Hepatitis C Virus Infection Status Research Articles

A preliminary assessment of the clinical utility of measuring hepatitis C virus antibody to evaluate infection status

To investigate the potential of hepatitis C virus (HCV) antibody measurement as a clinical approach to determine the infection status and potential for spontaneous-resolution among patients with HCV mono-infection and HCV/human immunodeficiency virus (HIV) co-infection. A total of 340 individuals who tested positive for serum anti-HCV antibodies and/or serum anti-HW antibodies were enrolled for study in 2009 from a single village in central China. Markers of liver function (alanine aminotransferase (ALT) and aspartate aminotransferase (AST)) and infection (anti-HCV antibodies, CD4⁺ T cell counts, HCV genotype, and HCV viral load) were measured at baseline and follow-up (in July 2012). At follow-up,the subjects were grouped according to ongoing HCV mono-infection (n=129), ongoing HCV/HIV co-infection (n=98), spontaneously resolved (SR)-HCV in mono-infection (n=65), and SR-HCV in HCV/HIV co-infection (n=48) for statistical analysis. Almost all of the subjects in the ongoing HCV mono-infection group showed high levels of HCV antibodies (S/CO more than or equal to 10), but the majority of the subjects in the SR-HCV in mono-infection group and in the ongoing HCV/HIV co-infection group. The SR-HCV mono-infection group showed a remarkable decrease in HCV antibodies from 2009 (HIV:7.75 ± 3.8; HIV+:7.61 ± 3.47) to 2012 (HIV:5.51 ± 3.67; HIW:4.93 ± 3.35) (HIV:t =10.67, P less than 0.01; HIV+:t =9.52, P less than 0.01). The ongoing HCV/HIV co-infection group showed a positive correlation between HCV antibodies S/CO ratio and CD4⁺ T cell count (r=028, P=0.008). In the ongoing HCV mono-infection group,the levels of HCV antibodies were significantly higher in individuals infected with HCV-1b than in those with HCV-2a (14.74 ± 1.68 vs.14.08 ± 1.44, t=2.20, P=0.03). In the ongoing HCV/HIV co-infection group, the numbers of subjects with elevated (more than 40 U/L) liver function markers were significantly different according to the HCV genotype infection:HCV-1b:ALT, 25/42 vs.16/56 (x²=9.45, P=0.002); HCV2a:AST, 28/42 vs.18/56 (x²=11.49, P=0.001). The HCV RNA positive rate was significantly higher in subjects with high HCV antibody cutoff values (S/CO more than or equal to 10) than in those with low HCV antibody (S/CO less than 10) (HIV:128/151 vs.1/43, x²=102.11, P less than 0.01; HIV+:88/98 vs.10/48, x²=69.44, P less than 0.01), regardless of HIV co-infection. Significantly more subjects in the ongoing HCV mono-infection group had elevated (more than 40 U/L) ALT or AST than the subjects in the SR-HCV mono-infection group with high levels of HCV antibody (S/CO more than or equal to 10) (ALT:57/128 vs.2/23, x²=10.52, P=0.001; AST:57/128 vs.0/23, x²=16.45, P less than 0.01). Serum HCV antibody levels, in combination with other clinical information such as liver function and HIV infection status, may aid in the preliminarily evaluation of an individual's HCV infection status and likelihood for spontaneous resolution. Low levels of HCV antibody (S/CO less than 10) may indicate a better chance of SR-HCV, after ruling out the possibility of suffering from immunosuppressive diseases such as HIV infection.

Is universal screening for hepatitis C infection prior to commencing antitumour necrosis factor-α therapy necessary?

Screening for hepatitis C virus (HCV) prior to the commencement of antitumour necrosis factor (anti-TNF)-α therapies for dermatological disease is recommended for all patients. To determine the incidence of HCV infection among dermatology patients who were screened for HCV infection prior to commencing anti-TNF-α therapies. We reviewed the HCV infection status of all patients attending our dermatology department who had been tested for evidence of HCV infection between January 2005 and November 2012. We identified patients who had been tested as part of routine screening prior to commencing anti-TNF-α therapy using dermatology departmental records. In total, 215 patients were screened for HCV infection prior to commencing anti-TNF-α therapies. Among this group, 143 patients (66·5%) were male and 72 (33·5%) were female. None of these patients tested positive for active HCV infection. One patient tested positive for HCV antibody with negative HCV antigen and HCV RNA. This indicated previous HCV infection that had cleared. This patient had abnormal liver function tests and a history of alcohol excess. There were no cases of active HCV infection diagnosed through pretreatment anti-TNF-α screening in our department, which is located in a low-prevalence area for HCV infection. In view of the lack of evidence of harm associated with anti-TNF-α use in HCV-infected patients, we propose that screening for HCV infection in low-prevalence areas should be targeted to those with pre-existing risk factors. This is consistent with current guidelines from the Royal College of General Practitioners. Targeted screening rather than universal screening may be a safe and cost-effective option among patients being evaluated for anti-TNF-α therapies.

