Hepatitis C Virus Positive Group Research Articles

Thyroid function abnormalities in hepatitis C positive patients in a single center in Basrah

Background: Hepatitis c virus (HCV) is global health problem it has many extrahepatic manifestations including hematologic, lymphoproliferative, endocrine, and renal diseases. The most common and important endocrine disorder are thyroid abnormalities.The aim of this study: Is to investigate the correlation between HCV infection and thyroid function abnormalities and the factors that may affect it.Patients and methods: This were a case-control study with 51 patients (27 males) were HCV positive who were attending Faiha Gastroenterology and Hepatology center and 49 HCV negative persons (34 males) from health workers and patients’ relatives represent control group. They were sent for thyroid function test in form of Thyroid stimulating hormone (TSH), free tetraiodothyronine (FT4), total triiodothyronine (T3), anti-thyroid peroxidase antibody, thyroglobulin, and anti-thyroglobulin.Results: thyroid function abnormalities were found in eighteen patients (35.3%) of HCV positive group ,and nine (18.4%)in control group but the difference was not significant (p = 0.057), also there was no difference in thyroid antibodies prevalence between the two groups (p ˃ 0.05).The distribution of thyroid abnormalities in HCV patients was as follows: Four patients (7.8%) have hypothyroidism, Four (7.8%) have subclinical hypothyroidism, and Ten (19.7%) have weird thyroid function, while in control group: Four (8.2%) have subclinical hypothyroidism, Five(10.2%) have weird thyroid function and none have hyperthyroidism in both groups. Abnormal thyroid function was more in women with age group 30-40 years and was statistically significant.Conclusion: Thyroid abnormalities are more in HCV positive patients where hypothyroidism is the most frequent, they are more in women, and more in 30-40 years old.With the majority of hypothyroidism has autoimmune origin.

Retrospective study to assess the impact of hepatitis C virus infection on the prognosis and management of multiple myeloma.

e20001 Background: Multiple Myeloma (MM) is a neoplasm of the post-germinal center, terminally differentiated B-cells. MM accounts for 1% of all types of cancer and 10% for all hematologic malignancies. Chronic hepatitis C virus (HCV) is an infection that affects over 71 million patients worldwide. Cytotoxic agents and immunosuppressive therapy as steroids are the main line of therapy in lymphoid malignancies, but these drugs may exacerbate chronic viral hepatitis and cause uncontrolled replication of hepatitis viruses. The impact of HCV infection on MM patients remains unclear. Objective: To assess the impact of HCV infection on the prognosis and management of MM patients. Methods: A 10-year retrospective study of MM patients was conducted at Cairo University Clinical Oncology Department from January 2009 to April 2019. Results: During this time, 150 patients were diagnosed with MM, 109 (72.7%) were HCV negative, 24 (16%) were HCV positive, and 17 (11.3%) with unknown HCV status. The median age was 51 and 54 years for HCV negative and positive groups respectively, with a statistically insignificant difference (p-value > 0.2). In the multivariate analysis, HCV infection was not an independent factor related to overall survival (OS), however age, creatinine and hemoglobin levels correlated significantly with OS (p < 0.009, 0.008, 0.031 respectively). The median OS for the HCV negative group was 31.11 months (95% CI: 22.62 - 39.61) compared to 37.66 months (95% CI: 7.19 - 68.13) for the HCV positive group. The median progression-free survival (PFS) for all patients was 18.9 months, for HCV positive patients was 15.36 months (95% CI: 13.18 – 17.54), and for HCV negative patients was 20.49 months (95% CI: 14.13 – 26.85). Age below 60 years and creatinine level less than 2 mg/dL were statistically significant for favorable disease-free survival (DFS) (p < 0.030, 0.034 respectively). Conclusions: Age, creatinine and hemoglobin levels are significant prognostic factors in MM but HCV status doesn’t affect the overall survival or progression-free survival. HCV infection should not contraindicate MM therapy.

