Hepatitis C Virus Risk Factors Research Articles

Hepatitis C and Baby Boomers: Efficient Utilization of Resources

Introduction: Hepatitis C Virus (HCV) infection is a silent epidemic currently affecting 3.5 to 5 million people in the US. With the advent of new direct acting antivirals (DAA) an aggressive screening and treatment approach is imperative. According to the guidelines all baby boomers should be screened. We hypothesized that universal screening of baby boomers without any risk factors may be an unnecessary burden and hence conducted this study. Methods: A retrospective chart review of all the baby boomers presented in between January 2010-October 2015 was performed. Information collected included the age, sex, race, HCV serology, genotype, alcohol consumption and HCV risk factors. The prevalence and risk factors stratification was performed and data was analyzed to particularly assess the prevalence of HCV with respect to their risk factors. The patients who were HCV positive but denied any risk factors were interviewed again about the presence of risk factors. Results: A total of 573 charts were reviewed. Prevalence of HCV was 26.8% (154/573 patients) with 59% males and 41% females. A total of 132 HCV infected patients were risk stratified as 22 patients were lost to follow up. Almost all (99.2 %) HCV infected population reported exposure to one of the risk factors, most common risk factors being intravenous drug abuse (37%), cocaine sniffing (26.5%) and blood transfusion before 1992 (19.6%). Only 1/132 HCV positive patients denied being exposed to identifiable risk factor. Majority of HCV negative patients, 85.2% (357/419) were negative for risk factors and 14.8 % patients were negative HCV but with positive risk factors. Conclusion: Complying with the CDC recommendation of universally screening baby boomers, we have faced resistance from some patients raising ethical issues. The fear and stigma of being tested for the disease that has been associated with high risk behaviors, adds to the psychological stress in the particular group of patient population. This study reinforces a striking association in between HCV infection and risk factors. Therefore, we suggest that aggressive screening of baby boomers with a risk factor questionnaire will be a more efficient practical approach rather than applying universal screening.Table 1: Risk Factor Stratification Of Baby Boomers

Popular Knowledge of Hepatitis C Risk Factors Is Low but Correlates with Level of Formal Education

Introduction: Affecting approximately three million people, Chronic Hepatitis C Virus (HCV) is a major health concern in the U.S. Novel, tolerable, highly effective therapy is available. Because HCV is frequently asymptomatic, patients are identified by screening tests. Testing is indicated in high risk cohorts (e.g., those born between 1945-1965) and those with risk factors. Unfortunately, patients may have inadequate or inaccurate understanding of HCV risk factors. This study evaluated the effect of educational attainment on knowledge of HCV transmission within an historically underserved community with a high prevalence of HCV. Methods: Individuals attending a health fair sponsored by the Rodham Institute completed an anonymous survey. The exposition was hosted in an urban setting with a population that is 92% African American. The survey included questions on demographic information, access to primary care, insurance status, as well as knowledge of various topics related to Hepatitis C. Responses were excluded if they did not answer questions regarding education level or HCV transmission. The university institutional review board approved the study. Statistical analysis was performed using Fisher's exact test, with significance set at p < 0.05 Results: Ninety-five responses were analyzed. All individuals reported access to Primary Care Provider (PCP). Twenty nine (30.5%) reported completion of college or graduate coursework and 17 (58.6%) understood that sharing intravenous needles was a risk factor for HCV transmission. Sixty six patients reports a lower level of formal education and 19 (28.8%) knew that shared needles could transmit HCV. Those with higher education were more likely to be aware of this risk factor (p=0.0107). Conclusion: Education is an important social determinant of health and may correlate with health literacy. This study found that, in a high-prevalence community, knowledge of HCV risk factors was low and that patients with less-than-college education levels failed to identify needle sharing as a mode of HCV transmission at twice the rate of the college educated respondents. These results indicate that outreach efforts should focus not only on the availability of treatment, but also on the risk factors HCV infection. Communities with lower levels of formal education may see even more benefits from such efforts. As many communities face a resurgence of injection opioid use, education about risks related to needle sharing becomes even more essential.

