were not implemented in the current research study that prevented statistical estimation of the sensitivity of anti-citrullinated protein antibody for arthritis in this cohort. Racial and ethnic differences should be put in consideration in future research studies that are recommended to be multi centric in fashion.

2217. Demographic Trends and Health Care Utilization Among Children With Hepatitis C Virus Infection

BackgroundHepatitis C virus (HCV) infection has received significant attention in recent years due to the ability for near universal cure, the price of therapy, and increasing incidence due to injection drug use. While the discussion largely focuses on HCV infection in adults, children with HCV are a consistent minority of patients with long-term adverse outcomes of HCV. Few studies have defined the healthcare utilization of HCV-infected children.ObjectiveTo define trends in pediatric HCV cases and healthcare utilization using a national administrative database.MethodsThe Pediatric Health Information Systems (PHIS) database contains inpatient encounter-level data from tertiary care pediatric hospitals in the United States. We identified pediatric HCV cases using validated ICD-9/ICD-10 diagnosis codes (070.41, 070.44, 070.51, 070.54, 070.70, 070.71, V0262, B18.2). We evaluated total cases identified, year of presentation, patient age, geographic location by state, aggregate cost of providing care and HIV-coinfection (ICD-9 code 042/ICD-10 code B20).ResultsSince 1992, there were 2,175 unique pediatric patients identified with HCV infection. Case rates were highest in patients 15–17 years with a peak of 24 cases/10,000 admissions that fell to 10 cases /10,000 in 2,000 and a low of 1 case/10,000 in 2015. Alarmingly, the rate in this group was back over two cases/10,000 in 2016 and 2017. HCV case rates in children 11–14 were the second highest with more sustained peak from 1992 to 2006 and no precipitous decline. There were 49 patients with HIV co-infection, with rates highest prior to 1998 (range of 6.5–18%), but since 2002 have been <2% until 2017 (2.5%). For inpatient costs, 10% of HCV infected children accounted for 75% of the total cost of care. In 2004–2006, total charges for 329 HCV-infected children were just over $23 million, compared with 2015–2017 when total charges for 247 HCV-infected children were $21.8 million. Comparing these two eras and adjusting for inflation, there was a 3% decline in charges per patient.ConclusionWhile the burden of inpatient HCV in children has declined since the peak in the early 1990s, there are worrisome increases detected in the last few years. A small minority of patients represent a disproportional amount of the total care provided. Early treatment of children would still likely prove cost-effective.Disclosures R. Jhaveri, Abbvie: Investigator, Research support; Gilead: Investigator, Research support; Merck: Grant Investigator, Grant recipient.

2225. Acute Hepatitis C Virus Infections in HIV-Infected Persons in the Era of Direct-Acting Antiviral Therapy

BackgroundAcute hepatitis C (HCV) infection can be sexually transmitted in HIV-infected men who have sex with men (MSM). Since 2014, direct-acting antivirals (DAA) have successfully cured many persons with chronic HCV infection. We examined the incidence of acute HCV infection in HIV-infected persons before and after the widespread use of DAA therapy.MethodsWe used the HIV Atlanta Veterans Affairs Cohort Study (HAVACS) to examine the incident rate (IR) of acute HCV infections during the period of 01 January 2013 to 31 December 2013 (pre-DAA era) and in the post-DAA era (January 1, 2017 to December 31, 2017). Acute HCV infection was identified using HCV seroconversion or HCV viremia with a negative HCV antibody. We also describe the demographic, clinical characteristics, and virologic outcomes of acute HCV infection cases observed since 2014.ResultsIn the pre-DAA era, 56 cases of acute HCV were seen among 1,378 persons (IR: 40.6 per 1000). In the post-DAA era, 29 cases were seen among 1,433 persons (IR: 20.2 per 1,000). HAVACS persons seen in 2017 were 52% less likely to be diagnosed with acute HCV infection than those seen in 2013. Of the seven acute HCV cases examined in detail, the median age is 41 years (range 33–60 years). All cases were male and African American race. Two persons had active IV drug use in addition to unprotected anal intercourse as a risk factor for HCV infection. The median CD4 just prior to HCV infection was 753 cells/cm2 (range: 590–1,046 cells/cm2). One person had a detectable HIV viral load (527 copies/mL) just prior to HCV infection while the other 6 persons had undetectable HIV viral loads. The peak AST ranged from 147 to 1,256 IU/L (median: 798 IU/L) while the peak ALT ranged from 171 to 1,530 IU/L (median: 855 IU/L). The median total bilirubin is 3.5 mg/dL. One person spontaneously cleared his HCV infection, two were treated with DAA therapy, and the other four are under active monitoring.ConclusionAcute HCV infections have significantly decreased in HIV-infected persons in the DAA era. However, acute HCV infections can cause severe transaminitis and jaundice. More work is needed to prevent HCV infections in HIV-infected persons.Disclosures All authors: No reported disclosures.