Abstract P4-14-12: Effects of hepatitis C virus infection on the safety of chemotherapy for breast cancer patients: A retrospective chart analysis

Abstract Background: Hepatitis C virus (HCV) infection is a major health problem in the United States and breast cancer is the second most common cancer in US women. Despite these prevalent diseases, there is limited information available on the effects of a concurrent HCV infection among breast cancer patients receiving chemotherapy and the problems they face during their treatment. There are limited guidelines for chemotherapy treatment in HCV positive breast cancer patients. Methods: We performed a retrospective 2:1 matched case control analysis on breast cancer patients with a confirmed active HCV infection who received chemotherapy at Boston Medical Center between January 2000 and April 2015. Cases with HCV infection (n=6) were matched with controls (n=12) who were HCV negative. The controls were matched on age (decade) of diagnosis, stage of breast cancer, and intended chemotherapy regimen. We investigated dose delays, dose changes, hospitalization, hematologic reasons for dose delays, and variation in blood counts during the treatment period in these patients from their medical records. Statistical analysis was done using R version 3.4.0 to compare these outcomes of interest between the two groups. Fisher’s exact and Wilcoxon rank sum tests were used to compare the categorical and continuous variables respectively. Results: The HCV positive group was at a significantly higher risk of dose delays (100% vs. 33%, p = 0.01), dose changes (67% vs. 8%, p = 0.02), and hospitalization during chemotherapy (83% vs. 25%, p = 0.04) than their HCV matched controls. The risk of getting a dose delay due to hematotoxicity was significantly higher in the HCV positive group than the HCV negative group (83% vs. 8%, p = 0.003). The HCV positive patients took longer time to complete their treatment cycles than the HCV negative group. Conclusions: Chronic HCV infection in breast cancer patients receiving chemotherapy may be complicated by their active HCV infection. Treatment challenges due to dose changes, dose delays and hospitalizations were significantly more common when compared to controls. Chemotherapy delays and dose changes during breast cancer treatment has a negative consequence. In the era of curative treatment for HCV, future studies focused on the effect and treatment of concurrent HCV and breast cancer treatment is warranted. Citation Format: Saptaparni Ghosh, Minghua L Chen, Janice Weinberg, Naomi Y Ko. Effects of hepatitis C virus infection on the safety of chemotherapy for breast cancer patients: A retrospective chart analysis [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P4-14-12.

1909-P: The Platelet-Derived Growth Factor a—An Additional Pathophysiological Factor in Hepatic Steatosis and Fibrosis Development Both in Patients with Hepatitis C and Patients with Prediabetes

Insulin resistance (IR) represents one of the key regulatory mechanisms in the development of non - alcoholic fatty liver disease. It is a common hepatocyte injury in hepatitis C virus (HCV) infection and type 2 diabetes mellitus (T2DM). Higher plasma platelet-derived growth factor A (PDGF- A) concentration is associated with increased hepatic steatosis and fibrosis in T2DM. PDGFs are key regulators of the connective tissue formation and potent mitogens for hepatic stellate cells. We investigated whether there is an association between PDGF-A serum concentration, IR and HCV mediated hepatic steatosis and fibrosis. This cross-sectional study comprised 90 nondiabetic participants aged 47.11±1.54 years divided into 3 groups: HCV negative group with IR (HCV-/IR-, N=12), HCV positive group without IR (HCV+/IR-, N=34), HCV positive group with IR (HCV+/IR+, N=44). The fasting PDGF-A concentration was determined by enzyme-linked immunoadsorbent assay. Homeostatic Model Assessment of IR score over 1.64 was categorised as IR. Fibrosis and steatosis were evaluated by elastography. Steatosis severity accessed by Controlled Attenuation Parameter (p<0.001) had the mean value of 15.9 kPa in the HCV+/IR+ (p<0.001) revealing the highest value in HCV-/IR+ (296.5 dB/m) group. The PDGF-A concentration correlated positively with steatosis (r=0.341, p=0.007) and fibrosis (r=0.264, p=0.071). Both IR positive groups had higher PDGF-A compared to HCV+/IR- group (p=0.006). In accordance with more pronounced steatosis, the HCV-/IR+ group revealed the highest PDGF-A. Concentration of PDGF-A is associated with the severity of hepatic steatosis in HCV and non-HCV patients with IR; i.e., that PDGF-A could represent one of the key regulatory mechanisms in the pathway from hepatic steatosis towards fibrosis. These results provide better understanding of pathways that regulate fibrosis. Disclosure K. Blaslov: None. V. Kokic Males: None. S. Kokic: None. I. Kruljac: None.

