Hepatitis C Virus Seroconversion Research Articles

Network-based strategies to combat HCV: Examining social and spatial drivers of transmission among PWID in New Delhi.

People who inject drugs (PWID) account for some of the fastest-growing HCV epidemics globally. While individual risk factors for infection are understood, less is known about network and spatial factors critical for elimination strategies. Two thousand five hundred twelve PWID in New Delhi, India, were recruited (2017-19) through network referrals. Biometrics identified duplicates and cross-network linkages. Participants completed semi-annual surveys and blood tests for HCV antibodies and RNA. Poisson regression and network analyses identified predictors of incident HCV and compared network-based intervention approaches. Baseline HCV antibody prevalence was 65.1%, of whom 79.6% were HCV RNA-positive. We observed 92 HCV seroconversions over 382.25 person-years (incidence: 24.1 per 100 person-years). Of the 92 seroconverters, 67% (62) were directly connected to an RNA-positive participant, and all were within one degree of separation from an RNA-positive participant. Individual-level factors associated with seroconversion included age, sexual activity, and injection behaviours. After adjusting for individual-level factors, seroconversion was significantly associated with number of RNA-positive partners (adjusted incidence rate ratio [AIRR] = 1.30) and injecting at a particular venue (AIRR = 2.53). This association extended to indirect ties, with 17% reduced odds of seroconversion for each degree of separation from the venue (AIRR = 0.83). Network analyses comparing intervention strategies found that targeting venues identified more cases compared to a treat-a-friend approach. We observed a fast-growing HCV epidemic driven by viremia within individuals' immediate networks and indirect social and spatial ties, demonstrating the importance of achieving broad, sustained virologic response and rethinking network-based interventions to include venues.

Hepatitis B and hepatitis C testing practices and observed seroconversions among dialysis facilities in Georgia

Background Individuals receiving hemodialysis for end-stage kidney disease are at increased risk of infection with hepatitis C virus (HCV) and hepatitis B virus (HBV) due to regular and frequent receipt of invasive medical treatment in a shared space. Aim This study assessed infection prevention and control practices in dialysis facilities, evaluated HCV and HBV testing practices, and estimated the number of cases of seroconversion for HCV and HBV infection in dialysis facilities in Georgia. Methods We invited all 27 dialysis centers that provide maintenance dialysis in Georgia to participate in a facility-based survey during April–June 2021. Results In total, 68.2% ( n = 15/22) of facilities performed anti-HCV screening upon admission to the center. At the majority of facilities ( n = 21/22, 95.5%), HBV screening was performed upon admission to the center. A total of 329 anti-HCV positive patients were reported from 20 of 22 facilities, 29.5% ( n = 97/329) were HCV RNA positive, 18.2% ( n = 60/329) were HCV RNA negative, and 52.3% ( n = 172/329) were not tested or their result was missing. Overall, 200 HBsAg-positive patients were reported from the same 20 facilities. At 10 facilities: 39 patients from seven facilities seroconverted for HCV infection, and 31 patients from eight dialysis facilities seroconverted for HBV infection. Conclusions We identified a high number of HBV and HCV seroconversions among dialysis patients in Georgia suggesting serious gaps in infection control practices. Strict adherence to infection prevention and control practices is essential to prevent transmission of HCV and HBV infections through contaminated equipment and surfaces.

Predictors of Seroconversion of Hepatitis-C Virus in End-Stage Renal Disease Patients