1272. A Routine, HIV and HCV Testing and Treatment Program in a Large, Multi-Campus Emergency Department Finds High Prevalence of Acute HIV and Chronic Hepatitis C

BackgroundOne in seven people living with HIV in the United States are unaware of their serostatus. Approximately 11,280 annual HIV infections (30.2%) are caused by this subset of individuals (CDC, 2017). In addition, acute HCV infections have nearly tripled since 2011, with many states seeing a dramatic increase in incidence among younger people outside the birth cohort (CDC, 2017). Because many individuals still use emergency departments (EDs) for their healthcare needs, these institutions play an increasingly important role in screening patients for HIV and HCV and linking them to medical services. Routine, opt-out testing initiatives are particularly effective at identifying new cases of HIV and HCV that could have otherwise been missed by a risk-based approach to screening.MethodsIn early May 2017, physicians and advanced practice nurses from Sutter Health’s Alta Bates Summit Medical Center (ABSMC) and a nearby outpatient HIV clinic implemented a routine HIV and HCV screening program at the hospital’s large, two-campus ED system in Oakland, CA. ED medical directors created a Nursing Standardized Procedure (NSP) to allow registered nurses (RNs) to independently order both blood tests using an automated, best practice authority (BPA) screen in the electronic health record (EHR) of any patient who met CDC-defined age criteria for testing.ResultsOf the 6,315 people screened for HIV between May 1, 2017 and March 31, 2018, 43 (0.7%) patients tested positive. Twelve (57%) of the 21 patients found to have a new HIV diagnosis also had symptomatic, acute HIV infection (AHI). All 12 patients with AHI initiated anti-retroviral therapy (ART) within five to 96 hours of their preliminary positive test result. Of the 5,820 patients screened for HCV, 424 (7.3%) were anti-HCV positive, while 185 (3.2%) patients had chronic infection. Thirty-nine percent of chronic HCV cases were among younger patients born before 1965. All patients with HIV or chronic HCV were referred to medical care at East Bay Advanced Care (EBAC).ConclusionAn automated, routine HIV-HCV testing program integrated into standard nursing workflow at a community ED resulted in the timely screening, diagnosis, and treatment of many patients with acute HIV, and identified a high prevalence of chronic HCV infections among younger patients.Disclosures R. Anson, Frontline of Communities in the United States (Gilead, Inc.): Grant Investigator, Grant recipient. C. Hall, Frontline of Communities in the United States (Gilead, Inc.): Grant Investigator, Grant recipient.

Prevalence of HCV Infection in Household Contacts of Chronic Liver Diseases Cases in Egypt.

Background Egypt has the highest prevalence of HCV infection worldwide. This project aimed at identifying the role of HCV transmission among household contacts to index cases in the persistent high incidence of HCV infection in Egypt. Methods This cross-sectional study recruited 70 Egyptian cases with chronic liver diseases and their household contacts (140 contacts) from Qalubeyia Governorate. An interview questionnaire was used to collect information on sociodemographic characteristics and risk factors to HCV infection. HCV-RNA was tested using real-time polymerase chain reaction (PCR). Univariate and multivariate analyses were carried out to estimate the risk of HCV infection among contacts. Results HCV viremia was detected in 85.7% of cases and 20% of contacts. HCV-RNA was detected in higher proportion of household contacts to cases than the general population. Contacts to HCV-positive cases were unlikely exposed to used syringe (P=0.02) and unlikely to have history of Bilharziasis (P=0.001) compared to contacts to HCV-negative cases. HCV-positive contacts were more likely older (P < 0.001) and married (P=0.008) and had higher crowding index (P=0.04) than HCV-negative contacts. Also, HCV-positive contacts were more likely exposed to blood transfusion (P=0.008) and shaving at community barber (P=0.04) and had history of Bilharziasis (P=0.01). The strongest predictors for HCV infection among contacts were old age (OR, 95% CI: 1.08, 1.02 to 1.15; P=0.01) and blood transfusion (8.08, 1.75 to 37.3; P=0.007). Conclusion Nonetheless, household contacts to HCV cases are exposed to increased risk of HCV infection, and environmental exposure particularly blood transfusion remained a major source of HCV infection.