Acceptance, yield and feasibility of attaching HCV birth cohort screening to colorectal cancer screening in Spain

IntroductionThe US Centers for Disease Control recommends hepatitis C virus (HCV) screening for baby boomers. Spain presents a similar distribution of infected patients. We performed a cross sectional prospective study to evaluate the prevalence of undiagnosed HCV infection in subjects born between 1949 and 1974. MethodsAll out-patients within the age range, both symptomatic and screening procedures, undergoing colonoscopy between December 2014 and June 2015 were offered a HCV antibody blood test and a survey including risk factors for HCV infection and attitude toward HCV screening. Patients with chronic HCV or with a previous negative HCV antibody test were excluded. ResultsA total of 570 subjects, 50% screening procedures, were analyzed. The median age was 55.7, 94.6% were born in Spain and 54.6% were women. Antibodies against HCV were found in 1.6% (95% CI: 0.8–3%) and HCV-RNA in 0.4% (0.1–1.3%). We found no statistically significant differences regarding HCV prevalence, risk factors or socioeconomic characteristics between subjects undergoing colorectal cancer screening and symptomatic subjects. ConclusionSymptomatic and screening subjects undergoing colonoscopy support HCV screening and present a similar HCV risk profile. Results suggest linking colorectal and HCV screening would yield good results.

Predisposing, enabling, and need factors associated with utilization of HCV testing services among PWID in two settings in India.

BackgroundThe Hepatitis C virus (HCV) is very common among people who inject drugs (PWID), yet PWID in India have suboptimal access to HCV testing and treatment. This study sought to identify HCV risk factors among male PWID who utilized a free needle and syringe exchange program and to examine the predisposing, enabling, and need factors associated with utilization of HCV testing services by those PWID reporting that they had been tested.MethodsA cross-sectional study was conducted in Imphal, Manipur and Amritsar, Punjab. These two settings have high HCV prevalence and large numbers of PWID. A team of 18 field investigators obtained data through face-to-face interviews using a structured multiple-choice questionnaire. The questionnaire was administered to 1241 of 2644 male PWID aged 15 years and above enrolled in the needle and syringe program of India’s AIDS Control Program, with study participants selected through consecutive sampling. Statistical analyses included descriptive statistics and multivariate regression.ResultsTwenty-four percent of PWID in our study sample reported having been tested for HCV. Unlike PWID in Imphal, more than half of PWID in Amritsar reported unprotected sex and use of alcohol or non-injecting drugs as being among their HCV risk factors (67.1 and 77.8 %, respectively). However, opioid substitution therapy non-adherence was reported more often in Imphal than in Amritsar. Education, marital status, place of residence and duration of injecting drug use were found to significantly enable access to HCV testing while alcohol use, frequent mobility and unprotected sex were found to significantly inhibit access to HCV testing for PWID after controlling for other explanatory variables.ConclusionsPredisposing and enabling determinants provide an area for developing effective interventions to improve HCV testing practices among PWID. HCV prevention programs that address safe injecting and sexual practices, OST adherence and frequent mobility customized for PWID by age are strongly recommended.

Risk factor analysis of hepatitis C virus seropositivity in Iranian blood donors: a case‐control study

Due to blood screening and blood donor selection, the prevalence of hepatitis C virus (HCV) is expected to be lower among blood donors compared to the general population. The effective control of blood-transmitted infectious diseases should be one of the goals of public health. Thus, this case-control study was conducted to evaluate the risk factors of HCV in a representative sample of blood donors in Iran. A case-control study was conducted on HCV-negative and on serologically confirmed HCV-positive donors across the country from 2009 to 2013. Univariate logistic regression, multiple logistic regression, and subgroup analyses were performed to assess the risk factors in first-time blood donors (FTs) and repeat blood donors (RDs) independently. A total of 970 cases and 1542 controls were selected from the cohort of Iranian blood donors registered in the Iran Blood Transfusion Organization. Intravenous (IV) drug abuse (ORFT , 6.42; 95% CI, 3.34-12.34; and ORRD , 27.62; 95% CI, 12.58-60.62), living with an IV drug abuser (ORFT , 3.47; 95% CI, 1.26-9.55; and ORRD , 6.95; 95% CI, 1.54-31.34), prison history (ORFT , 2.4; 95% CI, 1.48-3.88; and ORRD , 2.42; 95% CI, 1.38-4.27), sharing personal razors (ORFT , 2.00; 95% CI, 1.01-3.96; and ORRD , 5.62; 95% CI, 2.65-11.89), and medical exposure (ORFT , 1.97; 95% CI, 1.15-3.37; and ORRD , 2.19; 95% CI, 1.27-3.76) were significant independent risk factors in both types of blood donation. The findings of this analytic study on HCV exposure in Iranian blood donors conforms to those of international studies. Behavioral and medical factors should be examined in the donor health screening process.

