HCV RNA Testing Research Articles

Current Management of Blood Donors with Positive Anti-Hbc in Saudi Arabia

Background: Transfusion Services in Saudi Arabia are mainly hospital-based, where each major hospital recruit donors, test for Hepatitis B service antigen (HBs Ag), Hepatitis C antibody (Anti-HCV), Human Immune Deficiency Virus antibody (Anti-HIV), and Nucleic Acid Testing (NAT) for HBV-DNA, HCV-RNA, and HIV-RNA. In addition, Anti-HBc and Anti-HBs titer are tested for those who are negative for HBs Antigen and NAT, so that blood products from donors with high Anti-HBs titer (>100 u/ml) can be used. The aim of this limited retrospective study is to find out the prevalence of Anti-HBc among blood donors in different blood donation centers in Riyadh city, Saudi Arabia and current policies regarding blood utilization from donors with positive Anti-HBc.Materials and Methods: We reviewed blood donor records in 4 large hospitals in Riyadh between 2011-2015. Hospital names are not disclosed for confidentiality reasons. Instead, they were named A, B, C, and DResults: (see Table)1- The overall prevalence of Anti-HBc positive blood donors is 6.2%, however, there is a significant variation among institutions ranging from 2.8 % to 11.1 % (which needs to be investigated to explain reasons for this variation).2- Some institutions defer all donors with positive anti-HBc (although they carry out all tests), while others carry out anti-HBs and NAT testing and use blood with high titer anti-HBs (> 100 u/ml).Conclusion: There is a need for an expert consensus opinion regarding the cost-effectiveness of anti-HBc for either donor deferral or proceeding to NAT and anti-HBs titer testing. Such a consensus is practiced in many countries, based on the prevalence of anti-HBc and the availability of NAT testing [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

HCV co-infection and markers of liver injury and fibrosis among HIV-positive childbearing women in Ukraine: results from a cohort study.

BackgroundUkraine’s injecting drug use-driven HIV epidemic is among the most severe in Europe with high burden of HCV co-infection. HIV/HCV co-infected individuals are at elevated risk of HCV-related morbidity, but little is known about burden of liver disease and associated factors in the HIV-positive population in Ukraine, particularly among women.MethodsCharacteristics of 2050 HIV-positive women enrolled into the Ukrainian Study of HIV-infected Childbearing Women were described by HCV serostatus. Aspartate transaminase (AST) to platelet ratio (APRI) and FIB-4 scores were calculated and exact logistic regression models fitted to investigate factors associated with significant fibrosis (APRI >1.5) among 762 women with an APRI score available.ResultsOf 2050 HIV-positive women (median age 27.7 years, IQR 24.6-31.3), 33% were HCV co-infected (79% of those with a history of injecting drug use vs 23% without) and 17% HBsAg positive. A quarter were on antiretroviral therapy at postnatal cohort enrolment. 1% of the HIV/HCV co-infected group had ever received treatment for HCV. Overall, 24% had an alanine aminotransferase level >41 U/L and 34% an elevated AST (53% and 61% among HIV/HCV co-infected). Prevalence of significant fibrosis was 4.5%; 2.5% among 445 HIV mono-infected and 12.3% among 171 HIV/HCV co-infected women. 1.2% had a FIB-4 score >3.25 indicating advanced fibrosis. HCV RNA testing in a sub-group of 56 HIV/HCV co-infected women indicated a likely spontaneous clearance rate of 18% and predominance of HCV genotype 1, with one-third having genotype 3 infection. Factors associated with significant fibrosis were HCV co-infection (AOR 2.53 95%CI 1.03-6.23), history of injecting drug use (AOR 3.51 95%CI 1.39-8.89), WHO stage 3-4 HIV disease (AOR 3.47 95%CI 1.51-7.99 vs stage 1-2 HIV disease) and not being on combination antiretroviral therapy (AOR 3.08 95%CI 1.23-7.74), adjusted additionally for HBV co-infection, smoking and age.ConclusionsMost HIV/HCV co-infected women had elevated liver enzymes and 12% had significant fibrosis according to APRI. Risk factors for liver fibrosis in this young HIV-positive population include poorly controlled HIV and high burden of HCV. Results highlight the importance of addressing modifiable risk factors and rolling out HCV treatment to improve the health outcomes of this group.