Distance to treatment as a factor for loss to follow up of hepatitis C patients in North East England.

A large proportion of the 200 000 HCV-infected individuals in the UK are undiagnosed or lost to follow-up. Engaging known infected individuals in treatment is essential for elimination. Using PHE surveillance data and HCV treatment registers from North East of England (NE) treatment centres for 1997-2016, we estimated the number of HCV cases not linked to treatment and the proportion with active infection. We compared distances of treated and untreated cases to treatment services, and assessed the effect of expanding HCV treatment into existing drug and alcohol treatment centres in the NEE on treatment accessibility. The odds of being treated was associated with distance to treatment services. Confirmatory results for ~50% were not reported to PHE NE. Overall, 3385 patients reported to PHE NE had no record of treatment; we estimated 1621 of these may have been lost to follow-up after confirmation of active infection. Poor access to healthcare services may contribute to under-diagnosis or loss to follow-up. Expanding HCV treatment delivery into NEE drug and alcohol treatment centres would improve the accessibility of treatment services to people infected with/at risk of HCV. This may increase the proportion receiving treatment and support progress towards elimination.

Differential spatial distribution of hepatitis B virus by ethnicity in British Columbia, Canada: Expanded role of a large administrative cohort

IntroductionMost chronic hepatitis B virus (HBV) infections in Canada are diagnosed among immigrants from endemic countries and lack traditional risk factors while most acute infections are usually diagnosed in Caucasian population with co-occurring risk factors. Thus, understanding geographical distribution of HBV infection by ethnicity could inform screening and care strategies.&#x0D; Objectives and ApproachWe identified geographic clusters of HBV infection in British Columbia by ethnicity during the years 1990-2015 using the BC Hepatitis Testers Cohort (BC-HTC). The BC-HTC includes ~1.7 million individuals tested for HCV or HIV at the BC Public Health Laboratory or reported as a case of HCV, HIV, or HBV linked to healthcare administrative databases. We plotted maps of HBV diagnoses (acute and chronic) rate at the Dissemination Area level between 1990-2015 stratified by ethnicity and compared this distribution with injection drug use (IDU) distribution in BC.&#x0D; ResultsThe distribution of HBV varied considerably by ethnicity. From 1990 to 2015, a higher rate of HBV infection was found among East Asians and Caucasians followed by South Asians and other ethnicities. East Asians with highest rates were mainly concentrated in Vancouver city, Burnaby and Richmond (Metro Vancouver) while South Asians with highest rates were mostly concentrated in urban areas in Surrey and Abbotsford. Caucasians with higher rates were clustered in Downtown Eastside in Vancouver, Surrey and Abbotsford (Metro Vancouver) and urban areas in Greater Victoria (Vancouver Island), Prince George (Northern BC) and Kamloops (Interior BC). The distribution of IDU closely followed the distribution of HBV among Caucasians but did not align with other ethnic groups.&#x0D; Conclusion/ImplicationsResults highlight distinct areas of HBV infection clustering by ethnicity, which differ from areas with high IDU distribution except in Caucasians. Findings support ethnicity-based HBV screening/prevention and care services to areas with immigrants from HBV-endemic countries and integrated HBV and harm reduction services for early diagnosis and treatment in Caucasians.

The Effectiveness and Cost-Effectiveness of Hepatitis C Screening for Migrants in the EU/EEA: A Systematic Review.

