HCV Status Research Articles

Liver fibrosis is associated with cognitive impairment in people living with HIV.

Our aim was to better explore the association between liver fibrosis (LF) and neurocognitive impairment (NCI) in people living with HIV (PLWH). We performed a cross-sectional cohort study by consecutively enrolling PLWH at two clinical centers. All subjects underwent a comprehensive neuropsychological battery; NCI was defined as having a pathological performance (1.5 SD below the normative mean) on at least two cognitive domains. LF was explored using FIB4 index; in a subgroup of PLWH, LF was also assessed by transient elastography. A total of 386 subjects were enrolled, of whom 17 (4.4%) had FIB4 > 3.25. In the subgroup of PLWH (N = 127) performing also liver transient elastography, 14 (11%) had liver stiffness > 14kPa. Overall, 47 subjects (12%) were diagnosed with NCI. At multivariate regression analyses, participants with FIB4 > 1.45 showed a higher risk of NCI in comparison with those with lower values (aOR 3.04, p = 0.044), after adjusting for education (aOR 0.71, p < 0.001), past AIDS-defining events (aOR 2.91, p = 0.014), CD4 cell count, past injecting drug use (IDU), HIV-RNA < 50 copies/mL, and HCV co-infection. Also a liver stiffness > 14kPa showed an independent association with a higher risk of NCI (aOR 10.13, p = 0.041). Analyzing any single cognitive domain, a higher risk of abnormal psychomotor speed was associated with a liver stiffness > 14kPa (aOR 223.17, p = 0.019) after adjusting for education (aOR 0.57, p = 0.018), HIV-RNA < 50 copies/mL (aOR 0.01, p = 0.007), age, past IDU, and HCV co-infection. In PLWH, increased LF, estimated through non-invasive methods, was associated to a higher risk of NCI independently from HCV status.

Barriers and facilitators of hepatitis C treatment uptake among people who inject drugs enrolled in opioid treatment programs in Baltimore

BackgroundHepatitis C virus (HCV) infection is a major public health issue among people who inject drugs (PWID) with prevalence of 50–80% in the United States. Effective, simple, oral direct acting agents (DAA) of short duration with minimal side effects have been associated with cure rates > 95%. However, HCV treatment uptake among PWID remains low. We characterized the HCV care continuum, HCV treatment knowledge, as well as barriers and facilitators to HCV treatment uptake among PWID enrolled in two opioid treatment programs (OTPs) in Baltimore, Maryland, USA. MethodsBetween July and November 2016, 124 HCV infected PWID were recruited from two opioid treatment programs in Baltimore through convenience sampling. Participants completed a 50-item questionnaire to assess HCV treatment knowledge, attitudes, and practices. Progress through the HCV care continuum was assessed based on a series of questions assessing evaluation for HCV treatment, recommendation for HCV treatment by a provider, and HCV treatment initiation. HCV status was assessed based on participant self-report. ResultsThe median age was 52 years (IQR 44–58), 56% were male, the majority were African American (69%), and 19% reported HIV coinfection. Participants had been tested for HCV at their primary care provider's (PCP's) office (34%), drug treatment center (20%), emergency room (11%), or prison (9%), and most (60%) had been diagnosed with HCV over 5 years prior. The majority reported that HCV was a major health concern for them (91%), were aware there were new treatments for HCV (89%), and that the new treatments cure most people (69%). More than half (60%) had seen a health professional who could treat HCV, 40% had HCV therapy recommended by their HCV specialist, and 20% had started or completed treatment. In univariable analysis, PWID were significantly more likely to have been treated if they were HIV co-infected (OR 3.4 (95% CI 1.3–9.2)) or had a partner or friend concerned about their HCV (OR 3.4 (95% CI 1.2–9.7)), and were significantly less likely to have been treated if they had used any illicit drugs in the preceding 6 months (OR 0.4 (95% CI 0.2–0.99). In multivariable analysis, having a friend or partner concerned about their HCV remained significantly associated with HCV treatment (OR 5.0 (95% CI 1.4–17.7)). When questioned about what would facilitate HCV treatment, the majority (85%) reported that a friend telling them that HCV treatment had helped them and having HCV treatment provided at their opioid treatment program would make them more likely to engage in HCV treatment. ConclusionDespite a high prevalence of HCV among opioid treatment program patients and the availability of effective treatments, uptake remains low. We identified several key barriers and facilitators that can affect HCV treatment uptake.