Evaluation of HBV-DNA, HCV-RNA and HDV-RNA co-existance: 2-Year retrospective study

Background: The aim of this study was to evaluate positivities of HBV-DNA, HCV-RNA and HDV-RNA on patients with diagnostic of chronic viral hepatitis, in our province, and to determine of togetherness of these results obtained from tests. Methods: This study was done with 4442 serum samples submitted to Microbiology laboratory of Adiyaman University Education and Training Hospital between 2013-2015 years. HBV-DNA, HCV-RNA and HDV-RNA (Fluorion, Iontek), the results obtained using qualitative and quantitative analysis kits were analyzed retrospectively. Statistical analysis was performed with SPSS 22.0.0 using by Kolmogorov-Smirnov test and chi-square analysis. Results: In this study, 2145(%55) of 3902 samples applied HBV-DNA from HBsAg positive patients samples, according to the results of ELISA test, were detected in HBV-DNA test, as positive. Eighty one (%15) of 540 samples from patient specimens found positive for anti-HCV by ELISA were detected in HCV-RNA test, as positive. Thirteen of 140 samples (% 9.3) applied HDV-RNA test were detected as positive. Conclusions: In the study two samples were found to be positive for both HBV-DNA and HCV-RNA, four sera was found to be positive for both HBV-DNA and HDV-RNA while no sample was found to be positive for all three infections (HBV-DNA, HCV-RNA ve HDV-RNA).

HCV RNA Testing of Plasma Samples from Cornea Donors: Suitability of Plasma Samples Stored at 4 °C for up to 8 Days

Background: The HCV RNA testing of potential cornea donors frequently relies on blood samples stored pre mortem. The recommended storage time of maximum 72 h frequently excludes a significant fraction of donors. Methods: The influence of storage time of EDTA plasma samples at 4 °C on the viral load measured with the Roche HCV Quantitative Test vs. 2.0 was evaluated for 43 samples from HCV-positive individuals. Results: The mean reduction of the viral load after 4 °C storage for 6-8 days was 0.46 log₁₀ IU/ml (range +0.17 to -1.66 log₁₀ IU/ml). After 1-3 days a mean loss of 0.19 log₁₀ IU/ml (range +0.30 to -1.41 log₁₀ IU/ml) and after 3-5 days of 0.32 log₁₀ IU/ml (range +0.36 to -1.81 log₁₀ IU/ml) was observed. In 23.3% of samples, a viral load reduction ≥ 1 log₁₀ IU/ml (1.0-1.81 log₁₀ IU/ml) was found after prolonged storage (5-8 days). In none of the samples did the HCV load fall below the detection limit. Conclusion: Plasma storage for up to 8 days can quantitatively reduce the HCV RNA load, yet has no influence on the reliability of a qualitative HCV RNA detection by this ultrasensitive test to determine the HCV status of serologically negative cornea donors.

Hepatitis C RNA assay differences in results: Potential implications for shortened therapy and determination of Sustained Virologic Response.

Approval of Ledipasvir/Sofosbuvir for the treatment of chronic hepatitis C (HCV) includes the truncation of therapy from 12 to 8 weeks in treatment naïve, non-cirrhotic patients with baseline HCV RNA levels <6 million IU/mL (6.8 log10 IU/mL). The aim of this study was to evaluate this clinical cutoff with a different widely used commercially available HCV RNA test. Results from samples tested prospectively with Roche High Pure TaqMan HCV 2.0 test (HPS) were compared to those tested retrospectively with the Abbott RealTime HCV RNA test (ART). Using 6 million IU/mL as the cut-off, pre-treatment results were concordant in 70.4% of cases. When results with the same test measured at screening and baseline, clinical decisions could be impacted in 14.4% and 6.2% of cases for HPS and ART respectively. Using only HCV RNA cutoff of 6 million IU/mL, 29.55% of subjects would receive a different and potentially incorrect treatment duration based solely on HCV RNA test method used. A further 6–14% of subjects would have treatment decision change based on the day the sample was taken.

