HCV Incidence Research Articles

Trends in HCV prevalence among injecting drug users in Glasgow and Edinburgh during the era of needle/syringe exchange.

In 1998, we reported that anti-HCV prevalence among injectors from Glasgow had declined between 1990 and 1995. We set out to ascertain if the anti-HCV prevalence among injectors from Edinburgh had declined similarly during this period and if there had been any trend in prevalence among injectors from both cities since 1995. Residual sera from both cities' injecting drug users who had undergone named HIV testing were identified, linked to age band and gender information and tested anonymously for anti-HCV. Among Edinburgh's injectors, significant (p < 0.0001) decreases in anti-HCV prevalence from 69% (1989/90) to 13% (1997) and from 80% (1989/90) to 54% (1997) were seen in those aged < 25 y and > or = 25 y, respectively. Among Glasgow's injectors, a significant (p < 0.0001) decrease in prevalence from 91% (1990) to 43% (1997) was seen only among those aged < 25 y. Of both cities' 15-19 y olds, sampled during 1995-97, 17% (24/139) were anti-HCV-positive. The findings suggest that the incidence of HCV among young injectors continued to decrease during the 1990s--the era of needle/syringe exchange and other interventions--but is still too high. Further investigative and preventive work is required.

Prevalence and incidence of bloodborne viral infections among Danish prisoners.

In order to determine the prevalence and incidence of bloodborne viral infections among prisoners, we conducted a prospective study in a Danish medium security prison for males. The prisoners were offered an interview and blood test for hepatitis and human immunodeficiency virus HIV at inclusion as well as at release from prison or end of study. Of 403 prisoners available 325 (79%) participated in the initial survey and for 142 (44%) a follow-up test was available. 43% (140/325) of the participants were injecting drug users (IDUs) of whom 64% were positive for hepatitis B (HBV) and 87% for hepatitis C (HCV) markers. No cases of HIV or human T lymphotropic virus (HTLV) were found. 32% of all prisoners could transmit HBV and/or HCV by blood contact. 70% of IDUs had shared injecting equipment, and 60% had injected inside prison. Only 2% of IDUs were vaccinated against HBV. Duration of injecting drug use, numbers of imprisonments, and injecting in prison were independently and positively associated with the presence of HBV antibodies among IDUs by logistic regression analysis. The HBV incidence was 16/100 PY (95% CI: 2-56/100 PY) and the HCV incidence 25/100 PY (1-140) among injecting drug users (IDUs). We conclude that IDUs in prison have an incidence of hepatitis B and C 100 times higher than reported in the general Danish population. They should be vaccinated against hepatitis B and new initiatives to stop sharing of injecting equipment in and outside prison is urgently needed.

MYCOPHENOLATE MOFETIL ALLOWS OVERALL REDUCTION OF IMMUNOSUPPRESSION IN LIVER TRANSPLANTS WITHOUT ADVERSE EFFECTS

241 Despite proven effectiveness in reducing acute rejection in liver transplant (OLT) recipients, tacrolimus (Prograf®, TAC) and prednisone (PRED) still present significant side effects. The addition of mycophenolate (Cellcept®, MMF) may allow for lower doses of TAC and PRED, especially during the early post-transplant period. The purpose of this study is to evaluate the impact on overall reduction of immunosuppressive medications via addition of MMF to the TAC/PRED regimen without compromising the allograft function. 35 liver recipients on TAC regimen were given MMF immediately post-op. Mean age of transplant recipients was 49.3 years (ranges 25-65 years). 1 year patient survival was 91.2% (32/35). 19/35 (54.3%) of the patients were HCV positive. All received 1 gram methylprednisolone intra-op with rapid taper (PRED 100 mg on POD 1, 20 mg on POD 5). Immunosuppression was as follows: (Table) 17/35 (48.6%) of patients had evidence of renal insufficiency (RI) with creatinine clearance (Cr Cl) of <60 cc/min for at least 1 month prior to transplantation. TAC immunosuppression initiation was lowered in these patients. Mean changes in Cr Cl following OLT for the RI patients were +45.1%, +36.7%, and +67.9% at 1, 6, and 12 months post-op as compared to −25.4%, −17.4%, and −7.6% for normal renal function patients. The incidence of rejection episodes was 41.2% (7/17) in RI patients as compared to 27.8% (5/18) for the other group (p=0.32). HCV recurrence diagnosis was made via biochemical, HCV-RNA and liver biopsy studies. HCV recurred in 10 out of 19 (52.6%), mostly during the first 3 months (median: 2 months, range 1-12). The rate of wound infection was 2.9% (1/35). 22.9% (8/35) of patients had side-effects directly attributable to MMF (diarrhea, abdominal cramping, nausea, vomiting, neutropenia). Complete steroid withdrawal at 3 and 12 months post-op were 12% (3/25) and 90.9% (10/11), respectively. In summary, addition of MMF to TAC/PRED regimen allowed overall reduction of TAC/PRED doses. This prevented further renal function deterioration without an increased incidence of rejection or HCV recurrence.Table