Changing the odds: motives for and barriers to reducing HCV-related sexual risk behaviour among HIV-infected MSM previously infected with HCV

BackgroundAmong HIV-infected MSM who have been treated for HCV infection, the HCV reinfection rate is high. It is therefore essential to understand their perceptions of HCV risk behaviour and risk-reducing strategies.MethodsThis qualitative study among 20 HCV-infected MSM, the majority treated in the era before direct acting antivirals, provides insight into their ideas, motives, and barriers concerning HCV risk reduction, and aims to strengthen prevention strategies for both primary HCV infection and HCV reinfection.ResultsThe strongest motive to implement risk reduction strategies was the reward of avoiding HCV retreatment and its side effects, but this may change with the current implementation of less burdensome HCV treatment. Also, the sexual risk norms in the MSM scene, including social pressure towards risk-taking, HCV stigma, and non-disclosure of HCV status, all form barriers to safe sex. Drug use, strongly present in the context of clubs and group sex, directly impedes the self-efficacy of men to take risk reduction measures.ConclusionsTailored prevention messages, empowerment of self-efficacy for risk reduction, and more insight into risk behaviour over time are ingredients for effective HCV prevention among these men.

Syndemic Characterization of HCV, HBV, and HIV Co-infections in a Large Population Based Cohort Study

BackgroundLimited data are available on HBV, HCV, and HIV co-infections and triple infection. We characterized co-occurrence of HIV, HBV, and HCV infections at the population level in British Columbia (BC) to identify patterns of predisposing factors unique to co-infection subgroups. MethodsWe analyzed data from the BC Hepatitis Testers Cohort, which includes all individuals tested for HCV or HIV in BC between 1992 and 2013, or included in provincial public health registries of HIV, HCV, HBV, and active tuberculosis. Individuals were classified as negative, mono-, and co-infection groups based on HIV, HBV, and HCV status. We evaluated associations between risk factors (injection drug use, sexual orientation etc.) and co-infection groups using multivariate multinomial logistic regression. FindingsOf a total of 1,376,989 individuals included in the analysis, 1,276,290 were negative and 100,699 were positive for HIV, HBV, and/or HCV. Most cases (91,399, 90.8%) were mono-infected, while 3991 (4.0%) had HBV/HCV, 670 HBV/HIV (0.7%), 3459 HCV/HIV (3.4%), and 1180 HBV/HCV/HIV (1.2%) co-infection. Risk factor and demographic distribution varied across co-infection categories. MSM classification was associated with higher odds of all HIV co-infection groups, particularly HBV/HIV (OR 6.8; 95% CI: 5.6, 8.27), while injection drug use was most strongly associated with triple infection (OR 64.19; 95% CI: 55.11, 74.77) and HIV/HCV (OR 23.23; 95% CI: 21.32, 25.31). InterpretationSyndemics of substance use, sexual practices, mental illness, socioeconomic marginalization, and co-infections differ among population groups, highlighting avenues for optimal composition and context for health services to meet each population's unique needs. FundingBC Centre for Disease Control and Canadian Institutes of Health Research.