Hepatitis C virus core antigen assay: an alternative method for hepatitis C diagnosis.

Background The study aimed to evaluate a fully automated chemiluminescent immunoassay and compared it with a quantitative RNA assay and anti-HCV assay to verify the utility of this automated Ag assay as an alternative method for hepatitis C diagnosis. Methods A total of 229 serum samples previously tested for anti-HCV concentrations by the Architect Anti-HCV assay, were selected for HCV RNA testing by real time RT-PCR kit (Shanghai ZJ Bio-Tec Co., Ltd) and 125 specimens were tested for HCV Ag by the Architect HCV core Antigen kit. Results The log10 HCVAg and HCV RNA concentrations were highly correlated [ r = 0.834); with HCV RNA as the comparator test, HCVAg had 100% specificity, 100% positive predictive value (PPV) and 94.8% sensitivity. We found 1 pg/mL of total HCV core Ag is equivalent to approximately 6607HCV RNA international units (IU)/mL. Receiver operator characteristic curve analysis showed that the area under the curve of HCV core Ag (0.989) was greater than HCV Ab (0.871). HCV Ag concentrations and RNA-to-Ag ratio of the groups for HCV RNA concentrations ≤105 and >105 IU/mL were both significantly different from each other ( P < 0.05). Conclusion The Architect HCV core Ag assay may be an alternative method for hepatitis C diagnosis, performed on the same analytical platform and sample as the anti-HCV assay, shortening the diagnostic window period, demonstrating good correlation with HCV RNA assay with high specificity and positive predictive value.

S05 - Management of hepatitis C positive patients undergoing active treatment for malignancies: a position paper from the Associazione Italiana di Oncologia Medica (AIOM) and the Società Italiana di Malattie Infettive e Tropicali (SIMIT)

Background: The association of HBV reactivation and anti-cancer drugs is well-known. However, since HCV reactivation is unusual, little information is available in this setting. Aim of our study was to develop, on behalf of AIOM and SIMIT, practical recommendations for the management of HCV+ pts undergoing antitumor treatment. Methods: Data present in the literature were reviewed, including recommendations and expert opinions on HCV+ pts undergoing antitumor therapy. Experts of the Societies provided additional information for clarifying some issues in the absence of clear-cut information from the literature. Results: HCV screening rates are low in cancer pts. The risk of hepatitis C reactivation is higher with immunosuppressive agents. It may be difficult to separate naturally occurring cancer/therapy-related complications from true reactivation of hepatitis. No conclusive data are available concerning the appropriate monitoring of liver function and when an antiviral regimen has to be given. Conclusions: At present, the following recommendations can be reasonably proposed for the management of HCV+ pts undergoing anticancer therapy:•risk-based and birth cohort-based HCV screening, followed by HCV-RNA tests in positive subjects, has to be performed before initiating active cancer treatment;•monitoring of ALT every 3-4 weeks is necessary. If ALT level raises 3 times the normal value, HCV-RNA should be closely monitored for 3 months following treatment discontinuation;•the risk of hepatitis C reactivation is higher in pts receiving immunosuppressive drugs including rituximab, alemtuzumab, steroids and certain chemotherapeutic agents;•in pts at high risk of reactivation of hepatitis C, treatment with antiviral agents is recommended, especially when anticancer therapy is administered with a curative intent;•when reactivation is diagnosed, the decision to proceed with active anticancer therapy and/or initiating antiviral agents should be based on a discussion of prognosis and therapy options for both conditions. As targeted therapies, including checkpoint inhibitors, are an emerging area of oncology, clinicians treating HCV+ infected pts should be mindful of the potential, in the absence of clear cut data, for their immunosuppressive properties;•collaboration with a hepatologist or an infectious disease specialist is necessary in the management of HCV+ cancer pts. Studies are needed to identify optimal strategies for diagnosis and treatment of this pts.