Hepatitis B and C Virus Infections Are Not Associated With Worse Clinical Outcomes After Autologous Stem Cell Transplantation: On Behalf Of The Adult Lymphoma Working Group Of The Japan Society For Hematopoietic Cell Transplantation (JSHCT)

BackgroundClinical impact of chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infections is not well studied in a large series of patients with lymphoma undergoing autologous stem cell transplantation (ASCT). Retrospective analysis was performed to evaluate clinical outcomes of patients with lymphoma receiving ASCT with or without HBV and HCV infections. Patients and MethodsAmong 13218 adult patients registered in the Adult Lymphoma Working Group of the Japan Society for Hematopoietic Cell Transplantation (JSHCT) database, we selected patients who had the information on HBV and HCV infection status and received ASCT from 1989 to 2010. Patients diagnosed as Hodgkin lymphoma, mature or precursor T- and B-cell lymphoma were included. Histological diagnosis of natural killer (NK)-cell lymphoma and adult T-cell leukemia/lymphoma were excluded in this analysis. Patients who had human immunodeficiency virus (HIV) infection and history of previous transplantation were also excluded. Survival analysis was performed to compare patients positive for HBV and HCV with those negative for both. Prognostic indicator for survival was also investigated in patients positive for HBV and HCV. ResultsA total of 4641 patients with 2819 male were analyzed. The median age of all patients was 54 years (range: 16-81 years). The patient characteristics were summarized in Table 1. HBV and HCV infections were present in 162 (3.5%) and 104 (2.2%) patients, respectively. Ten patients (0.2%) had both HBV and HCV infections. Detailed data on anti-HBV antigen or antibody and genetic data were not available in the analysis. Patients with HBV and HCV infections were older and more diagnosed with advanced stage than those without infections. With a median follow-up of 2.8 years, the 2-year overall survival (OS) rate of all patients was 75% (95%CI: 73 to 76). Cumulative incidence of treatment-related mortality (TRM) at one year after ASCT was 5.8% (95%CI: 5.2 to 6.6). According to HBV and HCV positivity, the estimated 2-year overall survival (OS) rates were 74% (95%CI: 65 to 81), 77% (95%CI: 66 to 84), 60% (95%CI: 25 to 83) and 75% (95%CI: 73 to 76) in patients with HBV-positive, HCV-positive, both virus positive and negative patients, respectively. Cumulative incidence of TRM at one year was 11% (95%CI: 6.2 to 16) 6.6% (95%CI: 2.7 to 13) and 5.7 (95%CI: 5.0 to 6.4) in patients with HBV-positive, HCV-positive and both virus negative patients, respectively. In patients with or without HBV and HCV infections, there was no statistically significant difference in rates of OS (p=0.82, Figure 1) and TRM (p=0.63). [Display omitted] [Display omitted] In multivariate analysis of patients infected with HBV, factors associated with shorter OS were male sex (HR: 3.1, 95%CI: 1.2 to 7.6), non-remission/relapse status at ASCT (HR: 2.7, 95%CI: 1.2 to 5.9) and ASCT before 2005 years (HR: 3.6, 95%CI: 1.6 to 8.4). ASCT before 2005 years was associated with higher TRM in patients with HBV infection (HR: 4.4, 95%CI: 1.5 to 13). In patients with HCV infection, multivariate analysis revealed that partial remission (HR: 3.5, 95%CI: 1.2 to 10.6), non-remission/relapse (HR: 5.3, 95%CI: 1.9 to 14.6) status at ASCT and age≥ 50 years at ASCT (HR: 7.0, 95%CI: 1.5 to 31.9) were significantly associated with shorter OS. Non-remission/relapse status at ASCT was associated with higher TRM in patients infected with HCV (HR: 4.4, 95%CI: 1.1 to 18.3). Difference in histology was an adverse factor for outcomes in the HBV- and HCV-negative groups, however, the factor could not be identified as adverse indicator in the HBV- and HCV-positive groups. ConclusionsPrognosis of patients with HBV and HCV infections would be comparable to patients without those infections. Disease status at ASCT could be one of useful landmarks to predict outcomes in patients positive for HBV and HCV undergoing ASCT. After careful consideration, ASCT might be a feasible option for patients with HBV and HCV infections. Disclosures:No relevant conflicts of interest to declare.