Screening of viral hepatitis and HIV among migrants from Southeast Asia

Introduction Viral hepatitis B and C display high morbidity and mortality among migrants born in Southeast Asia and living in France whereas prevalence in French general population is low (0.3–0.8%). Moreover, access to screening tests for HIV and viral hepatitis B and C remain unknown in this population. Methods This prospective, multicenter and observational study was conducted at a free clinic (“Association DHEVA-KH”, Lyon, France) among Southeast Asian community associations. The study period has started in April 2016 and inclusions remain ongoing in February 2018. Participants were screened during each community event where people were able to be tested for HIV, HBV, and HCV by point-of-care rapid testing. The main study endpoints were the proportion of participants who were infected by HIV, HBV, and HCV status and who were linked to care when testing positive. This study was approved by local Committee on Ethics as usual practices. Results A total of 199 individuals, representing Southeast Asian immigrants, were included and all participants performed a blood draw for viral hepatitis B and C and 186 for HIV (93.4%). Mean age was 55.6 ± 14 years-old. One hundred twenty-four were women (62.3%). All patients retrieved their tests results; 170 of 199 (85.4%) patients tested prefered point-of-care rapid testing rather than classical serology tests. Only 20 people among 199 were previously tested for HIV or viral hepatitis B or C. Nine of the 199 (4.5%) participants testing positive [HIV, n = 0; HBV, n = 6 (3.0%); HCV, n = 3 (1.5%)]. Mean age was 60.8 ± 12.6 years-old. Seven infected people were women. Six were pensioners. Only one infected patient was covered by usual social security system. All infected patients were born in Southeast Asia. Seven of 9 testing positive participants have been able to consult medical staff later at hospital to be followed for their viral hepatitis. Conclusion In a Southeast Asian highly at-risk population for chronic viral infections, the simultaneous use of HIV, HBV, and HCV point-of-care tests clearly improves the screening and the access to care for HBV and HCV positive patients. Migrants from Southeast Asia display a higher prevalence for viral hepatitis rather than French general population. Nonetheless, the prevalence of people living with HIV remains low even null in our sample population among Southeast Asian community living in Lyon city.

3. X-ray repair cross complementing group 3 polymorphism in association with aflatoxin B1 exposure in chronic hepatitis (B & C) and hepatocellular carcinoma

Background and Aims: X-ray repair cross-complementing group 3 (XRCC3) is a constituent of DNA repair genes involved in the process of DNA double-strand breaks repair pathway. XRCC3 Thr241Met (C > T) polymorphism is a single nucleotide polymorphism (SNP) at codon 241 in exon 7. We aimed to study polymorphisms of XRCC3 Thr241Met in Chronic Hepatitis (B & C) and Hepatocellular carcinoma patients and healthy individuals. This was correlated with total aflatoxin content in various indigenous foods consumed by general population and chronic liver disease patients from Assam, India. Methods: We conducted a hospital based case control study including 70 Chronic Hepatitis (B & C) cases and 70 healthy controls, alongwith 20 Hepatocellular Carcinoma cases and 20 healthy controls by polymerase chain reaction-restriction fragment length polymorphism (PCR- RFLP) assay in Assamese population. Results: Out of 70 cases of chronic liver disease (HBV & HCV) 67.14% patients showed SNP for XRCC3 Thr241Met out of which 32.85% were homozygous (C/C), 50% were heterozygous (C/T) and 17.14% were mutated (T/T). Whereas out of 20 Hepatocellular carcinoma cases 30% were homozygous (C/C), 35% were heterozygous (C/T) and 35% were mutated (T/T). No significant association of SNP's was observed with duration of alcohol consumption, raised transaminase, low platelet count, HBsAg and Anti HCV status. The indigenous food samples were examined by HPLC technique which did not reveal significant aflatoxin content. Conclusions: The XRCC3 codon 241 polymorphism displayed a relationship with HCC and in chronic hepatitis B & C. Codon 241 mutation was significantly increased in patients of HCC and in chronic HBV or HCV. There is increased risk for the individuals with XRCC3 CT genotype [OR = 2.43 (1.17–5.03), p = 0.01*] and TT genotype [OR = 4.17 (1.30–13.34), p = 0.01*]. Hence, presence of mutation in the codon of XRCC3 TT genotype in patients of chronic HBV and HCV could indicate the likelihood of progression to HCC. The authors have none to declare.

HCV-negative mixed cryoglobulinemia and kidney involvement: in-depth review on physiopathological and histological bases.