Frequency and factors associated with hepatitis C virus infection among patients with diabetes, Dammam, KSA.

Hepatitis C virus (HCV) infection and diabetes mellitus (DM) are main causes of morbidity and mortality worldwide. There is an increasing evidence of association between HCV and type 2 DM. Comorbidity will cause devastating health and financial burdens. Early detection may help proper management and better prognosis. The aim of this study was to examine the frequency and risk factors of HCV among Saudi patients with diabetes. In this cross-sectional study, 1054 Saudi patients with diabetes type 1 and type 2 were randomly selected, interviewed, and tested for HCV in Dammam Medical Complex, KSA (2011), using the HCV Rapid Test. Positive cases were later confirmed using the INNO-LIA HCV score line immunoassay. Seropositivity of HCV was 1.9%. Regression analysis revealed the following independent predictors: sharing articles, elevated liver enzymes, exposure to blood or blood products in occupational setting, disease duration more than 5 years, tattooing, blood transfusion, and hospitalization more than two times. The study confirmed a positive association between HCV and DM. The frequency of HCV among patients with diabetes was 1.9%. Predictors of HCV among DM patients were sharing articles, elevated transaminases, occupational exposure to blood or its products, disease duration more than 5 years, tattooing, blood transfusion, and hospitalization more than two times. We recommend screening for HCV among DM patients with elevated serum transaminases and those having the disease for more than 5 years and education of patients with diabetes as regards their high risk for HCV and how to avoid infection.

Prevalence and Risk Factors of Hepatitis C Infection (HCV) in Birjand, Iran, 2014

Background: Hepatitis C virus (HCV) infection is an important global concern, with a frequency of 3% (i.e., 170 million of the population has HCV-Ab). Additionally, 50% of HCV and 80% of transfusion transmitted infections (TTI) are chronic. In 20% of cases, HCV occurs as an acute infection, and in the remaining 80% of cases, it becomes chronic. In chronic patients, risk of cirrhosis is up to 44%, risk of hepatocellular carcinoma (HCC) is 13%, and risk of mortality is 14%. As there is no vaccine available for the virus yet, and since most of the cases are asymptomatic, attention to the epidemiology of the disease among the population is a pressing concern. Objectives: The aim of this study is to determine the prevalence and risk factors of HCV in Birjand city. Patients and Methods: In this descriptive-analytical study, 5,235 people who live in Birjand city were selected; after gaining permission for the study, a signed consent form was obtained from each patient. Prevalence of HCV was determined by ELISA test, and positive cases underwent Polymerase chain reaction (PCR) and genotyping for confirmation. Results: The mean age of the participants was 39.7 ± 14.4. Among them, 52.2% were female and 29.9% had university degrees. Prevalence of HCV-Ab+ was about 0.2% with ELISA, and 0.14% of entire group were confirmed by PCR. No significant relationship was found for age, sex, and education (P > 0.05). Also, there was no significant relationship found with risk factors such as endoscopy, blood transfusion, surgery, hospitalization, phlebotomy, and alcohol drinking (P > 0.05). HCV-Ab was 200 times more prevalent in IV-drug abusers compared to non-addicted people. Also, the prevalence of HCV-Ab in non-IV-drug abuser addicts was 9.3 times higher than in non-addict patients. Prevalence of HCV-Ab in patients who reported illicit sexual activities was 13.3 times higher. In patients with a familial history of HCV, infection was 26.3 times more prevalent than in patients with no familial history (P < 0.001). Conclusions: In this study, the prevalence of HCV was 0.2%, which is lower than the mean prevalence in Iran (1%). Prevalence of HCV had a significant relationship with IV-drug abuse.