PTH-115 Increasing Access to Hepatitis C Treatment in The North East of England

Introduction Chronic infection with hepatitis C (HCV) is a major cause of cirrhosis and hepatocellular carcinoma. Many patients are now eligible for oral direct acting antivirals (DAAs), with cure rates >90% possible. The main challenge for viral hepatitis teams now is to engage known HCV infected individuals in treatment, and to find undiagnosed cases. There are an estimated 2000 HCV infected individuals in North of Tyne (NOT) Region (Newcastle, North Tyneside and Northumberland). However, it is unknown what proportion of HCV infected individuals diagnosed in this region ultimately receive treatment. Aim 1) To determine the proportion of HCV infected individuals in our region who were referred for treatment, received treatment and achieved a sustained virological response (SVR). 2) To determine whether contact can be made with patients who never had HCV RNA confirmatory testing, were never referred, or persistently missed clinic appointments. Methods We conducted a retrospective review of all patients with a NEW positive HCV antibody test between Jan 2011 and Dec 2012 in the NOT region. Patients were identified from the North East Public Health Laboratory. Medical records and treatment databases were accessed to establish outcomes for all patients. For patients never referred or lost to follow up a letter was sent to their GP advising them to contact the patient and discuss re-referral. Results Overall 92% of HCV antibody positive patients have HCV RNA testing performed (Figure 1). 88% of HCV RNA positive patients are referred for consideration for treatment. Of these, 47% commenced antiviral therapy, with an overall SVR of 66%. Persistent non-attendance was the main reason for not starting treatment. Letters were sent to GPs of 77 patients who were never referred or were lost to follow up. The GP response rate was 31% (24/77) after 8 weeks. Six (8%) patients were re-referred to the service. Conclusion There is a high rate of referral for HCV RNA positive patients (88%) in the North of Tyne region, with 47% commencing PEG-IFN based treatment. Some reasons for not starting treatment should resolve in the DAA era, increasing treatment rates.Contacting GPs to re-refer known HCV RNA positive patients is an inexpensive approach, but resulted in relatively few referrals. Improving HCV testing across the region is essential to increase access to treatment. Disclosure of Interest None Declared

Incident Hepatitis C Virus Genotype Distribution and Multiple Infection in Australian Prisons.

Hepatitis C virus (HCV) is a highly diverse pathogen that is classified into seven distinct genotypes. Simultaneous or sequential reinfection with multiple HCV genotypes is recognized in high-risk populations, such as injecting drug users (IDUs). Multiple infection is of clinical concern as different genotypes have various sensitivities to current antiviral therapies. Therefore, a better understanding of the frequency of multiple infection and of the genotypes currently being transmitted is clinically relevant. An Australian cohort of IDUs (n = 123), identified with primary incident infection, was followed for multiple infection by regular HCV RNA testing between 2005 and 2013. A total of 354 samples were tested. Sequencing of primary incident infections revealed that genotype 3a was the most common circulating genotype, followed by genotype 1a. Examination of longitudinally collected samples identified complex patterns of multiple infection, including reinfection and superinfection. In those with multiple infection, there was no apparent evidence of homotypic immunity conferring protection against reinfection of the same subtype. This study revealed frequent multiple infection in a high-risk prisoner cohort, illustrating the complex nature of HCV infection and reinfection and highlighting the need for pan-genotypic antiviral therapies.

Implementation of baby boomer hepatitis C screening and linking to care in gastroenterology practices: a multi-center pilot study.

BackgroundEstimates suggest that only 20 % of HCV-infected patients have been identified and <10 % treated. However, baby boomers (1945-1965) are identified as having a higher prevalence of HCV which has led the Centers for Disease Control and Prevention to make screening recommendations. The aim of this study was to implement the CDC’s screening recommendations in the unique setting of gastroenterology practices in patients previously unscreened for HCV.MethodsAfter obtaining patient informed consent, demographics, clinical and health-related quality of life (HRQOL) data were collected. A blood sample was screened for HCV antibody (HCV AB) using the OraQuick HCV Rapid Antibody Test. HCV AB-positive patients were tested for presence of HCV RNA and, if HCV RNA positive, patients underwent treatment discussions.ResultsWe screened 2,000 individuals in 5 gastroenterology centers located close to large metropolitan areas on the East Coast (3 Northeast, 1 Mid-Atlantic and 1 Southeast). Of the screened population, 10 individuals (0.5 %) were HCV AB-positive. HCV RNA testing was performed in 90 % (9/10) of HCV AB-positive individuals. Of those, 44.4 % (4/9) were HCV RNA-positive, and all 4 (100 %) were linked to caregiver. Compared to HCV AB negative subjects, HCV AB-positive individuals tended to be black (20.0 vs. 5.2 %, p = 0.09) and reported significantly higher rates of depression: 60.0 vs. 21.5 %, p = 0.009. These individuals also reported a significantly lower HRQOL citing having more fatigue, poorer concentration, and a decreased level of energy (p < 0.05).DiscussionAlthough the prevalence of HCV AB-positive was low in previously unscreened subjects screened in the gastroenterology centers, the linkage to care was very high. The sample of patients used in this study may be biased, so further studies are needed to assess the effectiveness of the CDC screening recommendations.ConclusionImplementation of the Baby Boomer Screening for HCV requires identifying screening environement with high prevalence of HCV+ individuals as well as an efficient process of linking them to care.