Chronic hepatitis C (HCV) is a public health priority in the European Union/European Economic Area (EU/EEA) and is a leading cause of chronic liver disease and liver cancer. Migrants account for a disproportionate number of HCV cases in the EU/EEA (mean 14% of cases and >50% of cases in some countries). We conducted two systematic reviews (SR) to estimate the effectiveness and cost-effectiveness of HCV screening for migrants living in the EU/EEA. We found that screening tests for HCV are highly sensitive and specific. Clinical trials report direct acting antiviral (DAA) therapies are well-tolerated in a wide range of populations and cure almost all cases (>95%) and lead to an 85% lower risk of developing hepatocellular carcinoma and an 80% lower risk of all-cause mortality. At 2015 costs, DAA based regimens were only moderately cost-effective and as a result less than 30% of people with HCV had been screened and less 5% of all HCV cases had been treated in the EU/EEA in 2015. Migrants face additional barriers in linkage to care and treatment due to several patient, practitioner, and health system barriers. Although decreasing HCV costs have made treatment more accessible in the EU/EEA, HCV elimination will only be possible in the region if health systems include and treat migrants for HCV.

Seroconversion after needlestick injuries - analyses of statutory accident insurance claims in Germany.

Objective: After a needlestick injury (NSI) with contaminated blood, there is a risk of seroconversion. Statutory accident insurance (SAI) claims data were used to determine the numbers of seroconversions for hepatitis B and C viruses (HBV, HCV) and for HIV.Materials and methods: Cases of HBV, HCV or HIV infection recognised as occupational diseases between 2006 and 2015 were selected from the BGW (Berufsgenossenschaft für Gesundheitsdienst und Wohlfahrtspflege) database. Cases where an NSI was reported to the accident insurer before the diagnosis of the infectious disease was made were included in the analysis. The causal link between the infection and the NSI identified was estimated based on diagnostic findings in medical case files. Results: In total, 566 cases with an occupation-related HBV, HCV or HIV infection were identified, including 44 cases where an NSI had been reported before diagnosis. Data on file indicated a possible causal link in 34 cases. In 16 of the 34 cases, seroconversion after the NSI was proven by diagnostic findings; in 13 of the 34 cases, seroconversion was possible but not proven because of the lack of initial findings. The index case was known in 23 of the 34 cases. The injuries occurred most often during waste disposal and high-risk procedures such as taking blood samples. The injuries were most often caused by cannulas for intravenous puncture. Subcutaneous devices were involved in two NSIs but there was no information on the initial serology or known index case. Conclusions: It is possible to identify seroconversion in SAI claims data. However, data on the injured person’s initial infection status is often incomplete and this makes it difficult to assess any causal link. The incidence of seroconversions resulting from injuries from subcutaneously applied devices is apparently low; this is consistent with the literature.

Frequency of Parenternal Exposure and Seroprevelence of HBV, HCV and HIV among Operating Room Personnel

Background: There are many experiences in the operation theatre professionals to get Hepatitis B virus, Hepatitis C virus and Human immunodeficiency virus during their profession in operating room due to accidental needle pricks or through cut by any sharp. The objective of this study is to find out the Frequency of parenteral exposure and seroprevelence of HBV, HCV and HIV among operating room personnel.Methodology: Frequency of parenteral exposure and seroprevalence of HBV, HCV and HIV among operating room personnel was found using ICT method.Results: All 108 (100 %) operating room personnel were HBV, HCV and HIV negative, none of them showed positive results. Among these 108 operating room personnel to complete my research, among these 58 (53.7%) were male and 50 (46.3%) were female.Conclusion: It is concluded by the study that there are no positive cases of HBV, HCV and HIV among operating room personnel in Gulab devi hospital and Masood hospital.

A Bayesian evidence synthesis approach to estimate disease prevalence in hard-to-reach populations: hepatitis C in New York City

Existing methods to estimate the prevalence of chronic hepatitis C (HCV) in New York City (NYC) are limited in scope and fail to assess hard-to-reach subpopulations with highest risk such as injecting drug users (IDUs). To address these limitations, we employ a Bayesian multi-parameter evidence synthesis model to systematically combine multiple sources of data, account for bias in certain data sources, and provide unbiased HCV prevalence estimates with associated uncertainty. Our approach improves on previous estimates by explicitly accounting for injecting drug use and including data from high-risk subpopulations such as the incarcerated, and is more inclusive, utilizing ten NYC data sources. In addition, we derive two new equations to allow age at first injecting drug use data for former and current IDUs to be incorporated into the Bayesian evidence synthesis, a first for this type of model. Our estimated overall HCV prevalence as of 2012 among NYC adults aged 20–59 years is 2.78% (95% CI 2.61–2.94%), which represents between 124,900 and 140,000 chronic HCV cases. These estimates suggest that HCV prevalence in NYC is higher than previously indicated from household surveys (2.2%) and the surveillance system (2.37%), and that HCV transmission is increasing among young injecting adults in NYC. An ancillary benefit from our results is an estimate of current IDUs aged 20–59 in NYC: 0.58% or 27,600 individuals.