Household Contacts of HCV Patients at Beltag Village, Egypt; Seropositivity and Habits

Background : Hepatitis C virus (HCV) is a major cause of chronic hepatitis and is considered as a worldwide problem. Egypt has the highest HCV prevalence in the world. The Centers for Disease Control and Prevention (CDC) recommend HCV screening for all adults at high risk of infection. Aim of the study: To determine the prevalence of HCV seropositivity among household contacts of HCV positive patients and study their habits. Methods: A cross sectional study was conducted in Beltag; a rural village affiliated to Nile Delta. Interviewed questionnaire was used including sociodemographic data and HCV risk factors information. All household contacts were assessed for HCV infection by testing for anti-HCV antibody using a commercial ELISA. Results: 102 of HCV hepatitis patients and 360 of their household contacts were included in the study. The prevalence of HCV seropositivity among household contacts was 35%. 78(61.9%) of seropositive contacts were over forty years old, 42(33.3%) received parenteral anti-schistosomal therapy, 72(57.1%) helped family HCV patients during bleeding episodes. Logistical regression showed that the most significant variable associated independently to HCV seropositivity in patients' contacts was helping HCV patients during bleeding episodes (OR = 7.262; 95% CI: 3.588– 14.698 p 0.000). Conclusion: This study approximates the findings of other studies which reported a high prevalence seropositivity among HCV patient’s contacts. Help HCV patients during bleeding episodes is the most significant risk factor for intrafamilial HCV transmission. Keywords HCV Patients , Seropositivity , Household contacts.

PREVALENCE AND RISK FACTORS OF HEPATITIS C VIRUS INFECTION IN HAEMODIALYSIS PATIENTS: TESTING ANTIBODIES, RNA AND GENOTYPES

Hepatitis C virus (HCV) infection is an important global public health problem affecting approximately 180 million people. Multiple risk factors are associated with HCV transmission among haemodialysis (HD) patients leading to an increased risk for liver-related mortality. Patients undergoing HD may show a decreased humoral and cellular immunity, which lowers the sensitivity of the HCV antibodies (Abs) test resulting in false negative antibody test, thus requiring HCV RNA testing. Our study is to determine the prevalence of HCV markers (antibody RNA and genotype) and risk factors of HCV infection among patients in HD unit in Baghdad. A sample of 54 patients were interviewed. HCV Abs (anti-HCV) was tested using third generation enzyme immunoassay (EIA-3) and immunoblot assay (Lia-Tek III) as screening and confirmatory test respectively. Sera of 46 patients (irrespective to anti-HCV results) were subjected to molecular analysis, using the most developed RT-PCR and DNA Enzyme immunoassay (DEIA) method. Seropositive rate of anti-HCV and HCV-RNA were (66.6%) and (60.9%) respectively. Anti-HCV seropositive rate was significantly higher in males (77.1%), and history of blood transfusion (85%). Blood transfusion acts as a significant risk for acquiring HCV (OR 44.2, 95% CI 7.6-256.9). Genotype 4 was the most prevalent (33.3%), followed by genotype 1a (25.9%) and genotype 1b (22.2%). We concluded that, the prevalence of HCV among the haemodialysis patients is high. It is significantly related to gender, duration of dialysis and number of blood transfusion. Blood transfusion acts as a significant risk factor. Molecular test for detection for HCV RNA is necessary and proper nosocomial prevention program should be implemented to prevent HCV transmission.

Prevalence of hepatitis B and C viruses infection among military personnel at Bahir Dar Armed Forces General Hospital, Ethiopia.

BackgroundMilitary personnel are high-risk people for parenteral and sexually transmitted diseases such as hepatitis B virus (HBV) and hepatitis C virus (HCV). Data regarding HBV and HCV prevalence among military personnel in Ethiopia is limited. Hence, the study aimed to determine sero-prevalence and associated risk factors of HBV and HCV among military personnel at Bahir Dar Armed Forces General Hospital, Ethiopia.MethodsA cross-sectional study was conducted in a total of 403 military personnel from February to May 2015. Socio-demographic characteristics and risk factors were collected through face to face interview using structured questionnaire. HBV and HCV infection was determined using HBsAg and anti-HCV antibody rapid tests. Logistic regression analysis was employed to assess possible risk factors for HBV and HCV infections.ResultsThe sero-prevalence of HBV and HCV infection were 4.2 and 0.2 %, respectively. None of the study subjects were co-infected with HBV and HCV. Higher prevalence of HBV infection (11.3 %) was observed in the age group of 40 and above. Being at the age of 40 years and above (COR 7.6; 95 % CI 2.0–29.0, p = 0.003), history of nose piercing (COA 5.9; 95 % CI 1.2–29.9, p = 0.033) and sexually transmitted infection (COR 4.3; 95 % CI 1.1–16.4, p = 0.03) were significantly associated with these viral hepatitis infections.ConclusionIntermediate prevalence of HBV and low prevalence of HCV were observed among military personnel. Strengthening HBV screening strategies among military personal may further reduce these viral diseases.