Hepatitis C diagnostic management gap in Pakistan—Clinicians’ knowledge impacting public health

Aim Hepatitis C virus (HCV) infects 10 million people in Pakistan with a prevalence rate of 4.9 %. Methods commonly used to diagnose HCV include anti-HCV and HCV RNA testing. However, HCV RNA is a molecular test that aims to identify active infection and is a test indicated for monitoring disease progression during therapy, while anti-HCV is a screening tool for detecting the presence of a virus in the body. Furthermore, liver function tests are part of routine testing in cases to assess the extent of liver damage. However, many clinicians in Pakistan are utilizing molecular tests to screen and diagnose HCV. Furthermore, elevated liver function test values are being justified for direct utilization of molecular tests instead of opting for anti-HCV tests. As HCV RNA tests detect only active infection and LFT values can be elevated or decreased because of other infections, using the HCV RNA test as a screening tool may have implications for patient management. Therefore, the main objective of this study was to evaluate clinicians’ perspectives for HCV test-based diagnostic management and identify the quality gap with respect to the utility of molecular tests.

Burden of Hepatitis C Virus Infection Among Older Adults in Long-Term Care Settings: a Systematic Review of the Literature and Meta-Analysis.

Hepatitis C virus (HCV) infection is a significant cause of morbidity and mortality worldwide. The magnitude of the HCV burden has previously been the subject of debate, as representative data tend to exclude high-risk populations, including institutionalized persons. The purpose of this systematic review and meta-analysis was to estimate the prevalence of HCV infection among older adults in long-term care (LTC) and assess factors associated with the prevalence of HCV in this setting. The Preferred Reporting Items for Systematic Review and Meta-Analyses checklist was used as the methodological guide. Two reviewers independently assessed the study quality using a validated modified quality assessment tool. Six articles met inclusion criteria; the majority were cross-sectional studies (83.3%) designed to estimate HCV infection prevalence rates and identify associated risk factors. HCV prevalence ranged from 1.4 to 11.8%. A pooled HCV infection prevalence of 3.3% (95% confidence interval: 1.5-7.2%) was estimated based on 1920 LTC residents with substantial heterogeneity noted (Q = 51.1, p < 0.001; I (2) = 90.2). Three of six studies reported statistically significant factors associated with an increased risk for HCV infection, including older age, female gender, history of blood transfusions, short duration of LTC residence, and hepatitis B virus positivity. This study reports a higher prevalence of HCV infection among older adults in LTC settings compared to community-dwelling older adults; however, accurate estimation of prevalence is limited by heterogeneity between and within studies, variation in sampling and recruitment methodologies, and absence of the HCV-RNA test to confirm active infection.

Effect of Antiviral Therapy on Serum Activity of Angiotensin Converting Enzyme in Patients with Chronic Hepatitis C.