DNA vaccine expressing the non-structural proteins of hepatitis C virus diminishes the expression of HCV proteins in a mouse model

Most of the people infected with hepatitis C virus (HCV) develop chronic hepatitis, which in some cases progresses to cirrhosis and ultimately to hepatocellular carcinoma. Although various immunotherapies against the progressive disease status of HCV infection have been studied, a preventive or therapeutic vaccine against this pathogen is still not available. In this study, we constructed a DNA vaccine expressing an HCV structural protein (CN2), non-structural protein (N25) or the empty plasmid DNA as a control and evaluated their efficacy as a candidate HCV vaccine in C57BL/6 and novel genetically modified HCV infection model (HCV-Tg) mice. Strong cellular immune responses to several HCV structural and non-structural proteins, characterized by cytotoxicity and interferon-gamma (IFN-γ) production, were observed in CN2 or N25 DNA vaccine-immunized C57BL/6 mice but not in empty plasmid DNA-administered mice. The therapeutic effects of these DNA vaccines were also examined in HCV-Tg mice that conditionally express HCV proteins in their liver. Though a reduction in cellular immune responses was observed in HCV-Tg mice, there was a significant decrease in the expression of HCV protein in mice administered the N25 DNA vaccine but not in mice administered the empty plasmid DNA. Moreover, both CD8+ and CD4+ T cells were required for the decrease of HCV protein in the liver. We found that the N25 DNA vaccine improved pathological changes in the liver compared to the empty plasmid DNA. Thus, these DNA vaccines, especially that expressing the non-structural protein gene, may be an alternative approach for treatment of individuals chronically infected with HCV.

Hepatitis C Virus Serosorting in People Who Inject Drugs: Sorting Out the Details

Hepatitis C Virus Serosorting in People Who Inject Drugs: Sorting Out the Details

The sexual transmission rate of HCV among heterosexual couples

Although hepatitis C virus (HCV) is primarily transmitted by blood-to-blood contact, evidence for sexual transmission of HCV among heterosexual couples remains controversial.1 Therefore, we read with great interest the study by Terrault et al. reporting on a very low risk of sexual transmission of HCV among 500 monogamous heterosexual couples of which the index person was known to be HCV infected.2 Terrault et al. estimated the minimum and maximum heterosexual transmission rate of HCV based on couples from which the partner was infected with a concordant HCV genotype. Unfortunately, interpretation of these study results is not straightforward because of several potential biases. First, in 2.4% of the included couples, the partner had a history of injecting drug use (IDU); in these couples, it is impossible to exclude HCV infection of the partner through sharing injecting equipment. Second, the minimum HCV transmission rate was based on three HCV concordant couples with significant evidence for highly related viral strains. However, two out of three partners within these couples had a history of either IDU, snorting drug use, or sharing snorting equipment, which makes transmission through drug use more likely than sexual transmission. Therefore, this bias will have lead to an overestimation of the HCV incidence rate. Third, although this study has a cross-sectional design, the researchers report it as a cohort study without having measured the HCV infection status and determinants of interest at the beginning of the sexual relationship. To calculate the HCV incidence rate, the researchers assumed that the index cases were HCV infected before the start of their sexual relationship. However, the HCV infection of the index cases might have occurred during the current relationship. This could have resulted in an underestimation of the incidence rate because too many person-years of exposure were included. Fourth, the investigators excluded couples who had a sexual relationship shorter than 36 months, without providing any specific reason. In addition, couples who had less than three sex acts in the preceding 6 months were excluded, even though they could have had many sex acts in the preceding years. These choices may have lead to a selected study population, which might result in a biased estimate of the transmission risk. To conclude, the study by Terrault et al. is subject to several forms of bias that may have had a substantial effect on the results. Most important, because drug-use-related transmission of HCV was not conclusively excluded, this study is likely to have overestimated the incidence rate of heterosexual transmission of HCV among HCV-monoinfected individuals. BART P.X. GRADY, M.D. MARIA PRINS, PH.D. MAARTEN SCHIM VAN DER LOEFF, M.D., PH.D. Cluster of Infectious Diseases Public Health Service Amsterdam, The Netherlands