Type II mixed cryoglobulinemia without evidence of HCV infection but rather with renal involvement has been occasionally described. The pathogenesis of cryoglobulinemic kidney disease is most likely related to immune complex deposition including cryoglobulins, and cryoaggregation after cold exposure could play a pivotal role in clinical expression of cryoglobulinemia. In these cases, acute kidney injury and proteinuria remain the most frequent clinical expression of a cryoglobulinemic glomerulonephritis. Type II cryoglobulinemia with the laboratory finding of both monoclonal and polyclonal cryoglobulins is the most prevalent bio-humoral pattern among HCV-negative phenotypes with renal involvement, while type III cryoglobulinemia with polyclonal Ig is rare. Histological data in renal biopsies support the hypothesis that regardless of the HCV status cryoglobulinemia vasculitis share thesamefrequent pathological finding of membranoproliferative glomerulonephritides, but other histological patterns have also been observed in a minority of cases. In HCV-negative mixed cryoglobulinaemia, the paraneoplastic origin of the immune dysfunction should be ruled out and sporadic cases have been reported, while there is no cumulative evidence on the prevalence of thesetumour-associated manifestations. Moving from the classification criteria and the etiopathogenesis of mixed cryoglobulinaemia, we provide a comprehensive review of the literature on the appearance of the disease with kidney injury in association with malignancies or autoimmune disorders without HCV coexistence.

Do serum markers of liver fibrosis vary by HCV infection in patients with alcohol use disorder?

IntroductionHCV infection is frequent in patients with alcohol use disorder (AUD). Ethanol and hepatitis C have a synergistic effect that increases the risk of end-stage liver disease. We aimed to assess fibrosis of the liver in patients admitted to treatment of AUD. MethodsData were collected in two hospital units between 2000 and 2014. Liver fibrosis was assessed by serum biomarkers APRI, FIB-4 and Forns, and Advanced Liver Fibrosis (ALF) was defined if APRI > 1.5, FIB-4 > 3.25 or Forns > 6.9. Correlations were analyzed by Pearson’s coefficients and logistic regression models were used. Results1313 patients (80% M) had complete data; age at admission was 45 years (IQR: 39–52 yrs), age of initial regular alcohol consumption was 20 years (IQR: 17–26 yrs) and the amount of alcohol consumed preceding admission was 200 g/day (IQR: 120–270 g/day). Prevalence of HCV infection was 18%. Prevalence of ALF in HCV positive patients was 40.6% by APRI, 30.6% by FIB-4, and 43.3% by Forns. Correlations were high for APRI vs. FIB-4 r = 0.906, APRI vs. Forns r = 0.710, and, FIB-4 vs. Forns r = 0.825. There was no significant difference in the APRI/FIB-4 correlation by HCV status (z = 1.35, p = 0.177). However, the APRI/Forns correlation was significantly higher in HCV positive patients (p < 0.001). Patients with HCV infection were two times more likely to present with ALF at admission (OR = 2.1, 95%CI:1.5–3.1). ConclusionsHCV infection is associated with severity of fibrosis in patients with excessive alcohol consumption. In this context, APRI and FIB-4 are highly correlated which facilitates the assessment of liver damage.

Knowledge of hepatitis C status moderates the relationship between history of drug treatment and sterile syringe use.

High-risk injection related behavior including use of non-sterile syringes is associated with negative health outcomes among people who inject drugs (PWID). Drug treatment programs have been reported to curb hepatitis C (HCV) transmission. This study aims to assess the role of drug treatment programs and knowledge of HCV status, and how they influence current injection-related risk. Data were collected in 2012 by the New Orleans arm of the CDC funded National HIV Behavioral Surveillance. Respondent driven sampling was used to recruit a sample of PWID. The analytic sample consisted of 473 participants. Univariate, bivariate, and linear regression analyses were performed. Findings indicated that history of drug treatment is associated with sterile syringe use among PWID. Further, knowledge of HCV status modifies the relationship between history of drug treatment and sterile syringe use in this sample. These findings highlight the importance of scaling up prevention efforts by expanding testing, counselling, and treatment for HCV among PWID who enter drug treatment facilities.