The Relation between Interstitial Lung Disease and Chronic HCV Infection

Background and study aim: Interstitial lung disease (ILD) includes a variety group of about 200 conditions that insult the lung parenchyma with different patterns of inflammation and fibrosis. Hepatitis C virus (HCV)is Flavivirus with diverse hepatic and extrahepatic diseases. Its direct and indirect pathogenic association with many pulmonary manifestations-including interstitial lung disease-has been suggested yet needs more elucidation. Patients and Methods: A case control study was conducted with a total of 50 chronic hepatic patients. They were equally divided into two groups, HCV positive group (group 1= 25 patients) and HCV negative group (group 2= 25 patients). Group 1 was subdivided into two subgroups, without-idiopathic interstitial pneumonias patients (without IIPs subgroup A= 13 patients) and with idiopathic interstitial pneumonias patients (IIPs subgroup B = 12 patients). Both groups were subjected to thorough history taking, clinical examination, and routine investigations. The diagnosis of HCV was confirmed by viral markers including HCV antibodies and PCR. Other chronic hepatic liver diseases were confirmed by abdominal ultrasound and ultrasound- guided liver biopsy. Arterial blood gases, auto antibodies, Computerized pulmonary function tests and radiological studies including plain X ray chest and heart and HRCT scanning were also done. All patients with idiopathic pulmonary fibrosis (IPF) had fulfilled the ATS/ ERS diagnostic guidelines. Both groups were matched according to age, sex and body mass index. Results: The HCV positive group was found to have a significantly higher frequency of ILD than the HCV negative group with also more restrictive pattern hypoxemia and higher scores of IPF (by computed tomography). Conclusion: ILD is more frequent in patients with chronic HCV infection with higher grades of fibrosis and hypoxemia. HCV infection may be predisposing factor for IPF.

Role of Hepatitis B Virus Infection in the Prognosis After Hepatectomy for Hepatocellular Carcinoma in Patients With Cirrhosis

The role of hepatitis B virus (HBV) infection in determining the prognosis after hepatectomy for hepatocellular carcinoma (HCC) in patients with cirrhosis is controversial. Retrospective study based on multicenter prospectively updated databases. Two tertiary referral centers specializing in hepatobiliary surgery. Two hundred four consecutive patients with cirrhosis undergoing hepatectomy for single nodules of HCC of 5 cm or smaller from January 1, 1997, through September 30, 2006. Patients were divided into the following groups according to their preoperative viral status: HBV positive and hepatitis C virus (HCV) negative (group 1); HBV negative and HCV positive (group 2); HBV negative and HCV negative (group 3); and HBV positive and HCV positive (group 4). A multivariate analysis was performed to determine factors associated with recurrence-free survival (RFS) among demographic, clinical, pathological, and surgical variables. The 2 centers had comparable RFS and early and late recurrence rates. Five-year RFS was significantly higher in groups 2 and 3 compared with group 1 (38%, 34%, and 9%, respectively; P = .007 and P = .05). Factors independently associated with RFS were HBV infection (P = .009; odds ratio, 1.79; 95% confidence interval, 1.15-2.78) and poor tumor differentiation (P < .001; odds ratio, 2.01; 95% confidence interval, 1.36-2.96). The concomitance of 0, 1, or 2 risk factors led to 5-year RFS rates of 49%, 20%, and 8%, respectively (P < .001). Infection with HBV is a strong predictive factor for lower RFS after hepatectomy for a single nodule of HCC of 5 cm or smaller in patients with cirrhosis, providing a further basis for adjuvant antiviral treatment. Patients who are seropositive for HBV with poorly differentiated HCC should also be considered to be at a high risk of recurrence and possibly included in a policy of salvage liver transplantation.

前インターフェロン不応C型慢性肝炎に対する二重濾過血漿交換併用ペグインターフェロン・リバビリン療法の初期効果-第1報-

We investigated lipid metabolism in nine patients with chronic hepatitis C virus (HCV), not responded by previous interferon therapy (IFN), undergoing double filtration plasmapheresis (DFPP) and peginterferon plus ribavirin (PEG·Rib) combination therapy. Three patients were non-responder of previous IFN monotherapy and 6 were PEG·Rib. HCV RNA became negative within 24 weeks in 5 out of 9. In the HCV RNA negative group, Triglyceride (TG) and Total-Cholesterol (T-Chol) or LDL-Chol levels increased gradiently after DFPP and were higher than those before treatment, but not in HCV positive group. DFPP plus PEG·Rib combination therapy might not only produce a reduction of HCV but also improve the environment of lipid metabolism effective for PEG·Rib during the early stage of treatment.