The distribution of HBV, HCV and HGV among livers with fulminant hepatic failure of different aetiology

Background/Aims: The aim of the study was to assess the impact factor of HCV and HGV in fulminant hepatic failure. Methods: The 5′-untranslated regions of HCV RNA and HGV RNA and a segment of the core antigen sequence of HBV were amplified after extracting the nucleic acids from snap-frozen tissue aliquots from explanted livers of 26 consecutive patients undergoing orthotopic liver transplantation for fulminant hepatic failure preoperatively diagnosed as either autoimmune ( n=2), HAV/HBV ( n=8), toxic ( n=4) or aetiologically unknown ( n=12). Results: HCV RNA was detected in five of 26 (19.2%) livers with fulminant hepatic failure. All five HCV RNA-positive livers belonged to the group of non-toxic, non-autoimmune liver failure ( n=20), three of them were found in the group of liver failure with unknown aetiology ( n=12) and two in the group of HBV-associated liver failure ( n=7), making an HCV incidence of 25%, 25%, and 28.6%, in the different groups, respectively. HGV RNA was detected in 10 of 17 (58.8%) explants and in all four groups of fulminant hepatic failure as defined preoperatively. HBV DNA was identified in six livers of 26 patients (23.1%) with fulminant hepatic failure. Neither HCV RNA nor HBV DNA was detected in the livers of patients with toxic or autoimmune fulminant hepatic failure. Conclusions: These results indicate that HBV and HCV, but not HGV, play an aetiologic role in fulminant hepatic failure. HCV-positive cases were concentrated either in the group of otherwise unexplained fulminant hepatic failure or in the group of HBV fulminant hepatic failure. HGV-positive cases, on the other hand, were found within all four preoperatively defined groups, indicating a role as cofactor rather than as single aetiologic agent.

Incidence of bloodborne virus infection and risk behaviours in a cohort of injecting drug users in Victoria, 1990-1995.

To assess changes in risk behaviours for transmission of bloodborne viruses and incidences and prevalences of these viruses in a field-recruited cohort of injecting drug users. Prospective longitudinal cohort study. Metropolitan and rural Victoria, June 1990 to December 1995. 626 current injecting drug users (i.e., who had injected drugs within the previous 12 months). Seroconversion to HIV and hepatitis B and C viruses (HBV and HCV), risk behaviours for infection. HIV incidence was very low (0.2 per 100 person-years). HCV incidence was high (10.7 per 100 person-years), but fell throughout the study, although the downward trend did not reach statistical significance. HBV incidence was moderate (1.8 per 100 person-years) and did not fall. Prevalence of risk behaviours, notably sharing needles and syringes, decreased significantly. Significant change has occurred in the risk behaviours of the cohort, confirming results of cross-sectional studies of injecting drug use. This change may be responsible for the apparent decline in HIV and HCV incidence. Further studies are needed to monitor the incidence of bloodborne viruses in injecting drug users. Efforts to decrease risk of transmission should continue.

Effective detection of active HCV infection: HCV RNA carrier state in a context free of hepatitis symptoms

HCV immunological assays have limited specificity due to considerable variability of genomic coding sequences. Accordingly, PCR RNA detection also shows variable incidence of HCV in a non-A, non-B (NANB) hepatitis context. We used in-house designed nested PCR applying primers from the 5′ untranslated region in 150 thalassemic patients classified in four groups according to anti-HCV screening and glutamic-pyruvate transaminase (GPT) levels. Group A: anti-HCV +/high GPT levels; group B: anti-HCV +/normal GPT levels; group C: anti-HCV −/high GPT levels; group D: anti-HCV −/normal GPT levels. Viral incidence and concentration, both high in group A, decreased towards group D. Group C RNA incidence was unexpectedly high and, moreover, one control case proved HCV-RNA +. Compared with the Amplicor kit our primers were considerably more sensitive.

Donor levels of serum alanine aminotransferase activity and antibody to hepatitis B core antigen associated with recipient hepatitis C and non-B, non-C outcomes.

Hepatitis virus(es) that are neither hepatitis B (HBV) nor hepatitis C (HCV) (non-B, non-C [NBNC]) may be transmitted by transfusion. The present study assessed donor values for alanine aminotransferase (ALT) and antibody to hepatitis B core antigen (anti-HBc) for their association with HCV and NBNC hepatitis outcomes among allogeneic blood recipients. Data on blood donors and recipients enrolled in the Transfusion- Transmitted Viruses Study in four United States cities from 1974 through 1980 were supplemented by anti-HBc testing of donors and anti-HCV evaluation of recipients. Two statistical approaches estimated the value of these indirect tests in detecting donors associated with HCV seroconversion and NBNC hepatitis in recipients. For HCV cases, donor ALT alone (at > or = 60 IU/L) had a sensitivity and a specificity of 30 and 96 percent, respectively, and anti-HBc alone (at > or = 60% inhibition) had a sensitivity and specificity of 53 and 86 percent, respectively. The two markers combined had a sensitivity and a specificity of 69 and 83 percent. For NBNC hepatitis cases, each measure had low sensitivity (20%) that was not improved by using both (28%) [corrected]. The indirect tests proved to be equal in sensitivity to the first-generation anti-HCV tests. The positive predictive power of these indirect tests in the 1980s was sufficient to affect HCV incidence in studies during that period. Improved anti-HCV assays, however, replaced the need for indirect tests. The sensitivity of indirect tests for NBNC hepatitis contributed little.