A multicentre survey of hepatitis C awareness in a high‐risk population

To assess the awareness of hepatitis C virus (HCV) infection status in a high-risk population. A targeted population survey of clients of methadone maintenance clinics in metropolitan and rural New South Wales, using an interviewer-administered face-to-face questionnaire. Main outcome measures include awareness of HCV status, time elapsed since last tested and children's HCV status. A total of 329 clients completed the survey, of which 97% perceived to have been tested for HCV in the past. One hundred and seventy (52%) participants considered themselves to be negative for HCV. Of these the median time since last tested was 2 years (2 weeks-25 years). Although 94% of all parents believed that their child's HCV status was negative, only 49% of respondents stated that their children had been tested for HCV. Voluntary testing was offered to all clients and their children with only one accepting. Awareness of HCV infection status in this high-risk population is suboptimal. This indicates that existing educational strategies are inadequate and that there is a disconnect between their health needs and the medical care they receive. Novel approaches need to be considered to improve the knowledge of HCV transmission and hopefully improve HCV-associated health outcomes in high-risk populations.

Prevalence of Hepatitis C Virus Infection in Alcoholic Patients: Cohort Study and Systematic Review

Prevalence of chronic hepatitis C virus (HCV) infection among alcoholics is thought to be higher than in the general population, although prevalence rates reported are quite variable. Our study is aimed to analyze HCV prevalence in a cohort of alcoholics and to perform a systematic review on this topic. A total of 396 alcoholic patients consecutively referred to our Alcoholism Unit were included. HCV infection status and other clinical variables were recorded for each patient. Variables associated with HCV infection were analyzed by means of logistic regression. Additionally, we performed a systematic review focused on previous studies on this topic. Among our alcoholic patients, 14 of them (3.53%) had chronic HCV infection. Variables independently associated with HCV infection were female gender, injection drug use (IDU) and the presence of alcoholic liver disease (ALD). Twenty-four studies analyzing HCV prevalence in alcoholic patients were included in our systematic review, showing prevalence rates of HCV infection ranging from 2.1 to 51% and an average weighted prevalence of 16.32%. In our series, the prevalence rate of chronic HCV infection among alcoholic patients is lower than previously reported, which is probably explained by the relatively low number of patients with ALD or IDU in our sample. Prevalence rates previously published are quite different and the presence of ALD and/or IDU can act as confounding factors for HCV prevalence among alcoholics.

Mother-to-Child Transmission of Hepatitis C Virus (HCV) Among HIV/HCV-Coinfected Women.

Maternal human immunodeficiency virus (HIV) coinfection has been associated with increased hepatitis C virus (HCV) mother-to-child transmission (MTCT). We hypothesized that HCV/HIV-coinfected women with well-controlled HIV disease would not have increased HCV MTCT. The NISDI Perinatal and LILAC cohorts enrolled HIV-infected pregnant women and their infants in Latin America and the Caribbean. This substudy evaluated the HCV infection status of mothers at participating sites and their live born, singleton infants who had a 6-month postnatal visit by December 31, 2008. Mothers who were anti-HCV-positive, or who had CD4 counts (cells/mm(3)) <200 with detectable HCV RNA, were considered HCV-infected. All HCV-infected women were tested for HCV RNA. Infants with HCV RNA were considered HCV-infected. Of 1042 enrolled women, 739 (71%) mother-infant pairs met the inclusion criteria. Of the 739 women, 67 (9%) were anti-HCV-positive and 672 anti-HCV-negative [68 (10%) with CD4 counts <200; of these, 3 (4.4%) were HCV RNA-positive]. Therefore, our study population comprised 70 HCV-infected (47 with HCV RNA) and 669 HCV-uninfected women (and their infants). Factors associated with maternal HCV infection included unemployment (odds ratio [OR] = 2.58); tobacco (OR = 1.73) or marijuana (OR = 3.88) use during pregnancy; enrollment HIV viral load ([VL] copies/mL) ≥10 000 (OR = 2.27); HIV clinical disease stage C (OR = 2.12); and abnormal alanine aminotransferase (OR = 4.24) or aspartate aminotransferase (OR = 11.98). Four of 47 infants (8.5%) born to HCV-viremic women were HCV-infected, and all 4 mothers had HIV VL <1000 at hospital discharge after delivery. HCV MTCT among HIV/HCV-coinfected women with well-controlled HIV disease may be lower than reported in other coinfected populations. Studies with longer infant follow-up are needed.