Kidney Paired Donation Protocol for Participating Donors 2014.

Kidney Paired Donation Protocol for Participating Donors 2014.

Trends and risk factors for HIV, HCV and syphilis seroconversion among drug users in a methadone maintenance treatment programme in China: a 7-year retrospective cohort study.

ObjectiveThis study explores the trends and associated factors of HIV, hepatitis C virus (HCV) and syphilis seroconversion among Chinese methadone maintenance treatment (MMT) clients over a follow-up period of up to 7 years.DesignDrug users from 14 MMT clinics in Guangdong Province were recruited during 2006–2014. Participants were seronegative with at least one HIV, HCV or syphilis infection at baseline and had completed at least one follow-up test during the study period. We estimated HIV, HCV and syphilis seroconversion rates in follow-up years and identified the underlying predictors using a multivariate Cox regression model.ResultsAmong 9240 participants, the overall HIV seroconversion rate was 0.20 (0.13 to 0.28)/100 person-years (pys), 20.54 (18.62 to 22.46)/100 pys for HCV and 0.77 (0.62 to 0.93)/100 pys for syphilis, over the study period. HIV seroconversion rate showed a moderate but non-significant annual decline of 13.34% (−42.48% to 30.56%) (χ2 trend test; p=0.369), whereas the decline of HCV seroconversion was 16.12% (5.53% to 25.52%) per annum (p<0.001). Syphilis seroconversion rate remained stable (p=0.540). Urine results positive for opioid predicted HIV seroconversion (≥60% vs <60%; HR=3.40, 1.07 to 10.85), being unmarried (HR=1.59, 1.15 to 2.20), injection drug use in the past 30 days (HR=2.17, 1.42 to 3.32), having sexual intercourse in the past 3 months (HR=1.74, 1.22 to 2.47) and higher daily dosage of methadone (≥60 mL vs <60 mL; HR=1.40, 1.01 to 1.94) predicted HCV seroconversion. Being female (HR=3.56, 2.25 to 5.64) and infected with HCV at baseline (HR=2.40, 1.38 to 8.36) were associated with subsequent syphilis seroconversion.ConclusionsMMT in China has demonstrated moderate-to-good effectiveness in reducing HIV and HCV incidence but not syphilis infection among participating drug users.

Demographic characteristics and intravenous drug use among hepatitis C patients in the Kota Setar district, Kedah, Malaysia.

OBJECTIVES:This study explored the demographic characteristics of hepatitis C patients in the Kota Setar (KS) district, Kedah, Malaysia, the prevalence of intravenous drug use (IVDU) as a risk factor among these patients, and the associations between IVDU and demographic characteristics.METHODS:Retrospective data pertaining to 713 patients from January 2009 to December 2013 were retrieved from hospital and disease notification records for analysis. The risk factors for hepatitis C virus (HCV) infection were grouped into IVDU and non-IVDU risk factors for analysis using multiple logistic regression.RESULTS:Of the hepatitis C patients included in this study, the most common age group was 31 to 40 years (30.2%), and male patients (91.2%) made up the overwhelming majority. Ethnic Malays constituted approximately 80.4% of the patients, and IVDU was the main risk factor (77.8%) for HCV infection. Multiple logistic regression showed that male patients were 59 times more likely to have IVDU as a risk factor for HCV infection. Single patients were 2.5 times more likely to have IVDU as a risk factor. Patients aged ≥71 years were much less likely than patients aged ≤30 years to have IVDU as a risk factor for HCV infection.CONCLUSIONS:IVDU was found to be an important risk factor for HCV infection among patients in the KS district. The factors associated with IVDU included age, sex, and marital status. Appropriate preventive measures should be developed to target the groups in which IVDU is most likely to be a risk factor for HCV infection.