Background: Chronic kidney disease (CKD) is a significant health challenge globally. Hemodialysis, the primary treatment for CKD, not only sustains lives but also increases the risk of disease transmission, particularly hepatitis C (HCV), with a 48.9% seroconversion rate. This study aimed to identify factors contributing to HCV seroconversion of hemodialysis patients in Karachi. Methods: A cross-sectional study was conducted at three dialysis units within tertiary care hospitals in Karachi, from June 2022 to June 2023. A total of 141 patients aged between 18 and 65, of any gender, undergoing chronic hemodialysis for a minimum of 6 months, demonstrating good adherence, and possessing comprehensive serological data for HCV (baseline test and follow-up screening) were included. Data was analyzed using SPSS version 27 and a comparison between baseline characteristics and risk factors with seroconversion of HCV was done using independent samples t-test/Chi-square test. A p<0.05 was considered statistically significant. Results: The patients had a mean age of 33.30±8.04 years. Seroconversion occurred in 14.9% of cases, with 21% testing positive for HCV on PCR. Notably, a higher prevalence of blood transfusion history (p=0.002), surgery history (p=0.001), a family history of HCV (p=0.001), dialysis at multiple centers (p=0.001), and initiating dialysis with an arteriovenous fistula (p=0.015) was observed among HCV-positive patients who underwent seroconversion, in comparison to those who remained HCV-negative. Conclusion: A history of blood transfusion and surgery, a family history of HCV, dialysis at multiple centers, and initiation of dialysis with arteriovenous fistula are notable predictors for seroconverted positive HCV patients.

FACTORS ASSOCIATED WITH SEROCONVERSION IN HEMODIALYSIS PATIENTS

: In this prospective cohort study conducted at Hijaz Hospital in Lahore from January 2022 to January 2023, we aimed to investigate the prevalence and factors influencing HCV seroconversion in hemodialysis patients. A total of 380 patients participated in the study, responding to a structured questionnaire covering sociodemographic factors and hemodialysis duration. ELISA testing was conducted quarterly, resulting in two groups: HCV-positive and HCV-negative. Results revealed that 63.4% (241 individuals) experienced seroconversion from HCV-negative to HCV-positive status during hemodialysis. Significant associations were observed between HCV seroconversion and emergency hemodialysis at a site other than the primary one (P = 0.017). Other significant associations included IV drug abuse (P = 0.007), blood transfusions (P = 0.001), and dental procedures (P = 0.005). The presence of anemia and the lack of vascular access at the start of hemodialysis were also significantly associated with HCV seroconversion (P = 0.001). However, no associations were found between HCV seroconversion and age, surgical procedures, needle stick injuries, or alcohol intake. In conclusion, this study highlights an alarming HCV seroconversion rate among hemodialysis patients. Factors such as anemia, blood transfusions, duration of dialysis, lack of vascular access, and emergency dialysis demonstrated strong correlations with HCV infectivity. These findings emphasize the importance of implementing stringent infection control measures and vigilant monitoring to mitigate the risk of HCV transmission in hemodialysis settings.

Is HCV elimination among persons living with HIV feasible? Data from the NoCo study in the setting of the ICONA cohort.

Whether the HCV test-and-treat strategy impacted on the rate of new HCV infections among PLWH in Italy is unknown. Prospective study of PLWH in the ICONA network. At baseline, PLWH were tested for HCV-Ab; HCV-RNA (if HCV-Ab positive) and, if positive, treated with DAA. SVR12 indicated eradication. Seroconversions and re-infections were evaluated yearly in HCV-Ab neg and HCV-RNA neg at first screening. We estimated the following: HCV seroconversions, incidence of HCV reinfections, and access to DAA and SVR12 rates tighter with factors associated with each outcome. Data were analysed by Cox regression, Poisson regression and logistic regression models. Sixteen thousand seven hundred and forty-three PLWH were included; 27.3% HCV-Ab positive; of these, 39.3% HCV-RNA positive. HCV seroconversion incidence: .48/100 PYFU (95% CI: .36-.65); re-infections incidence: 1.40/100 PYFU (95% CI: .91-2.04). The risk factor for HCV re-infection was young age: aIRR 1.85, 95% CI: 1.17-2.95) per 10 years younger. 86.4% of HCV viremic in follow-up started DAA. PWID vs. heterosexuals (aHR .75, 95% CI .62-.90), HIV-RNA >50 copies/mL (aHR .70, 95% CI .56-.87), HCV genotype other than G1, G2, G3, G4 or with multiple/missing HCV genotype and post-COVID-19 calendar periods were associated with lower DAA access. 922/965 (95.5%) PLWH achieved SVR12. We estimated 72% reduction of chance to achieve SVR12 in PLWH with a CD4 count <200/mm3 (vs. CD4 ≥200/mm3 aOR .18, 95% CI: .07-.46). 95.5% of DAA-treated individuals eradicated HCV, but they represent only 53.2% of HCV viremic PLWH and 66.4% of those in follow-up. HCV-RNA positivity by year decreased from 41.7% in 2017 to 11.7% in 2022. The screening-and-treat campaign implemented in Italy, even if only partially effective, resulted in a dramatic drop in HCV circulation in our cohort.