Concordance between self‐reported and actual hepatitis C virus infection status in a cohort of people who inject drugs

Accurate knowledge of individual hepatitis C virus (HCV) status is an important component of comprehensive health services for people who inject drugs (PWID). In this paper we compare the perceived HCV status of PWID in a longitudinal cohort study with their actual status, as verified by HCV-RNA testing. Participants who consented to blood testing at first follow up (352/688) were included. Self-reported HCV status (positive/negative/don't know), was compared with serology test results for participants. In comparing self-report with HCV-RNA results, 274 of 352 participants had valid serology and self-report results; of these, 220 (80%) accurately reported their HCV status. The findings of this study suggest that large proportions of PWID know their true HCV infection status, but the discordant participants represent potential HCV infection risks. Despite the majority of participants displaying concordance, this study reinforces the need for regular blood testing and the giving of accurate, practical and comprehensive HCV result information.

Hepatitis C virus infection is independently associated with depression among methadone maintenance treatment heroin users in China

Depression and hepatitis C virus (HCV) infection are two common conditions among heroin users in methadone maintenance treatment (MMT). However, the comorbid relationship between depression and HCV infection among MMT patients is not well understood.One hundred and fifteen MMT patients were recruited from the Yangpu MMT Clinic in Shanghai. Demographic characteristics, drug use and HCV-related information were collected using a structured interview. The Beck Depression Inventory (BDI-II) and the Perceived Stress Scale (PSS) were administered to evaluate participants' symptoms of depression and stress severity. HCV antibody (anti-HCV) test results were collected from patients' MMT clinical medical records.58.2% of participants were anti-HCV positive, and 41.3% scored moderate-to-severe for symptoms of depression (BDI-II scores >19). The prevalence of depressive symptoms (BDI-II score >19) was greater in HCV positive than HCV negative participants (51.6% versus 27.7%, respectively; P = 0.02). There was no significant difference in the perceived stress level by anti-HCV status; overall, the perceived stress level score was 15.9 ± 5.7. In logistic regression analysis, positive anti-HCV status (OR = 3.75, 95% CI = 1.42-9.90), and greater perceived stress (OR = 1.23, 95% CI = 1.11-1.36) were independently associated with depression, after controlling for gender, age, duration of drug use and the awareness of HCV infection.Depression and HCV infection are common and co-occurring among MMT patients in Shanghai. HCV infection itself appears to be associated with depressive symptoms regardless of whether the individual is aware of his HCV infection status. This finding indicates that it is important to consider the impact of depressive symptoms on injection risk behaviors and HCV transmission when planning intervention programs in MMT clinics.

Chronic HCV infection was associated with severe insulin resistance and mild atherosclerosis: a population-based study in an HCV hyperendemic area

Hepatitis C virus (HCV) affects glucose and lipid metabolism in vitro; however, it is unclear whether HCV infection is associated with insulin resistance and atherosclerosis at the population level. We aimed to investigate this association in a Japanese cohort of the Seven Countries Study, and our investigation was conducted in Tanushimaru, an HCV hyperendemic area. A total of 1908 inhabitants of Tanushimaru were classified into 3 groups according to HCV infection status: those who were uninfected (n = 1780), those with transient infection (n = 88), and those with chronic infection (n = 40). Insulin resistance and atherosclerosis were evaluated by homeostasis model assessment for insulin resistance (HOMA-IR) and carotid intima-media thickness (IMT), respectively. Intergroup differences in variables were evaluated by age- and sex-matched multivariate regression analysis. Significant intergroup differences were seen in fasting glucose and insulin levels. The HOMA-IR value was significantly higher in the group with chronic infection than the values in the uninfected and transiently infected groups (3.0 ± 0.39 vs. 1.3 ± 0.03 vs. 1.5 ± 0.14; P < 0.001). In contrast, low-density lipoprotein (LDL)-cholesterol and triglyceride levels were significantly lower in the group with chronic infection than the levels in the other groups. IMT was reduced in the group with chronic infection, with a significant intergroup difference (0.67 ± 0.02 vs. 0.71 ± 0.003 vs. 0.72 ± 0.01 mm; P = 0.003). This population-based study in an HCV hyperendemic area revealed that chronic HCV infection was associated with severe insulin resistance and with mild atherosclerosis, suggesting a unique characteristic of HCV-related metabolic abnormality.