Introduction:Renin-angiotenzin system (RAS) is frequently activated in patients with chronic liver disease. Angiotenzin - II (AT-II), produced by angiotenzin converting enzyme (ACE), has many physiological effects, including an important role in liver fibrogenesis. Combined antiviral therapy with PEG-IFN and ribavirin besides its antiviral effect also leads to a reduction in liver parenchyma fibrosis.Aim of the study:Determining the value of ACE in serum of patients with chronic hepatitis C before and after combined antiviral therapy, as well as the value of ACE activities in sera of the control group.Materials and methods:We studied 50 patients treated at Gastroenterohepatology Department, in the time-period of four years. Value of ACE in serum was determined by Olympus AU 400 device, with application of kit “Infinity TN ACE Liquid Stable Reagent”. HCV RNA levels in sera were measured by real time PCR. HCV RNA test was performed with modular analysis of AMPLICOR and COBAS AMPLICOR HCV MONITOR test v2.0, which has proved infection and was used for quantification of the viruses and monitoring of the patients’ response to therapy. Liver histology was evaluated in accordance with the level of necroinflammation activity and stage of fibrosis.Results:Serum activities of ACE in chronic hepatitis C patients is statistically higher than the values in the control group (p=0.02). Antiviral therapy in chronic hepatitis C patients statistically decreases serum activities of ACE (p= 0.02) and indirectly affects fibrogenesis of the liver parenchyma. Correlation between ACE and ALT activity after the therapy was proved (0.3934).Conclusion:Our findings suggest that the activity of ACE in serum is a good indirect parameter of the liver damage, and could be used as an indirect prognostic factor of the level of liver parenchyma damage. Serum activity of ACE can be used as a parameter for non-invasive assessment of intensity of liver damage.

Evaluation of fluvastatin in combination with the standard of care therapy (PEG-IFN/Ribavirin) in Egyptian patients with hepatitis C virus.

Cholesterol biosynthesis suppresses the replication of HCV-1b replicons, thus influencing hepatitis C virus (HCV) natural history. This study aimed at comparing the efficacy and safety of fluvastatin (FLV) as an adjuvant therapy to the standard of care (SOC) therapy, i.e., pegylated interferon (PEG-IFN) and ribavirin, for the treatment of HCV patients. Sixty HCV patients were enrolled and allocated to either group I, who received the triple therapy (fluvastatin + SOC), or group II, who received SOC; the duration for both treatments was 48 weeks. All patients were subjected to pretreatment liver biopsy and monthly biochemical tests (liver profile, CBC), and quantitative HCV-RNA test was performed at weeks 0, 4, 12, 48, and 72. All virological responses were higher in group I than in group II, with no statistical difference. Group I showed no manifestations of hepatotoxicity. Fluvastatin yielded a borderline, significantly higher complete early virological response than SOC; therefore, it is a safe adjuvant to the SOC therapy.

Implementation of Baby Boomer Hepatitis C (HCV) Screening and Linking to Care in Gastroenterology (GE) Practices: A Multicenter Pilot Study

Introduction: Treatment of HCV has been limited by identification of infected patients and by linking them to care. Some estimates suggest that only 20% of HCV-infected patients have been identified and < 10% have been treated. In addition, baby boomers born between 1945 and 1965 have been identified as having higher prevalence of HCV leading to screening recommendations by the Centers for Disease Control and Prevention (CDC). The aim of this study was to implement the CDC's screening recommendations in GE practices. Methods: This was a multi-center study involving 5 GE practices selected by the American College of Gastroenterology and the Chronic Liver Disease Foundation (CLDF). After obtaining patient informed consent, demographics, clinical and quality of life (QoL) data were collected. A blood sample was screened for HCV antibody (HCV AB) using the OraQuick HCV Rapid Antibody Test. HCV ABpositive patients were tested for presence of HCV RNA and, if HCV RNA-positive, linked to a clinician for treatment discussons. Results: We screened 2,000 subjects in 5 GE centers located close to large metropolitan areas on the East Coast (3 Northeast, 1 Mid-Atlantic and 1 Southeast). Of the screened subjects, 39.8% were male, age 59.7±6.0 years, 72% White, 5% Black, and 20% Hispanic. Thirty percent self-reported a history of anxiety, 22% of depression, and 38% of clinically overt fatigue. Additionally, 15.6% had a history of diabetes, 43.4% of hypertension, 47.8% of hyperlipidemia, 27.5% reported drinking alcohol and 10.2% smoked. Of the screened population, 10 patients (0.5%) were HCV AB-positive. HCV RNA testing was performed in 90% (9/10) of HCV AB-positive patients. Of those, 44.4% (4/9) were HCV RNA-positive, and all 4 (100%) were linked to a HCV treater. Compared to HCV AB-negative subjects, in HCV AB-positive patients, there was a trend towards a higher proportion of Blacks (20.0% vs. 5.2%, p=0.09). Also, HCV AB-positive patients more frequently reported a history of depression: 60.0% vs. 21.5%, p=0.009. HCV AB-positive patients also had lower QoL as documented by more fatigue, poor concentration, and more frequently reported decreased level of energy (p < 0.05). Conclusion: Although the prevalence of HCV AB-positive was low in subjects screened in these GE centers (0.5%), linkage to care was high (90% to 100%). HCV AB-positive patients reported more QoL impairment as compared to HCV AB-negative subjects. A history of depression was the only predictor of being HCV AB-positive.