The effect of introducing point-of-care or dried blood spot analysis on the uptake of hepatitis C virus testing in high-risk populations: A systematic review of the literature

BackgroundTesting for hepatitis C virus (HCV) infection typically relies upon blood samples taken by traditional phlebotomy for laboratory processing. Novel testing methods, including using dried blood spots (DBS) and point-of-care (PoC) testing enable easier access to high risk populations who have less frequent contact with healthcare professionals. Many of these individuals have been exposed to HCV but have not previously been tested. We aimed to establish whether the availability of these novel testing methods increased either uptake of testing or the number of new diagnoses of HCV. MethodsThe PubMed, Cochrane and SCOPUS databases were searched for terms relating to the study. References and associated bibliographies were also examined for further relevant articles. Studies were included if they contained quantitative data on frequency of testing and/or new diagnoses following the introduction of PoC and/or DBS testing of high-risk populations. Studies were then examined for findings and limitations and graded upon the quality of evidence provided. ResultsNo studies were found which introduced PoC testing and determined its effect on frequency of testing or new diagnoses. Six studies were identified in which DBS testing was introduced and its effect evaluated. Two of the studies were randomised controlled trials, two were prospective cohort studies, one was an ecological study and one was a clinical audit. Populations studied included those attending substance misuse clinics, prisons and needle exchanges. Injection drug use was the commonest risk factor for HCV. Five of the six studies provided evidence that the introduction of DBS testing increased the number of tests, new diagnoses or both. ConclusionCurrent evidence indicates that DBS testing availability may increase the uptake of testing for HCV in high-risk populations. There is currently no evidence regarding the efficacy of PoC testing in these populations.

Short Communication: Coronary Heart Disease Risk by Framingham Risk Score in Hepatitis C and HIV/Hepatitis C-Coinfected Persons.

We compared the Framingham risk score (FRS) for 10-year coronary heart disease (CHD) risk in age- and race-matched hepatitis C virus (HCV)-infected and HCV-uninfected persons: 114,073 HCV-infected (111,436 HCV-monoinfected and 2,637 HIV/HCV-coinfected) and 122,996 HCV-uninfected (121,380 HIV and HCV-uninfected and 1,616 HIV-monoinfected) males without cardiovascular disease, diabetes, or hepatitis B. In unadjusted analyses, FRS was similar between the HCV-infected and HCV-uninfected groups [median (interquartile range, IQR) risk points 13 (10-14) vs. 13 (10-14), p=0.192]. Cholesterol levels were lower and current smoking more prevalent in the HCV groups (both HCV and HIV/HCV) compared with the uninfected groups (p<0.001 for both). Prevalence of non-FRS CHD risk factors, such as substance abuse and chronic kidney disease, in the cohort was high, and differed by HCV and HIV status. Adjusting for age, race/ethnicity, body mass index, chronic kidney disease, drug and alcohol use, and HIV status, HCV infection was associated with minimally lower FRS (β=-0.095 risk points, p<0.001), suggesting a small but significant difference in 10-year CHD risk estimation in HCV-infected as compared to HCV-uninfected persons when measuring risk by FRS. Given the complex relationship between HCV, HIV, and CHD risk factors, some of which are not captured by the FRS, the FRS may underestimate CHD risk in HCV-monoinfected and HIV/HCV-coinfected persons. HCV- and HIV/HCV-specific risk scores may be needed to optimize CHD risk stratification.

Seroprevalence of hepatitis viruses and risk factors in blood donors of Veracruz, Mexico.

Hepatitis B and C are among the most important transfusion-transmitted infections and sources of liver diseases worldwide. In Veracruz, Mexico, liver diseases are important causes of mortality, and the prevalence reports of these viruses are scarce. This study sought to determine the prevalence of these infections in blood donors, in order to increase the safety of blood products in this region. A retrospective study was performed on blood donors who attended the Veracruz State Blood Transfusion Center from 2006 to 2010. All samples were screened for transfusion-transmitted infections. The prevalence rates of hepatitis B virus (HBV) and hepatitis C virus (HCV) were determined, and demographic data obtained from clinical records were used to evaluate risk factors. A total of 56,377 donors were serologically screened; of them, 403 were seropositive for HCV (357 men and 46 women), and 61 were positive for HBsAg (52 men and 9 women). The overall prevalence rates were 0.72% (0.63%-0.76%) for HCV and 0.11% (0.08%-0.14%) for HBsAg. The risk factors for HBsAg positivity were being a cattleman and living in the Huasteca Baja region, whereas those for HCV were being a fisherman, living in the Papaloapan region, and having an elementary-level or lower education. This is the first study to show that being a fisherman is a risk factor for HCV. The implementation of nucleic acid test technology will help to identify the real risks for transfusion-transmitted hepatitis C in Veracruz.