Influence of HCV infection and its subtypes on clinical course of alcoholic liver disease.

Since the assay of HCV antibody has been developed, it became clear that HCV is involved not only in patients with non-A non-B hepatitis but also in some alcoholic patients. The aim of this study is to examine the prevalence of HCV in chronic alcoholics and to elucidate the influence of HCV and its subtypes on pathogenesis and clinical feature of alcoholic liver disease. To that effect, sera from 100 alcoholics were tested for antibody against C100 of HCV by ELISA and for HCV RNA by reverse transcriptation and the PCR method. The incidence of HCV Ab/RNA was 0%/17% in patients with non specific reactive hepatitis, 0%/0% in fatty liver, 17%/17% in alcoholic hepatitis, 50%/73% in chronic hepatitis, 15%/18% in liver fibrosis and 19%/31% in liver cirrhosis. HCV Ab and RNA were positive in 21% and 31% of alcoholics, respectively. Subtypes of HCV were identified by dot blot hybridization method. Type K1, K2a and K2b were detected in 68%, 25% and 7% of 28 patients with positive HCV RNA, respectively. Type PT was not detected. In addition, serum transaminase activities were evaluated after 4 weeks abstinence. The incidence of normalization of the enzyme activity was lower in patients with positive HCV RNA than that with negative HCV RNA. Furthermore, when it was estimated in relation to HCV subtypes, the incidence of normalization in patients with type K1 was lower than that with type K2. In conclusion, the prevalence of HCV infection in alcoholic patients was much greater than general population.(ABSTRACT TRUNCATED AT 250 WORDS)

A longitudinal study on the incidence and transmission patterns of HIV, HBV and HCV infection among drug users in Amsterdam

In the present study data on the incidence of HBV and HCV were used to indicate the prevalence of and trends in risk behavior, assuming that drug users (DUs) who become infected with HBV or HCV are also at risk for infection with HIV. In addition, we determined to that extent the transmission patterns of HIV, HBV and HCV differed. DUs were selected from a cohort study in Amsterdam, had at least one follow-up visit between December 1985 and September 1989 and reported never to have had homosexual contacts. Among 305 DUs, of whom 70% injected recently, the prevalence of HIV, HBV and HCV were 31%, 68% and 65% respectively. These prevalences were strongly interrelated and the same risk factors were found. The cumulative incidence of either HIV or HBV or HCV was 30% among prevalent HIV-negatives. Despite a previously reported reduction in risk behavior, only the HIV incidence tended to decrease initially, and after 1986 the incidences of HIV, HBV and HCV remained disturbingly high and stable (mean: 4, 9 and 10 per 100 person-years, respectively). As at present HBV appears to be transmitted more heterosexually than HIV in our study group and the HIV-epidemic may follow the HBV-epidemic in its transmission patterns, preventive activities targeted at both injecting and sexual behavior should be expanded.

HCV incidence in a dialysis center: preliminary reports.

Incidence of seroconversion to anti-HCV from December 1989 to May 1991 was evaluated in patients and in their sexual partners. In December '89, 13 of 66 and in May '91, 26 of 75 patients were HCV positive. 9 of 13 new, seroconverted patients had been transfused. Seroconverted mean dialytic age was lower than that of previous HCV-positive patients. All the sexual partners were HCV negative. Blood transfusion seems to be the main risk factor for HCV infection, while environmental contamination is still debatable.

CHRONIC LIVER DYSFUNCTION IN HEART TRANSPLANT RECIPIENTS, WITH SPECIAL REFERENCE TO VIRAL B, C, AND NON-A, NON-B, NON-C HEPATITIS

In order to assess the prevalence, causes, and severity of chronic liver dysfunction (LD) in heart transplant patients, 80 transplanted patients followed for 60 months (median; range, 1.5-98 months) were reviewed. Sustained liver dysfunction was found in 50 patients, occurring during the first year after heart transplantation in 42 (84%) of them. Most patients were asymptomatic (80%). Causes for the liver dysfunction included non-A, non-B hepatitis in 16 cases (32%), viral B hepatitis in 13 (26%), delta hepatitis in one (2%), drug-induced hepatitis in six (12%), and cardiac failure in seven (14%). Anti-HCV antibodies were found in 56.2% of patients with non-A, non-B hepatitis and in 22% of patients with HBV hepatitis. It was found neither in patients with drug-induced hepatitis cardiac failure nor in patients with normal liver tests. This study outlines a high prevalence of LD (62.5%) in heart transplant patients, the high frequency of viral-related chronic LD (usually of moderate severity), and high incidence of HCV and HBV hepatitis.