Use of parenteral caffeinum natrio-benzoicum: an underestimated risk factor for HCV transmission in China.

BackgroundFuyu city in China has a high prevalence of hepatitis C virus (HCV) infection resulting in a high morbidity and mortality from chronic liver disease and hepatocellular carcinoma. This study was conducted to identify the risk factors for HCV infection in Fuyu city.MethodsRecruitment of study subjects involved a cross-sectional survey using non-random, convenience sampling. Information on demographic variables, risk factors for HCV infection, clinical manifestations, behavioral practices and family history was collected by administering a questionnaire. Anti-HCV antibody was detected using Abbott ARCHITECT i2000SR. HCV infection was confirmed by HCV-RNA testing by the Roche Taqman HCV test. Univariate and multivariate analyses were performed to identify the factors associated with HCV infection.ResultsOut of 3,228 persons that participated in the survey, 3,219 were enrolled in the study. The prevalence of HCV infection was 42.1 % (1355/3219). Among 734 patients with chronic HCV infection whose HCV-RNA genotyping was performed, genotype 1b was the most common (58.0 %), followed by genotype 2a (40.2 %), while co-infection with genotypes 1b and 2a was detected in 1.8 % of the subjects. On univariate analysis, male gender, older age, parenteral caffeinum natrio-benzoicum and share syringes (PCNBSS), and nine other factors were significantly associated with HCV infection. After adjusting for potential confounders, male gender, old age, cigarette smoking, lower education level, history of blood transfusion, blood donation, prior dental surgery, and PCNBSS were found to be independently associated with HCV infection.ConclusionsThe prevalence of HCV infection is likely to be high among residents in Fuyu and we observed that genotypes 1b and 2a dominated in the city. Our findings support the hypothesis that PCNBSS which became endemic in Fuyu city during 1970s-1980s is strongly associated with HCV positivity.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-2299-8) contains supplementary material, which is available to authorized users.

Short duration response-guided treatment is effective for most individuals with recent hepatitis C infection: the ATAHC II and DARE-C I studies.

Background Individuals with recent HCV infection may benefit from shortened duration therapy. These studies evaluated the efficacy and safety of response-guided regimens with pegylated interferon-α2a and ribavirin for people with recent HCV infection. Methods Participants with recent hepatitis C (duration of infection ≤18 months) enrolled in the ATAHC II (pegylated interferon-α2a ± ribavirin) and DARE-C I (pegylated interferon-α2a, ribavirin and telaprevir) studies were included for analysis. Treatment duration was response-guided (ATAHC II: 8, 16, 24 or 48 weeks; DARE-C I: 8, 12 or 24 weeks) and dependent on time to first undetectable HCV RNA using Roche Taqman HCV RNA testing. The primary efficacy end point was sustained virological response at 12 weeks (SVR12) by intention-to-treat. Logistic regression analyses were used to identify predictors of SVR. Results A total of 82 participants (62% HIV-positive) were enrolled in ATAHC II (treated, n=52) and 14 (79% HIV-positive) in DARE-C I. The predominant modes of HCV acquisition were injecting drug use (ATAHC II 55%, DARE-C I 36%) and sexual intercourse with a partner of the same sex (ATAHC II 39%, DARE-C I 64%). SVR12 was 71% in both ATAHC II (37/52) and DARE-C I (10/14) with 56% in ATAHC II receiving shortened therapy (8 or 16 weeks). SVR was associated with a rapid virological response (odds ratio 10.80; P=0.001). Conclusions The majority of participants were able to receive short duration response-guided therapy with pegylated interferon-α2a and ribavirin. Response-guided therapy for recent hepatitis C infection could be considered in the absence of available interferon-free therapies. ClinicalTrials.gov registry (ATAHC II: NCT01336010; DARE-C I: NCT01743521).