Prevalence of hepatitis C virus infection among human immunodeficiency virus-1-infected pregnant women in Malawi: The BAN study

BackgroundIn Sub-Saharan Africa, prevalence estimates of hepatitis C virus (HCV) vary widely. ObjectivesTo assess the prevalence of HCV infection among HIV-infected, pregnant women screened for a large clinical trial in Lilongwe, Malawi. Study designPlasma from 2041 HIV-infected, pregnant women was screened for anti-HCV IgG using a chemiluminiscent immunometric assay (CIA). Specimens with a signal-cut-off ratio≥1.00 were considered reactive and those with S/Co ratio<1.00 non-reactive. All CIA-reactive specimens were tested by a recombinant immunoblot assay (RIBA) for anti-HCV and by PCR for HCV RNA. ResultsOf 2041 specimens, 110 (5.3%, 95% CI: 4.5–6.5%) were CIA reactive. Of the 109 CIA reactive specimens available for RIBA testing, 2 (1.8%) were positive, 28 (25.7%) were indeterminate, and 79 (72.5%) were negative. All CIA-reactive specimens were HCV RNA negative (n=110). The estimated HCV prevalence based on the screening assay alone was 5.3%; based on supplemental RIBA testing, the status of HCV infection remained indeterminate in 1.4% (28/2040, 95% CI: 0.1–2.0) and the prevalence of confirmed HCV infections was 0.1% (2/2040, 95% CI: 0–0.4%). ConclusionsHCV seroprevalence among HIV-infected, pregnant women in Malawi confirmed by supplemental RIBA HCV 3.0 is low (0.1%); CIA showed a high false-reactivity rate in this population.

Use of hepatitis C-positive donors in transplantation

Transplantation (Tx) is a therapeutic alternative intervention for terminal organ dysfunction, fatal disease or, in some cases, to improve the quality of life and reduce the risk of complications from chronic diseases. One of the major limitations in performing transplants is obtaining donor organs because of the difficulties in the process of organ donation of deceased donors and the unavailability of compatible living donors. In Brazil, there are many more patients on waiting lists, especially for liver and kidney transplants, than the number of procedures performed. Therefore, non-ideal donors are sometimes considered for transplantation, including those with a higher risk of primary graft dysfunction and infection transmission, such as hepatitis C virus (HCV)-seropositive donors. HCV-seropositive donors have routinely been used by a few groups or in cases of extreme urgency. However, the safety of transplantation from HCV-positive donors has not been clearly determined and may vary according to the type of transplant. To establish a set of recommendations, we performed an analysis based on the data available in the literature. The following items were considered according to the type of transplantation: 1) the position on the list, 2) the urgency of transplantation, 3) the HCV infection status of the donor (serology, viral replication and histological activity), 4) the HCV infection status of the recipient (serology, viral replication and histological activity) and 5) the safety data available regarding the use of HCV-seropositive donors. We analyzed liver, kidney, heart, lung and hematopoietic stem cell transplants (HSCTs). The IDSA (Infectious Diseases Society of America) rating system was used to establish levels of evidence. 1. Liver Transplantation Chronic liver disease due to HCV accounts for almost one-half of liver Tx indications. The risk of the histological recurrence of hepatitis after transplantation is approximately 70%. The graft and recipient survival is lower compared with other etiologies. Descriptive and comparative studies and case-control analyses have shown that the use of seropositive donors for seropositive recipients does not interfere with graft or patient survival. 2. Kidney Transplantation Some descriptive studies have shown that the use of seropositive donors for seropositive recipients does not interfere with graft or patient survival. However, one publication described five cases of discordant donor and recipient genotypes: in three of these cases, elevated enzyme levels and genotype substitution or association were observed in the recipient after transplant. 3. Heart Transplantation Little data are available regarding heart Tx. One multicenter study reported a lower survival rate in patients who received organs from seropositive donors, regardless of the HCV serostatus of the recipient. 4. Lung Transplantation Little data are also available regarding lung Tx. However, in a multicenter survey, 72% of the participating groups considered the use of HCV-seropositive donors for HCV-seropositive recipients. Nevertheless, there have been no descriptions of liver disease progression or graft and patient survival in positive viremia recipients. It is important to consider that treatment with interferon-gamma is usually not recommended after lung Tx due to the high risk of acute cellular rejection. 5. Hematopoietic Stem Cell Transplantation (HSCT) In HSCT, there have been reports of a significantly increased risk of hepatitis in HCV-seronegative recipients of seropositive donors, especially when there is evidence of viral replication. Because HSCT often involves situations in which there is an imminent risk of death and the need for an HLA-matched living donor, the decision should be based on the urgency of the Tx and level of viremia in the donor.