Outcome of Kidney Transplants from Viremic and Non-Viremic Hepatitis C Virus Positive Donors into Negative Recipients: Results of the Spanish Registry.

Historically, donor infection with hepatitis-C virus (HCV) has been a barrier to kidney transplantation. However, in recent years, it has been reported that HCV positive kidney donors transplanted into HCV negative recipients offer acceptable mid-term results. However, acceptance of HCV donors, especially viremic, has not broadened in the clinical practice. This is an observational, multicenter, retrospective study including kidney transplants from HCV positive donors into negative recipients reported to the Spanish group from 2013 to 2021. Recipients from viremic donors received peri-transplant treatment with direct antiviral agents (DAA) for 8-12 weeks. We included 75 recipients from 44 HCV non-viremic donors and 41 from 25 HCV viremic donors. Primary non function, delayed graft function, acute rejection rate, renal function at the end of follow up, and patient and graft survival were not different between groups. Viral replication was not detected in recipients from non-viremic donors. Recipient treatment with DAA started pre-transplant avoids (n = 21) or attenuates (n = 5) viral replication but leads to non-different outcomes to post-transplant treatment with DAA (n = 15). HCV seroconversion was more frequent in recipients from viremic donors (73% vs. 16%, p < 0.001). One recipient of a viremic donor died due to hepatocellular carcinoma at 38 months. Donor HCV viremia seems not to be a risk factor for kidney transplant recipients receiving peri-transplant DAA, but continuous surveillance should be advised.

Comprehensive needle and syringe program and opioid agonist therapy reduce HIV and hepatitis c virus acquisition among people who inject drugs in different settings: A pooled analysis of emulated trials.

Although the Netherlands, Canada and Australia were early adopters of harm reduction for people who inject drugs (PWID), their respective HIV and hepatitis C (HCV) epidemics differ. We measured the pooled effect of needle and syringe program (NSP) and opioid agonist therapy (OAT) participation on HIV and HCV incidence in these settings. For each cohort, we emulated the design and statistical analysis of a target trial using observational data. We included PWID at risk of HIV or HCV infection from the Amsterdam Cohort Studies (1985-2013), Vancouver Injection Drug Users Study (1997-2009) and Melbourne Injecting Drug User Cohort Study (SuperMIX) (2010-2021). Separately for each infection and cohort (only HCV in SuperMIX), marginal structural models were used to compare the effect of comprehensive (on OAT and 100% NSP coverage or on OAT only if no recent injection drug use) versus no/partial NSP/OAT (no OAT and/or <100% NSP coverage) participation. Pooled hazard ratios (HR) and 95% CI were calculated using random-effects meta-analysis. We observed 94 HIV seroconversions and 81 HCV seroconversions among 2023 and 430 participants, respectively. Comprehensive NSP/OAT led to a 41% lower risk of HIV acquisition (pooled HR = 0.59, 95% CI = 0.36-0.96) and a 76% lower risk of HCV acquisition (pooled HR = 0.24, 95% CI = 0.11-0.51), compared with no/partial NSP/OAT, with little heterogeneity between studies for both infections (I2 = 0%). In the Netherlands, Canada and Australia, comprehensive needle and syringe program and opioid agonist therapy participation appears to substantially reduce HIV and hepatitis C acquisition compared with no or partial needle and syringe program/opioid agonist therapy participation. These findings from an emulated trial design reinforce the critical role of comprehensive access to harm reduction in optimizing infection prevention for people who inject drugs.