Increased Health and Social Vulnerability Among Hepatitis C Infected Individuals Co-infected with Hepatitis B.

Hepatitis B (HBV) and hepatitis C (HCV) infections contribute significant morbidity in the United States, particularly among those with a history of incarceration, homeless-ness, and/or co-morbid mental illness. Data from the Philadelphia Department of Public Health's viral hepatitis registry were matched at the person-level to the city's shelter, jail, and mental health system datasets (vulnerability datasets), and descriptive statistics were calculated. Between January 2010 and December 2014, 29,807 cases of HCV and 133 cases of HBV/HCV were reported. Fifty-eight percent of HCV cases and 70% of HBV/HCV cases were found in at least one vulnerability dataset. Compared with HCV cases, HBV/HCV cases were more likely to have a mental health diagnosis and history of incarceration, and to have spent more days in jail, and were less likely to be receiving treatment for HCV. Data are needed to describe more adequately the trajectory of HBV/HCV co-infected individuals to improve health service planning and policy.

Which Infectious Blood Donors Could Be Identified by the Donor History Questionnaire - Comparison of Blood Donors Infected with HIV or HCV with Notified Cases from General Population in Germany

Background: Potential risks for transfusion-transmissible infections are identified by donor history questionnaires (DHQs), and donors with higher risks are deferred from donation. We assessed to which extent the currently used DHQs support the identification of infections among blood donors. Methods: Between 2006 and 2013, we analyzed data from notified HIV and HCV cases in the general population and positive blood donors in Germany. Logistic regressions were used to identify relevant infection risks. We estimated the possible effect of improved capture of risk factors for donor selection by calculation of population attributable fractions (PAF). Results: Risky sexual contacts - MSM as well as heterosexual contacts - were the most prominent infection risks among HIV-infected donors. Whereas MSM contacts were significantly less reported by donors than by cases from the general population, 58% of donors disclosed heterosexual risks compared to 26% of notified cases. The complete identification of heterosexual risk contacts might prevent acceptance of 53% of HIV-infected donors. HCV-infected donors were more likely to report heterosexual exposure, imprisonment, and piercing/tattoo than notified HCV cases. Improved recording of piercing/tattoo could prevent acceptance of 16% of HCV-infected donors. Conclusion: Donor selection should be improved with special attention to the identification of (hetero)sexual risk factors, invasive procedures (piercing/tattoo and imprisonment) applying well-designed DHQs, effective donor education, and confidential environment in all steps of the selection process.

Detecting Hepatitis B and C by Combined Public Health and Primary Care Birth Cohort Testing.

Both chronic hepatitis C (HCV) and B virus (HBV) infections are generally asymptomatic, and many remain undetected or are diagnosed at a late stage. Studies that evaluate best practice hepatitis testing strategies are needed to better detect this hidden population. In this prospective cohort study, we aimed to determine the diagnostic yield (test uptake and rate of positive test results) of a combined public health and primary care birth cohort testing strategy in detecting hidden cases of HCV and HBV infections. We invited all patients aged between 40 and 70 years (n = 6,743) registered with 11 family practices serving 2 higher prevalence areas, or hotspots (ie, estimated HCV prevalence of 1%; national estimated prevalence is 0.1-0.4%), in the south of the Netherlands. Test uptake was 50.9% (n = 3,434 patients). No active or chronic HCV infection was detected: 0.00% (95% CI, 0.00%-0.11%). Positive test rates were 0.20% (95% CI, 0.08%-0.42%) for anti-HCV (n = 7), 0.26% (95% CI, 0.12%-0.50%) for hepatitis B surface antigen (n = 9), and 4.14% (95% CI, 3.49%-4.86%) for antihepatitis B core (n = 142). This best practice testing strategy was effective in achieving a high test uptake. It completely failed, however, to detect hidden chronic HCV infections and is not recommended for countries with a low prevalence of the disease.