Are we underestimating the quality of aviremic hepatitis C-positive kidneys? Time to reconsider.

Kidney Donor Risk Index (KDRI) introduced in 2009 included hepatitis C serologic but not viremic status of the donors. With nucleic acid amplification testing (NAT) now being mandatory, further evaluation of these donors is possible. We conducted a retrospective matched case-control analysis of adult deceased donor kidney transplants performed between December 5, 2014 to December 31, 2016 with the KDRI score and hepatitis C virus antibody (HCV Ab) and NAT testing status obtained from the United Network for Organ Sharing database. The 205 aviremic HCV Ab+ NAT - kidney transplants were compared to KDRI matched control kidneys that were HCV Ab-NAT-. The aviremic HCV kidneys were recovered from donors who were significantly younger, more likely to be white, and less likely to have hypertension and diabetes. The majority of the recipients of the aviremic HCV kidneys when compared to matched controls were HCV positive: 90.2% vs 4.3%. The recipients were significantly older, were on dialysis for a shorter time, and were transplanted sooner. The graft survival of aviremic HCV kidneys was similar (P<.08). If the HCV status of the aviremic kidneys was assumed to be negative, 122 more kidneys could have been allocated to patients with estimated posttransplant survival <20. Seven kidneys would no longer have Kidney Donor Profile Index >85%. Further policies might consider these findings to appropriately allocate these kidneys.

The Role of Aging, Drug Dependence, and Hepatitis C Comorbidity in Alcoholism Cortical Compromise

The prevalence of alcohol misuse increased substantially over a decade in adults, particularly in those aged 65 years or older. Ramifications for brain structural integrity are significant, especially in older adults. To combine cross-sectional, longitudinal data to test age-alcoholism interactions and examine the association between prevalent comorbidities (drug dependence and hepatitis C virus [HCV] infection) and cortical volume deficits in alcohol dependence. During 14 years, 826 structural magnetic resonance images were acquired in 222 individuals with alcohol dependence and 199 age-matched control participants (aged 25-75 years at initial study), parcellated with a common atlas, and adjusted for brain volume. Longitudinal data were available on 116 participants with alcoholism and 96 control participants. DSM-IV criteria determined alcohol and drug diagnoses; serology testing determined HCV status. The study was conducted at SRI International and Stanford University School of Medicine from April 11, 2003, to March 3, 2017. Magnetic resonance imaging-derived regional cortical volumes corrected for supratentorial volume and sex. Of the 222 participants with alcoholism, 156 (70.3%) were men; mean (SD) age was 48.0 (10.0) years; the mean age for the 199 control participants was 47.6 (14.0) years. Participants with alcohol dependence had volume deficits in frontal (t = -5.732, P < .001), temporal (t = -3.151, P = .002), parietal (t = -5.063, P < .001), cingulate (t = -3.170, P = .002), and insular (t = -4.920, P < .001) cortices; deficits were prominent in frontal subregions and were not sex dependent. Accelerated aging occurred in frontal cortex (t = -3.019, P < .02) and precentral (t = -2.691, P < .05) and superior gyri (t = -2.763, P < .05) and could not be attributed to the amount of alcohol consumed, which was greater in younger-onset than older-onset participants with alcoholism (t = 6.1191, P < .001). Given the high drug-dependence incidence (54.5%) in the alcoholism group, analysis examined drug subgroups (cocaine, cannabis, amphetamines, opiates) compared with drug-dependence-free alcoholism and control groups. Although the alcohol plus cocaine (t = -2.310, P = .04) and alcohol plus opiate (t = -2.424, P = .04) groups had smaller frontal volumes than the drug-dependence-free alcoholism group, deficits in precentral (t = -2.575, P = .01), supplementary motor (t = -2.532, P = .01), and medial (t = -2.800, P = .01) volumes endured in drug-dependence-free participants with alcoholism compared with control participants. Those with HCV infection had greater deficits than those without HCV infection in frontal (t = 3.468, P = .01), precentral (t = 2.513, P = .03), superior (t = 2.533, P = .03), and orbital (t = 2.506, P = .03) volumes, yet total frontal (t = 2.660, P = .02), insular (t = 3.526, P = .003), parietal (t = 2.414, P = .03), temporal (t = 3.221, P = .005), and precentral (t = 3.180, P = .01) volume deficits persisted in the uninfected participants with alcoholism compared with control participants with known HCV status. Drug dependence and HCV infection compounded deleterious effects of alcohol dependence on frontal cortical volumes but could not account for the frontally distributed volume deficits in the drug-free participants with alcoholism. We speculate that age-alcohol interactions notable in frontal cortex put older adults at heightened risk for age-associated neurocompromise even if alcohol misuse is initiated later in life.