Effects of hepatitis C virus infection on haematocrite and haemoglobin levels in Egyptian hemodialysis patients

Aim: Hepatitis C virus (HCV) infection is common among the Egyptians. This prevalence is higher among hemodialysis (HD) patients in whom anemia is a common finding. Recently, some case reports and few studies indicated that red cell status increased after hepatitis C viral infection among HD patients. The aim of our study is to investigate whether HCV-positive HD patients have higher hemoglobin (Hb) and hematocrit (HCT) values compared to HCV-negative patients. Methods: Ninety-nine chronic (HD) patients were the subject of this study. Their HCV status was determined by anti-HCV antibodies and confirmed with RNA polymerase chain reaction (PCR). Those with a history of blood transfusion or massive blood loss during the last 6 months were excluded from the study. Results: 70.7% of our patients tested positive for anti-HCV antibody (56.9 % were male). The mean age for HCV positive group was (40.41±14.17 years) while it was (47.35±19.18 years) for HCV negative group (P=0.08). HCV positive group has a longer hemodialysis duration (66.54 ± 43.92 months) compared to HCV negative patients (30.96±23.17 months, P=0.006). Mean Hb was similar in HCV-positive compared to HCV negative group (10.32±2.03 versus 10.22±1.52 gm/dl respectively) (P=0.63). Mean HCT values were also similar in both groups being 30.94± 6.089% in HCV positive versus 30.77± 4.53% in HCV negative group, respectively (P= 0.094). Fifty-five patients (39 HCV positive and 16 were HCV negative) received erythropoietin (EPO) therapy whilst only twenty patients received IV iron. Mean Erythropoietin dose was 5000±2236.06 Units/week in HCV- positive patients versus 6250±2720.29 Units /week in HCV - negative group (P=0.09). Liver function tests were normal except for alanine aminotransferase (ALT) that was significantly higher among HCV-positive compared to HCV-negative patients (31.75±36.4 vs 15.1±7.21 U/L, P=0.05). Conclusion: HCV-positive and HCV-negative Egyptian chronic hemodialysis patients have comparable hemoglobin as well as hematocrit levels and the erythropoietin dose was not influential as its lower value in HCV-positive patients did not reach a statistically significant level.

Excess body weight, liver steatosis, and early fibrosis progression due to hepatitis C recurrence after liver transplantation

To investigate how weight gain after OLT affects the speed of fibrosis progression (SFP) during recurrent hepatitis C virus (HCV) infection of the graft. Ninety consecutive patients (63 males, median age 53 years; 55 with HCV-related liver disease), transplanted at a single institution, were studied. All were followed for at least 2 years after OLT and had at least one follow-up graft biopsy, performed not earlier than 1 year after the transplant operation. For each biopsy, a single, experienced pathologist gave an estimate of both the staging according to Ishak and the degree of hepatic steatosis. The SFP was quantified in fibrosis units/month (FU/mo). The lipid metabolism status of patients was summarized by the plasma triglycerides/cholesterol (T/C) ratio. Body mass index (BMI) was measured before OLT, and 1 and 2 years after it. In the HCV positive group, the highest SFP was observed in the first post-OLT year. At that time point, a SFP <=0.100 FU/mo was observed more frequently among recipients who had received their graft from a young donor and had a pre-transplant BMI value >26.0 kg/m(2). At completion of the first post-transplant year, a BMI value >26.5 kg/m(2) was associated with a T/C ratio <=1. The proportion of patients with SFP >0.100 FU/mo descended in the following order: female recipients with a high T/C ratio, male recipients with high T/C ratio, and recipients of either gender with low T/C ratio. Hepatic steatosis was observed more frequently in recipients who, in the first post-transplant year, had increased their BMI >=1.5 kg/m(2) in comparison to the pre-transplant value. Hepatic steatosis was inversely associated with the staging score. Among HCV positive recipients, excess weight gain post-OLT does not represent a factor favoring early liver fibrosis development and might even be protective against it.

Detection of hepatitis C virus RNA in saliva is not related to oral health status or viral load

Hepatitis C is a worldwide public health problem and its transmission is clearly associated with the parenteral route, however, the virus has also been isolated from other body fluids. Hepatitis C virus (HCV) RNA has been detected in saliva, yet the relationship between HCV and oral pathology is not clearly understood. Therefore, an investigation on HCV-RNA in saliva and its correlation with oral pathology was undertaken. Saliva and blood samples were collected from 50 anti-HCV positive patients and from 25 patients with non-HCV chronic liver disease. HCV-RNA was detected in all of the saliva samples from the HCV positive group. None of the saliva or serum samples from the non-HCV group were positive for HCV-RNA. The patients were examined for dental and oral health (dentate, partially dentate, edentulous, evidence of gum disease, or mucosal lesions); however, no correlation was found between HCV-RNA in saliva, oral health, and viral load. These results suggest that HCV-RNA presence in saliva is independent of the viral load and the oral pathology of HCV positive individuals.