Hepatitis B and C virus infections among patients with end stage renal disease in a low-resourced hemodialysis center in Vietnam: a cross-sectional study.

BackgroundHemodialysis services in Vietnam are being decentralised outside of tertiary hospitals. To identify the challenges to infection control standards for the prevention of bloodborne infections including hepatitis B virus (HBV) and hepatitis C virus (HCV) we tested the magnitude of HBV and HCV infections in the largest unit in Ho Chi Minh City servicing patients with end stage renal disease.MethodsAll 113 patients provided consent HBV surface antigen (HBsAg) and HCV core antigen (HCV-coreAg) testing. Positive patients were tested for viral genotypes. All participants completed a questionnaire on demographic characteristics, risk factors and previous attendance to other hemodialysis units.ResultsSeroprevalence of 113 patients enrolled was 7% (8/113, 95% CI 2.3%-11.8%) HBsAg, 6% (7/113, 95% CI 1.7%-10.6%) HCV-coreAg and 1% (1/113, 95% CI 0.8%-2.6%) co-infection. Having a HBV positive sexual partner significantly increased the risk of acquiring HBV (P = 0.016, Odds Ratio (OR) =29, 95% CI 2–365). Risk factors for HCV included blood transfusion (P = 0.049), multiple visits to different hemodialysis units (P = 0.048, OR = 5.7, 95% CI 1.2–27.5), frequency of hemodialysis (P = 0.029) and AST plasma levels >40 IU/L (P = 0.020, OR = 19.8, 95% CI 2.3–171). On multivariate analysis only blood transfusion remained significant risk factor for HCV (P = 0.027, adjusted OR = 1.2).ConclusionsHCV screening for HCV of blood products must improve to meet the infection prevention challenges of decentralizing hemodialysis services. The level of HCV and HBV in our hemodialysis unit is a warning that universal precautions will be the next challenge for decentralised hemodialysis services in Vietnam.

Acceptability and yield of birth-cohort screening for hepatitis C virus in a Canadian population being screened for colorectal cancer: a cross-sectional study

Screening for hepatitis C virus (HCV) is recommended in patients born between 1945 and 1965 ("baby boomers") in the United States. Because these patients are often screened for colorectal cancer, dual screening for HCV may enhance case identification. Our objectives were to assess the acceptability and yield of screening for HCV among patients undergoing screening for colorectal cancer. Patients referred for a colonoscopy to screen for colorectal cancer completed an anonymous survey regarding the acceptability of screening for HCV, risk factors and prior testing. The impacts of demographics and risk factors for HCV on willingness to be screened were determined using logistic regression, and the stored sera of 483patients who had undergone screening for colorectal cancer between February 2011 and August 2012 were tested for HCV antibodies. Among 1012 survey respondents (median age 56 yr; 911 [90.0%] were baby boomers, 880 [87.0%] were white and 223 [22.0%] were born outside Canada), 123 patients (12.2%) reported prior testing for HCV. HCV was previously diagnosed in 9 of these patients (0.9%, representing 1.0% of the patients who were baby boomers): 5 (55.6% of those diagnosed) reported risk factors. Excluding patients diagnosed with HCV, 903 (90.0%) respondents indicated that they would consent to testing of blood or saliva for HCV. After adjusting for age, sex and status of immigration, patients who were white (odds ratio [OR] 3.38, 95% confidence interval [CI] 1.81-6.32) and patients with risk factors (>1 v. 0: OR 3.67, 95% CI 1.12-12.02) had a greater acceptance of screening. Among 483 patients screened for colorectal cancer, 3 were anti-HCV positive (0.6%, 95% CI 0.1%-1.8%), representing 0.8% (95% CI 0.2%-2.4%) of the patients who were baby boomers. Acceptance of screening for HCV is high among patients undergoing screening for colorectal cancer in the Calgary area. However, the low prevalence of HCV suggests that the cost-effectiveness of birth-cohort screening in this population warrants evaluation.