A177 BIRTH COHORT SCREENING FOR HEPATITIS C IN AN OUTPATIENT ENDOSCOPY UNIT: A PILOT STUDY

Abstract Background Chronic hepatitis C (HCV) is a curable asymptomatic infection that can progress to liver failure and hepatocellular carcinoma if left untreated. The Canadian Liver Foundation (CLF) recommends one-time HCV screening in all Canadians born from 1945–1975. A large proportion of outpatient endoscopic procedures are for colon cancer screening in this birth cohort providing an opportunity for HCV screening and linkage to HCV care. Aims We aimed to assess the feasibility of developing a targeted birth-cohort HCV screening program in the outpatient endoscopy setting. Methods This is a cross-sectional study of patients born from 1945–1975 presenting to the outpatient endoscopy unit at Hotel Dieu Hospital in Kingston, Ontario in September, 2016. Patients were scheduled for upper endoscopy, colonoscopy, and/or sigmoidoscopy. All patients were given written information on HCV and the CLF recommendation of birth-cohort screening. Patients were then asked to complete a short survey regarding previous HCV screening and acceptance of being screened during their endoscopy visit. Results During a 30 day period, 95% (223/235) of eligible patients completed the survey. The cohort was 53% female with a median age of 59 years (IQR 52–66 years). 83% had either never been screened or were unaware of their HCV status. Overall, 87% of participants would be accepting of HCV screening during their endoscopy visit, 9% would not accept screening and 4% stated they were unsure. These results suggest that almost 2,000 patients could be targeted for HCV screening in the endoscopy unit annually. Conclusions Most patients born from 1945–1975 presenting for outpatient endoscopy have not been screened for HCV but are accepting of screening during their procedural visit. This identifies a target population for the development of an HCV screening program to increase HCV identification and facilitate linkage to HCV care. Funding Agencies None

Injection-related hepatitis C serosorting behaviors among people who inject drugs: An urban/rural comparison

ABSTRACTAlthough previous research has focused on injection drug use behaviors in both urban and rural settings, few have drawn direct comparisons between adjacent rural and urban areas. Using data from the National HIV Behavioral Surveillance study as well as original data collected in a similar fashion, we compare the risk behaviors of people who inject drugs (PWID) in San Juan, Puerto Rico, with those of PWID in nearby rural areas. Specifically, we examine whether one’s own hepatitis C (HCV) infection status can be used to predict whether one asked their most recent co-injection partner about their HCV status. Acquiring such information allows injectors to seek out co-injection partners of concordant status as a way to minimize the risk of viral transmission. Results indicate that urban PWID with a known HCV+ status were more likely to know their last co-injector partner’s HCV status than were their peers with a negative or unknown HCV status. However, this relationship was not present in the rural data. These findings suggest that there are different risk norms in rural and urban PWID communities and that interventions successful in one type of community may not be so in others.

To determine correlation between biochemical parameters of nutritional status with disease severity in HCV related liver cirrhosis.