Awareness of infection, knowledge of hepatitis C, and medical follow-up among individuals testing positive for hepatitis C: National Health and Nutrition Examination Survey 2001-2008

Many persons infected with hepatitis C virus (HCV) are unknown to the healthcare system because they may be asymptomatic for years, have not been tested for HCV infection, and only seek medical care when they develop liver-related complications. We analyzed data from persons who tested positive for past or current HCV infection during participation in the National Health and Nutrition Examination Survey (NHANES) from 2001 through 2008. A follow-up survey was conducted 6 months after examination to determine (1) how many participants testing positive for HCV infection were aware of their HCV status before being notified by NHANES, (2) what actions participants took after becoming aware of their first positive test, and (3) participants' knowledge about hepatitis C. Of 30,140 participants tested, 393 (1.3%) had evidence of past or current HCV infection and 170 (43%) could be contacted during the follow-up survey and interviewed. Only 49.7% were aware of their positive HCV infection status before being notified by NHANES, and only 3.7% of these respondents reported that they had first been tested for HCV because they or their doctor thought they were at risk for infection. Overall, 85.4% had heard of hepatitis C; correct responses to questions about hepatitis C were higher among persons 40-59 years of age, white non-Hispanics, and respondents who saw a physician after their first positive HCV test. Eighty percent of respondents indicated they had seen a doctor about their first positive HCV test result. These data indicate that fewer than half of those infected with HCV may be aware of their infection. The findings suggest that more intensive efforts are needed to identify and test persons at risk for HCV infection.

Clinical features of patients with type 2 diabetes mellitus and hepatitis C infection

The objective of the present cross-sectional study was to assess the prevalence and the clinical and laboratory features of hepatitis C virus (HCV)-positive patients with type 2 diabetes mellitus (DM) attending either an outpatient clinic or hemodialysis units. Serologic-HCV testing was performed in 489 type 2 DM patients (303 outpatients and 186 on dialysis). A structured assessment of clinical, laboratory and DM-related complications was performed and the patients were then compared according to HCV infection status. Mean patient age was 60 years; HCV positivity (HCV+) was observed in 39 of 303 (12.9%) outpatients and in 34 of 186 (18.7%) dialysis patients. Among HCV+ patients, 32 were men (43.8%). HCV+ patients had higher serum levels of aspartate aminotransferase (0.90 ± 0.83 vs 0.35 ± 0.13 μKat/L), alanine aminotransferase (0.88 ± 0.93 vs 0.38 ± 0.19 μKat/L), gamma-glutamyl transferase (1.57 ± 2.52 vs 0.62 ± 0.87 μKat/L; P < 0.001), and serum iron (17.65 ± 6.68 vs 14.96 ± 4.72 μM; P = 0.011), and lower leukocyte and platelet counts (P = 0.010 and P < 0.001, respectively) than HCV-negative (HCV-) patients. HCV+ dialysis patients had higher diastolic blood pressure than HCV- patients (87.5 ± 6.7 vs 81.5 ± 6.0 mmHg; P = 0.005) and a lower prevalence of diabetic retinopathy (75 vs 92.7%; P = 0.007). In conclusion, our study showed that HCV is common among subjects with type 2 DM but is not associated with a higher prevalence of chronic diabetic complications.

Clinical outcomes of Torque teno virus-infected thalassemic patients with and without hepatitis C virus infection

BackgroundAlthough a marked proportion of thalassemic patients acquire Torque teno virus (TTV) through blood transfusion, its clinical importance is unclear. This study was designed to investigate the clinical importance of TTV infection in thalassemic patients with and without hepatitis C virus (HCV) co-infection in Iran.MethodsIn this case-control study, 107 thalassemic patients on chronic transfusion and 107 healthy individuals were selected. According to HCV and TTV infection status (detected by semi-nested PCR), patients were categorized into 4 groups: TTV and HCV negative, TTV positive, HCV positive, and TTV and HCV positive. Blood ferritin, alanine aminotransferase (ALT), and aspartate aminotransferase (AST) levels in these 4 groups were assessed.ResultsApproximately half of the thalassemic patients (50.5%) and 27.1% of controls had TTV infection. Thalassemic patients had a greater chance of TTV infection compared to the control group with a sex-adjusted OR of 4.13 (95% CI=2.28-8.13). The increased levels of ALT, AST, and ferritin in the TTV and HCV-infected group were not significantly different from those in the TTV and HCV negative group. Co-infection with TTV and HCV did not significantly increase ALT, AST, and ferritin levels compared to infection with TTV alone.ConclusionAlthough common in thalassemic patients, TTV infection appears to have a negligible role in increasing the severity of liver disease, even when co-infection with HCV occurs.