Using HIV Surveillance Data for Targeted, Community-based Hepatitis C Virus Testing among Baby Boomers in Washington, D.C.

Community-based hepatitis C virus screening can identify individuals who are unaware of their infection and not regularly engaged in care. We report on a pilot study exploring the utility of using HIV surveillance data to identify targeted, geographical areas with high HIV prevalence and poor care indicators for screening baby boomers at risk for HCV. Between August-September 2014, we conducted community-based HCV rapid testing in high-risk census tracts. Eligible participants were born from 1945-1965 and not currently engaged in HCV care. Overall, 30% were HCV-antibody positive, 34% had a medical visit in the past year and among those with a medical visit, 75% had never been HCV-tested before. Using HIV surveillance data for targeted, community-based HCV testing yielded a high prevalence of untreated HCV cases. A large proportion had never been HCV-tested, suggesting this testing paradigm may be effective in reaching individuals at risk for HCV in a community-based setting.

PURSUING EPIDEMIOLOGICAL INVESTIGATION OF CASES OF POSSIBLE HBV OR HCV INFECTION OF THE RECIPIENT WITH TRANSFUSIONS OF DONOR BLOOD COMPONENTS

Background. Nosocomial transmission of HBV and HCV is often believed to be associated with transfusion of inapparent infection blood. Nevertheless, recently both promotion of voluntary (fee free) donorship and the evolution of laboratory screening, including the introduction of high-sensitivity tests, have significantly reduced the transfusion-associated complications, including infectious ones. The incidence ratae of primary transfusion-transmitted infections in patients with hematological malignancies remains to be high. A lot of publications are devoted to epidemiological studies on the determination of the source of infection with parenteral viral hepatitis by virtue of molecular analysis of viral strains, which is one of the important tools for obtaining objective data on the presence or absence of epidemiological relationship in the investigation of iatrogenic cases of infection. However, there is still no clear algorithm for pursuing epidemiological investigations of such cases. The aim of this study was to develop the procedure for the epidemiological investigation of probable transfusion-transmitted HBV and HCV infection with the use of Laboratory Information System and Transfusiology Information System software in patients with hematological malignancies. Material and methods. 6 cases of primary HBV and 3 cases of primary HCV were registered in patients with hematological malignancies in the National Medical Research Center for Hematology. All patients had a history of blood transfusions. A two-steps procedure for the epidemiological investigation was developed. 5 epidemiological investigations were held according to this procedure. 35 archival blood samples (7 from patients and 28 from blood donors) were tested for serological and/or molecular markers of HBV and HCV to fulfill this. Results. First step of procedure includes the determination of the date of initial infection (IID). IID is an earliest point of maximal likelihood of the detection of viral markers by laboratory techniques. This value is calculated on the basis of the results of a comprehensive virological examination of the recipient. The second step includes a history of blood transfusions from IID up to date of initial detection of primary infection evaluation. Then the analysis of donor-recipient pairs should be executed for the detection of probable sources of infection. As the result of study 5 epidemiological investigations were held in accordance to the developed procedure and the Laboratory Information System and Transfusiology Information System software. Two of the five investigations cannot be completed because of donors’ rejection to undergo a follow-up examination. In other cases infection transmission through the blood transfusion was excluded. Conclusion. A standard operating procedure of epidemiological investigation of HBV or HCV transmission has been developed and implemented. In order to reveal the latent forms of these infections a protocol of viral screening in patients with hematological malignancies at the admission to hematology ward was also developed and implemented.