Methamphetamine injecting is associated with phylogenetic clustering of hepatitis C virus infection among street-involved youth in Vancouver, Canada

BackgroundAmong prospective cohorts of people who inject drugs (PWID), phylogenetic clustering of HCV infection has been observed. However, the majority of studies have included older PWID, representing distant transmission events. The aim of this study was to investigate phylogenetic clustering of HCV infection among a cohort of street-involved youth. MethodsData were derived from a prospective cohort of street-involved youth aged 14–26 recruited between 2005 and 2012 in Vancouver, Canada (At Risk Youth Study, ARYS). HCV RNA testing and sequencing (Core-E2) were performed on HCV positive participants. Phylogenetic trees were inferred using maximum likelihood methods and clusters were identified using ClusterPicker (Core-E2 without HVR1, 90% bootstrap threshold, 0.05 genetic distance threshold). ResultsAmong 945 individuals enrolled in ARYS, 16% (n=149, 100% recent injectors) were HCV antibody positive at baseline interview (n=86) or seroconverted during follow-up (n=63). Among HCV antibody positive participants with available samples (n=131), 75% (n=98) had detectable HCV RNA and 66% (n=65, mean age 23, 58% with recent methamphetamine injection, 31% female, 3% HIV+) had available Core-E2 sequences. Of those with Core-E2 sequence, 14% (n=9) were in a cluster (one cluster of three) or pair (two pairs), with all reporting recent methamphetamine injection. Recent methamphetamine injection was associated with membership in a cluster or pair (P=0.009). ConclusionIn this study of street-involved youth with HCV infection and recent injecting, 14% demonstrated phylogenetic clustering. Phylogenetic clustering was associated with recent methamphetamine injection, suggesting that methamphetamine drug injection may play an important role in networks of HCV transmission.

The Usefulness of Anti-HCV Signal to Cut-off Ratio in Predicting Viremia in Anti-HCV in Patients With Hepatitis C Virus Infection.

Background:Hepatitis C Virus (HCV) infection is diagnosed by antibody and RNA based methods. Patients with anti-HCV sample rate/cutoff rate (S/CO) ratios > 1 are reported as anti-HCV positive. RNA based methods are introduced to confirm positivity in seropositive samples.Objectives:The current study aimed to assess relationship between S/CO rates and HCV-RNA levels in the laboratory to identify HCV viremia in patients with a positive anti-HCV.Patients and Methods:All serum samples were assayed for anti-HCV by ELISA method. A total of 265 anti-HCV positive patients were tested for HCV-RNA testing by quantitative method using Artus HCV RG Real-time Polymerase Chain Reaction (RT- PCR) kit. Statistical analysis was done by SPSS version 16.Results:Of the 265 patients with HCV infection, 204 (77%) were male and the mean age was 43.53 ± 13.17 years, ranging 1 - 81 years. No correlation was found between S/CO ratios and HCV-RNA levels. There was significant difference in S/CO ratio between viremic and non-viremic subjects. The sensitivity, specificity, negative predictive value, and positive predictive value were 100%, 81.4%, 100%, and 77.2%, respectively in the S/CO ratio of 2.7.Conclusions:The present study indicated that anti-HCV S/Co ratio is useful to predict non-viremic patients. A cut-off value of 2.7 can determine the usefulness of HCV-RNA testing. Patients with S/CO < 2.7 are not viremic; therefore, HCV-RNA testing is not recommended. It is suggested that laboratories report S/CO ratio along with anti-HCV results to manage HCV infection better, especially in countries that quantitative HCV testing is expensive or not available.

P0748 : Course of HCV RNA and HCV core antigen testing are predictors for reaching SVR in transplant recipients

P0748 : Course of HCV RNA and HCV core antigen testing are predictors for reaching SVR in transplant recipients