Patient-to-Patient Hepatitis C Virus Transmissions Associated with Infection Control Breaches in a Hemodialysis Unit

Background: Three patients attending a hemodialysis unit were diagnosed with acute hepatitis C virus (HCV) infection. We investigated the scope and mode of transmission. Methods: Patients and staff were tested to determine HCV infection status; all HCV-RNA-positive sera underwent quasispecies analysis to assess genetic relatedness. Staff practices were evaluated via interviews and observations. A cohort study was performed to assess risk factors for incident HCV infection. Results: HCV infection was documented at time of hire or unit admission for 2 staff and 12 patients (prevalent case-patients). Seven (13%) of 52 patients HCV susceptible at admission to the unit subsequently acquired HCV infection (incident case-patients). Analysis of HCV quasispecies from the hyper variable region 1 identified 2 separate clusters each containing 3 incident case-patients and 1 prevalent case-patient. Incident case-patients received a higher median number of intravenous medications per dialysis session compared to susceptible patients (2.1 vs 1.8, p-value = 0.0606). Only one incident case-patient received dialysis on the same machine as their genetically related prevalent case-patient. Preparation of injection medications at the dialysis station on a mobile medication cart, and failures to clean environmental surfaces between patients were infection control breaches identified as likely modes of HCV transmission. Conclusions: Epidemiologic and laboratory data revealed transmission of HCV among patients at the same dialysis unit. Transmission was most likely related to infection control breaches. Our findings reinforce the risk of patient-to-patient HCV transmission in hemodialysis units when staff fails to adhere to recommended infection control practices.

Impact of age on FDG uptake in the liver on PET scan

Purpose The intensity of physiological 18F-2-deoxy-D-glucose (FDG) uptake in the liver varies. It is important to be familiar with the varying degree of FDG accumulation in the liver that represents normal distribution and physiological changes, before attempting to interpret whole-body positron emission tomography (PET) imaging for malignancy detection. The aim of this study is to evaluate the possible factors influencing the intensity of physiological FDG uptake in the liver on FDG PET imaging. Materials and Methods From 2005 to 2007, a total of 339 consecutive healthy subjects, referred from the Department of Community Medicine and Health Examination Center of our hospital for health screening, were retrospectively recruited for analysis. Demographic data were collected from chart records. Whole body FDG PET imaging and serologic determination of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection status were performed on all subjects. The mean and maximum standard uptake values (SUVs) of the liver were calculated. The relationships between sex, age, HBV and HCV infection status, and SUVmax and SUVmean of the liver on FDG PET imaging were evaluated. Results There was no statistically significant relationship between sex, HBV and HCV infection status and maximum standard uptake value (SUVmax) or mean standard uptake value (SUVmean) of the liver. After adjusting for covariables, age was a statistically significant predictor of SUVmax ( B=0.18; P= .001) and SUVmean ( B=0.16; P= .004) of the liver on FDG PET imaging. Conclusion Age has a significant and positive impact on both maximum and mean standard uptake values of the liver on FDG PET imaging. High physiological background FDG uptake will reduce diagnostic sensitivity and accuracy for malignancy detection in the liver.

Prevalence of hepatitis C virus infection among health-care workers: A 10-year survey

Hepatitis C virus (HCV) is one of the most common blood-borne pathogens transmitted from patients to health-care workers (HCWs). HCV infection status among HCWs and occupational blood exposure accidents were monitored to assess the risk of HCV infection among 403 HCWs from a single institution between 1999 and 2009. Additionally, HCV-related malignancies were evaluated in the HCV-positive HCWs. HCV infection was detected in 3% of the subjects at the first survey. The HCWs that initially tested negative for HCV remained negative during the 10 years of the survey. Of note, a statistically significant decrease was observed in the number of HCWs that experienced occupational blood exposure accidents, from 116 in 1999 to 72 in 2009 (p=0.0002). One HCV-infected HCW developed B-cell non-Hodgkin lymphoma (NHL) of the liver. The heavy chain gene combinations detected in the DNA from the NHL tissue were of the type usually found in HCV-associated lymphomas, supporting the role of HCV infection in the lymphomagenesis of this patient. The set of universal precautions recommended by the US Center for Disease Control and Prevention aided in the prevention of HCV transmission from patients to HCWs, as all 390 HCV-negative HCWs remained negative for the duration of the survey. Consequently, these recommendations also serve to prevent the development of HCV-associated malignancies such as hepatocellular carcinoma or B-cell NHL.