Objective:To identify correlation between biochemical parameters of nutritional status with disease severity in HCV related liver cirrhosis in patients attending tertiary care hospital.Methods:Total 259 HCV related liver cirrhosis patients who attended the outpatient department of KRL Hospital, Islamabad from June 2016 to January 2018 were included in this cross-sectional study. HCV status was confirmed with PCR. Cirrhosis was pre-established by ultrasound, while cirrhosis severity was gauged by CTP score. Biochemical parameters for nutrition status included serum albumin, creatinine, cholesterol, LDL, HDL, triglycerides, hemoglobin, ferritin, sodium, potassium, magnesium and calcium. Other demographic and clinical data were also recorded.Results:The mean age of patients was 58.73 ± 6.04 years with 57.1% being males. The average BMI was 22.72 ± 1.69 kg/m2. Majority patients i.e. 123 (47.5%) belonged to CTP-A, 67 (25.9%) were in CTP-B and 69 (26.6%) in CTP-C groups. Significant negative correlations of cirrhosis severity were established with BMI, albumin, creatinine, cholesterol, LDL, TG, HDL, hemoglobin, sodium and magnesium indicative of malnutrition. Analysis of biochemical parameters amongst individual cirrhosis groups revealed significant negative correlation across the same factors in group CTP-C, while CTP-A correlated positively with these parameters. The only significant correlation found in CTP-B was with albumin, HDL, hemoglobin, sodium and magnesium.Conclusion:Considering limitations of standard ways alone to assess malnutrition in liver cirrhosis, biochemical parameters are valid to aid in diagnosing malnutrition.

HBs Ag and HCV Status Need to Be Specified Before Using Assisted Reproductive Technique

HBs Ag and HCV Status Need to Be Specified Before Using Assisted Reproductive Technique

Injection Partners, HCV, and HIV Status among Rural Persons Who Inject Drugs in Puerto Rico

ABSTRACTBackground: The prevalence of hepatitis C (HCV) and HIV among persons who inject drugs (PWID) and the ability of these diseases to spread through injection networks are well documented in urban areas. However, less is known about injection behaviors in rural areas. Objectives: This study focuses on the association between the number of self-reported injection partners with the PWID's self-reported HCV and HIV status. Injection networks provide paths for infection and information to flow, and are important to consider when developing prevention and intervention strategies. Methods: Respondent driven sampling was used to conduct 315 interviews with PWID in rural Puerto Rico during 2015. Negative binomial regression was used to test for associations between the number of self-reported injection partners and self-reported HCV and HIV statuses. Multinomial logistic regression was used to test for associations with the participant's self-reported HCV and HIV statuses. Results: Self-reported HCV status is significantly associated with injection risk network size. Injection partner networks of self-reported HCV− respondents are half what is reported by those with a positive or unknown status. Self-reported HIV statuses are not associated with different numbers of injection partners. Conclusions: Smaller injection networks among those who self-report a HCV− status suggests that those who believe their status to be negative may take protective action by reducing their injection network compared to those have a self-reported HCV+ or an unknown status. Although the cross-sectional design of the study makes it difficult verify, such behavior has implications for prevention programs attempting to prevent HCV transmission.

Endoscopic Therapy is Effective for Recurrent Anastomotic Biliary Strictures after Orthotopic Liver Transplantation

IntroductionOrthotopic liver transplantation anastomotic biliary strictures (OLT ABS) are managed with endoscopic biliary stent therapy but the recurrence rate is substantial. Our aims were to retrospectively determine the recurrence rates of OLT ABS after initial successful stent therapy, characterize the management of recurrences and identify associated variables. Materials and MethodsClinical data from 943 patients receiving non-living donor OLT at our institution from 2005-2012 were reviewed, and 123 OLT ABS patients receiving stent therapy were identified. Features of their endoscopic stent therapy and other pertinent clinical information were evaluated. ResultsABS recurred in 25.5% of patients (24/94) after an initial successful course of stent therapy. Recurrences were received a second course of endoscopic stent therapy and 67% of patients (16/24) achieved long-term remediation of ABS. Six patients underwent a third course of endoscopic stent therapy with 4 patients achieving remediation. Overall remediation rate among ABS recurrences was 83.3% (20/24). A bivariate comparison demonstrated HCV infection, age, median months of maximal stenting and a lower maximum cumulative stent diameter were risk factors for ABS recurrence. Using a Cox regression model, only HCV status proved to be a risk factor for recurrence. DiscussionIn conclusion repeat stent therapy achieved high stricture remediation rates. Recurrence after the first or even second course of stenting should not imply failure of endoscopic therapy. A positive HCV status may be associated with higher stricture recurrence rates and this association should be further investigated.