Prevalence and behavioural risks for HIV and HCV infections in a population of drug users of Dakar, Senegal: the ANRS 12243 UDSEN study.

ObjectivesData on the extent of drug use and associated HIV, hepatitis C and hepatitis B infection in West Africa are lacking. The objectives of ANRS12244 UDSEN study were to estimate the size of the heroin and/or cocaine drug user (DU) population living in the Dakar area (Senegal), and assess the prevalence and risk factors of HIV, hepatitis C virus (HCV) and hepatitis B virus (HBV), including behavioural determinants in this population, in order to set up an integrated prevention and treatment programme for DUs.Design and methodsA capture-recapture method was applied for population size estimation, whereas the respondent-driven sampling (RDS) method was used to recruit a sample of DUs living in the Dakar area and determine HIV, HBV and HCV prevalence. Behavioural data were gathered during face-to-face interviews, and blood samples were collected on dried blood spots for analysis in a central laboratory. Data analysis was performed using the RDS analysis tool, and risk factors were determined by logistic regression. Access to laboratory results was organized for the participants.ResultsThe size of the DU population in the Dakar area was estimated to reach 1324 (95% confidence interval (95% CI: 1281–1367)). Based on the 506 DUs included in the study, the HIV, HCV and HBV prevalence were 5.2% (95% CI: 3.8–6.3), 23.3% (95% CI: 21.2–25.2) and 7.9% (95% CI: 5.2–11.1), respectively. In people who inject drugs (PWID), prevalence levels increased to 9.4% for HIV and 38.9% for HCV (p=0.001 when compared to those who never injected). Women were more at risk of being HIV infected (prevalence: 13.04% versus 2.97% in males, p=0.001). Being PWID was a risk factor for HCV and HIV infection (odds ratio, OR: 2.7, 95% CI: 1.7–4.3, and OR: 4.3, 95% CI: 1.7–10.7, respectively), whereas older age and female sex were additional risk factors for HIV infection (10% increase per year of age, p=0.03 and OR: 4.9, 95% CI: 1.6–156, respectively). No specific determinant was associated with the risk of HBV infection.ConclusionsHigh HIV and HCV prevalence were estimated in this population of DUs (including non-injectors) living in the Dakar area, Senegal, whereas HBV prevalence was close to that of the global Senegalese population, reflecting a risk of infection independent of drug use. Women seem to be highly vulnerable and deserve targeted interventions for decreasing exposure to HIV, while behavioural risk factors for HIV and HCV include the use of unsafe injections, reflecting the urgent need for developing harm reduction interventions and access to opioid substitution therapy services.

Epidemiology of hepatitis C in Croatia in the European context.

We analyzed prevalence, risk factors and hepatitis C virus (HCV) genotype distribution in different population groups in Croatia in the context of HCV epidemiology in Europe, with the aim to gather all existing information on HCV infection in Croatia which will be used to advise upon preventive measures. It is estimated that 35000-45000 of the Croatian population is chronically infected with HCV. Like in other European countries, there have been changes in the HCV epidemiology in Croatia over the past few decades. In some risk groups (polytransfused and hemodialysis patients), a significant decrease in the HCV prevalence was observed after the introduction of routine HCV screening of blood/blood products in 1992. Injecting drug users (IDUs) still represent a group with the highest risk for HCV infection with prevalence ranging from 29% to 65%. Compared to the prevalence in the Croatian general population (0.9%), higher prevalence rates were found in prison populations (8.3%-44%), human immunodeficiency virus-infected patients (15%), persons with high-risk sexual behavior (4.6%) and alcohol abusers (2.4%). Low/very low prevalence was reported in children and adolescents (0.3%) as well as in blood donors (0%-0.009%). In addition, distribution of HCV genotypes has changed due to different routes of transmission. In the general population, genotypes 1 and 3 are most widely distributed (60.4%-79.8% and 12.9%-47.9%, respectively). The similar genotype distribution is found in groups with high-risk sexual behavior. Genotype 3 is predominant in Croatian IDUs (60.5%-83.9%) while in the prison population genotypes 3 and 1 are equally distributed (52.4% and 47.6%). Data on HCV prevalence and risk factors for transmission are useful for implementation of preventive measures and HCV screening.