BEHAVIORAL PATTERNS TOWARDS OZONE THERAPY FOR HCV INFECTION

During the last decade, Viral Hepatitis C (HCV) has emerged as a new biological threat. Studies were performed in Egypt, between 1999 and 2008 to evaluate the role of ozone therapy for HCV. Whether the disease was in early or late stage, ozone therapy was found to be an effective, safe and, less expensive method in treating hepatitis “C” patients, used alone or in combination with drug therapy. Our study aims to investigate attitudes among physicians and patients towards the disease conditions, predisposing factors and, different therapeutic approaches including ozone therapy for HCV. Using two interview questionnaires, first for physicians (n=42) and the second for patients (n=50), managing HCV cases, via face to face structured interviews at the site of treatment reception in Cairo and Alexandria. Sites were grouped into three categories: (1) Ministry of Health governmental organizations and university hospitals (2) Army Facilities (3) Private clinics and centers. Snowball sampling method for ozone therapy, and conventional therapists interviewed after obtaining permission from the director of each establishment visited. Negative attitudes towards ozone therapy were observed among our study sample physicians with significant differences when distributed by place of study and physicians specialty. In our study sample 38.1% of physicians believe that ozone therapy is not scientific evidence based medicine. Moreover, 54.8% assumed that ozone is an illegal and unapproved therapy for HCV. (93.1%) of the patients interviewed in governmental organization clinics and university hospitals never received ozone. 62.5% interviewed in private and army clinics had ozone therapy, and they all had positive attitudes towards ozone therapy for HCV. More research is needed to elucidate the debate concerning ozone therapies.

Effectiveness and cost-effectiveness of nationwide campaigns for awareness and case finding of hepatitis C targeted at people who inject drugs and the general population in the Netherlands

BackgroundHepatitis C virus infection (HCV) is a serious, but underdiagnosed disease that can generally be treated successfully. Therefore, a nationwide HCV awareness campaign was implemented in the Netherlands targeting people who inject drugs (PWID) in addiction care (‘PWID intervention’) and high-risk groups in the general population (‘public intervention’). The objective of this study is to assess the effectiveness and cost-effectiveness of the interventions used in this campaign. MethodsFor the ‘PWID’ intervention, all addiction care centres in the Netherlands provided proactive individual HCV consultation and testing. The ‘public intervention’ consisted of health education through mass media and instruction of health care professionals. A Markov chain model was used to estimate incremental cost-effectiveness ratios (ICER, cost per QALY gained). We included a ‘DAA treatment’ scenario to estimate the effect of these treatment strategies on cost-effectiveness. ResultsThe ‘PWID intervention’ identified 257 additional HCV-carriers. The ICER was €9056 (95% CI: €6043–€13,523) when compared to ‘no intervention’. The ‘public intervention’ identified 38 additional HCV-carriers. The ICER was €18,421 (95% CI: €7376–€25,490,119) when compared to ‘no intervention’. Probabilistic sensitivity analysis showed that the probability that the ‘PWID intervention’ was cost-effective was 100%. It also showed a probability of 34% that the ‘public intervention’ did not exceed the Dutch threshold for cost-effectiveness (€20,000). New treatment regimens are likely to improve cost-effectiveness of this strategy. ConclusionIn a nationwide HCV awareness and case finding campaign, the intervention targeting PWID was effective and cost-effective. An intervention targeting risk groups in the general population showed only a modest effect and is therefore less likely to be cost-effective.

Impact of viral hepatitis aetiology on survival outcomes in hepatocellular carcinoma: A large multicentre cohort study.

While HBV and HCV are risk factors for HCC, uncertainty exists as to whether these viral infections have prognostic significance in HCC. Thus, we compared the overall survival of patients with HBV, HCV and nonviral HCC, and evaluated whether the presence of HBV and HCV predicts patient outcomes. We conducted a multicentre study of HCC cases diagnosed at six Melbourne tertiary hospitals between Jan 2000-Dec 2014. Patient demographics, liver disease and tumour characteristics and patient outcomes were obtained from hospital databases, computer records and the Victorian Death Registry. Survival outcomes were compared between HBV, HCV and nonviral hepatitis cases and predictors of survival determined using Cox proportional hazards regression. There were 1436 new HCC cases identified including 776 due to viral hepatitis (HBV 235, HCV 511, HBV-HCV 30) and 660 from nonviral causes. The median survival of HBV, HCV and nonviral HCC patients was 59.1, 28.4 and 20.9months, respectively (P<.0001). On multivariate analysis, independent risk factors for survival included HCC aetiology, gender, BCLC stage, serum AFP, total number and size of lesions, and serum creatinine and albumin. After adjusting for these and method of detection, HBV remained an independent predictor of improved overall survival when compared to both nonviral (HR 0.60%, 95% CI 0.35-0.98; P=.03) and HCV-related HCC (HR 0.51%, 95% CI 0.30-0.85; P=.01). In this large multicentre study, HBV is independently associated with improved overall survival compared with HCV and nonviral-related HCC. Further studies are needed to determine the underlying factor(s) responsible.