Multicentre Study of HCV Status in Egyptian Patients with B-Cell Non-Hodgkin’s Lymphoma with Assessment of Patients’ Immunological State

Hepatitis C Virus is both hepatotropic and lymphomatropic virus affecting more than 180 million individuals worldwide. Chronic hepatitis C infection is associated with several hematological manifestations such as monoclonal-gammopathy of uncertain significance (MGUS), mixed cryoglobulinemia (MC), and B-cell non-Hodgkin lymphoma (B – NHL).

Hepatitis C Screening: The Downstream Dissemination of Evolving Guidelines in a Resident Continuity Clinic.

BackgroundIn 2012, the Centers for Disease Control and Prevention (CDC) published guidelines supporting one-time screening for hepatitis C (HCV) in all persons born between 1945 and 1965. It is estimated that 75% of adults infected with HCV fall within this cohort. Furthermore, it is projected that this preventative health intervention would lead to the diagnosis of 800,000 unknown cases and the prevention of 120,000 deaths.ObjectivesThe primary objectives are to measure adherence to HCV screening in a continuity practice staffed by internal medicine residents and attending physicians and to measure the effect of educational interventions to enhance HCV screening. The secondary objectives include finding whether insurance or provider status affects adherence to HCV screening.MethodsIn 2015, we performed a retrospective chart review of asymptomatic patients born between 1945 and 1965 to estimate the rate of HCV screening. In order to meet inclusion criteria, the patients must have had an HCV status that was unknown and must have been seen by a primary care provider ≥ 2 times between January 1 and December 31, 2013. The data extracted included whether HCV testing was ordered, whether testing was performed primarily for screening purposes, demographic information, insurance status, number of clinic visits, and whether the primary provider was a resident or attending physician. Subsequently, in 2016 we implemented an educational intervention aimed at improving these rates. Afterwards, we repeated the chart review to determine if screening rates had improved.ResultsOut of 294 patients reviewed pre-intervention, 200 patients were eligible for inclusion, of which 17 (8.5%) patients were offered screening for HCV, of which 13 (76.5%) patients completed testing. Following an educational intervention, 484 patients were reviewed and 100 patients were included, of which 34 (34%) patients were screened. Compared to a pre-intervention screening rate of 8.5%, post-intervention screening had improved to 34%, a 300% increase (p<0.001).ConclusionsEducational interventions are feasible and can lead to significant improvements in clinical practice enabling for the rapid dissemination of evolving guidelines.

Direct-acting antiviral treatment against hepatitis C virus infection in HIV-Infected patients – “En route for eradication”?

Direct-Acting Antivirals (DAAs) opened a new era in HCV treatment. We report the impact of HCV treatment in French HIV-HCV coinfected patients. All HIV-HCV patients from the Dat'AIDS cohort followed between 2012 and 2015 were included. HCV status was defined yearly as naive, spontaneous cure, sustained virological response (SVR12), failure or reinfection. Among 32,945 HIV-infected patients, 15.2% were positive for anti-HCV antibodies. From 2012 to 2015, HCV incidence rate increased from 0.35%PY to 0.69%PY in MSM, while median incidence was 0.08%PY in other patients. Median reinfection rate was 2.56%PY in MSM and 0.22%PY in other patients. HCV treatment initiation rate rose from 8.2% in 2012 to 29.6% (48.0% in pre-treated patients vs 22.6% in naïve patients). SVR12 rate increased from 68.7% to 95.2%. By the end of 2015, 62.7% of the patients were cured either spontaneously or following SVR. HCV treatment dramatically increased in HIV-HCV patients in France from 2012 to 2015 resulting in HCV cure in nearly two-thirds of the patients in this cohort. Combined with a declining HCV prevalence, the prevalence of active HCV infection among HIV patients will drastically decrease in the forthcoming years.