Impaired renal allograft, but not patient survival, in patients with antibodies to hepatitis C virus

The impact of hepatitis C virus (HCV) infection in renal transplant patients is controversial and there are no data on the outcome of renal transplantation in this sub-group of Irish patients. To examine the outcome of renal transplantation in patients with hepatitis C. We examined the outcome of first grafts from renal transplant patients with hepatitis C antibody positive and compared them to a control group. During this period, 24 HCV positive patients received 33 grafts. All were treated with standard immunosuppression. Graft survival rate was less in the HCV positive cases (p=0.0087). Graft survival at 1 year was 75% in the HCV positive group versus 85% in the HCV negative group, 40% versus 62% at 5 years and 14% compared with 40% at 10 years. Patient survival was similar in both groups (p=0.78). Patient survival at 1 year was 96% versus 94%, 87% versus 80% at 5 years and 70% in both groups at 10 years. In the Irish renal transplant population, the presence of hepatitis C antibodies, before or after transplantation is associated with worse long-term graft, but not patient survival.

Treatment of membranoproliferative glomerulonephritis associated with hepatitis C virus infection. Niigata Research Group of Glomerulonephritis and Nephrotic Syndrome.

Interferon has been used as a new therapeutic agent for glomerulonephritis since a manifest relationship between membranoproliferative glomerulonephritis (MPGN) and hepatitis C virus (HCV) infection was documented. However, several side effects and rebound phenomenon have been significant problems. We retrospectively evaluated the therapeutic effect and safety of the standard treatment with steroids and/or immunosuppressive agents for MPGN patients with an HCV infection. Remission and renal survival rates as well as clinical and histological data were compared between MPGN groups with or without an HCV infection. In addition, the hepatic function was followed-up after the treatment. The subjects were 42 biopsy proven MPGN patients. Seven were positive for an HCV infection. Secondary causes of MPGN excluding an HCV infection were omitted. Most patients were treated with steroids and/or immunosuppressive agents. The mean age of the MPGN patients with an HCV infection was significantly higher than that of those without an HCV infection. The renal function and the interstitial change of the former group were significantly worse than those of the latter. Nevertheless, remission and renal survival rates were not significantly different between the two groups. None in the HCV positive MPGN group showed an impairment of hepatic function during the clinical course. However, 2 subjects died from severe pneumonia during the treatment. The standard treatment with steroids and/or immunosuppressive agents did not reveal a statistical difference in the therapeutic efficacy between MPGN patients with or without an HCV infection. However, some in the former group showed a poor prognosis.

NOSA in HCV infection: markers or makers of disease?

See article on page 435 In this issue Lenzi et al (see page435) provide convincing evidence that non-organ specific autoantibodies (NOSA) are highly prevalent in subjects exposed to hepatitis C...

徳島県におけるＨＣＶ抗体スクリーニングの輸血後非Ａ非Ｂ型肝炎予防効果に関する研究

The significance of hepatitis C virus (HCV) antibody determination as a screening test was examined prospectively by clarifying the positive rate of HCV antibody in transfusional blood and examining the incidence of posttransfusional non-A non-B hepatitis and characters of HCV antibody positive blood after HCV antibody screening in Tokushima Prefecturte.The following results were obteined.1. The HCV antibody positive rate in blood after conventional screening with aspartate aminotranserase (ALT) activity was 0.9% and the rate in all donors blood were 1.35%.2. The HCV antibody positive rate in blood of more than 36 KU ALT activity was 7.6%. The positive rate in blood of less than 35 KU ALT activity was 1.2%. The HCV antibody positive rate in higher ALT activity blood showed significantly higher values.3. No significant difference was observed in HCV antibody positive rate between HBs antigen negative group and positive group.4. Various test values were compared between HCV positive group and negative group after conventional screening. As a result, ALT showed significantly heighter values in the HCV antibody positive group. No significant difference was observed in alkalinephosphatase, total protein, albumin, albumin-globulin-index, blood urea nitorogen, cholesterol between both groups.5. Posttransfusional non-A non-B hepatitis occurred in 3 (3.4%) of 87 cases that received transfusion with HCV antibody screened blood. It was significantly lower than the rate before initiation of HCV antibody screening.6. It became clear that introduction of trnasfusion blood screening with HCV antibody is effective in the prevention of posttransfusional hepatitis.