Multicenter evaluation of the new Alinity s anti-HCV II assay for routine hepatitis C virus blood screening

BackgroundAnti-HCV immunoassays remain the primary serologic test for HCV screening among blood donors. Since 1990s, Anti-HCV assays have evolved and those currently available detect infection earlier and have improved sensitivity and specificity compared with older generation assays. The new Alinity s Anti-HCV II assay, with its innovative design, has improved sensitivity, which shall further enhance safety of blood. MethodsAlinity s Anti-HCV II assay was evaluated at 2 blood services (HKRCBTS & SNBTS). The overall sensitivity was evaluated using known positive samples (n = 5 at HKRCBTS; 50 at SNBTS) and 3 seroconversion panels (panel members =14 at each site). A total of 7,532 blood donor samples were tested to determine the clinical specificity. ResultsThe clinical sensitivity of the new assay was found to be 100% at both sites. HCV seroconversion panel detection rates were 57.1% (8/14) and 14.3% (2/14) for the Alinity s Anti-HCV II and Anti-HCV assays respectively, resulting in an improvement in seroconversion sensitivity of 42.8% for the Anti-HCV II assay over the Anti-HCV assay. The specificity of the Anti-HCV II assay was 100% at HKRCBTS, and 99.95% at SNBTS. ConclusionsThe Anti-HCV II assay detected all known positive specimens and was able to detect samples in seroconversion panels earlier compared to the Anti-HCV assay. The assay showed excellent clinical specificity and generated fewer false-reactive results and was found to be suitable for routine blood donor screening.

Incidence of primary hepatitis C virus infection among people who inject drugs in Australia pre- and post-unrestricted availability of direct acting antiviral therapies.

The 2016 Global Health Sector Strategy (GHSS) on viral hepatitis aims to reduce new hepatitis C virus (HCV) infections by 80% by 2030, including a 30% reduction by 2020. This study aimed to estimate primary HCV incident infection among a national sample of people who inject drugs (PWID) before and after the introduction of unrestricted access to HCV direct-acting antiviral (DAA) therapy via Australia's Pharmaceutical Benefits Scheme in 2016. A simple deterministic linkage method identified repeat respondents in serial cross-sectional surveys conducted among PWID. Two separate retrospective cohorts of HCV antibody-negative respondents were created, corresponding to the pre- (2010-15) and post- (2016-21) DAA time-periods. This study took place in Australia. Among 757 PWID retained (376 pre-DAA, 381 post-DAA), more than half were male (60%), the majority were heterosexual (80%), the median age was 40 years (interquartile range = 33-46 years) and the predominant drugs last injected were heroin (24%), pharmaceutical opioids (27%) and methamphetamine (41%). The primary outcome was HCV seroconversion, defined as a negative HCV antibody test result followed by a positive HCV antibody result. Time to primary incident HCV infection was estimated using the person-years (PY) method. A total 97 of 376 (2010-15) and 41 of 381 (2016-21) HCV seroconversions were identified. Primary HCV incidence more than halved, from 13.6 per 100 PY [95% confidence intervals (CI) = 11.2, 16.6] in 2010-15 to 5.4 per 100 PY (95% CI =3.9, 7.3) in 2016-21. The decline was independent of observed differences in demographic and drug use characteristics over the two time-periods (adjusted hazard ratio =0.47, 95% CI =0.31-0.69, P<0.001). Australia has had a 53% reduction in primary hepatitis C virus (HCV) incidence among people who inject drugs following unrestricted availability of HCV direct acting antiviral therapy in March 2016. Given that PWID are the predominant population at risk of HCV infection in Australia, findings add to the evidence that Australia has probably met its 2020 Global Health Sector Strategy subtarget of a 30% decline in new infections.

Hepatitis C Seroconversion Remains High among Patients with Regular Hemodialysis: Study of Associated Risk Factors.

An analytical cross-sectional study involving patients from 2 dialysis units (1 referral hospital and 1 private dialysis unit) in Denpasar, Bali, Indonesia, from January 2020 to December 2021. We evaluated age, gender, duration of hemodialysis, vascular access, history of transfusion, history of surgery, diabetes mellitus, hepatitis B, human immunodeficiency virus (HIV) infection, and type of dialyzer as possible risk factors of hepatitis C seroconversion among hemodialysis patients. A total of 338 hemodialysis patients were enrolled in this study. We found hepatitis C seroconversion in 94 patients (27.8%), all of which occurred after regular dialysis was started. Vascular access type (OR 42.07, 95% CI 5.757-307.472) and dialyzer reuse (OR 8.324, 95% CI 4.319-16.044) were showing a statistically significant association with hepatitis C seroconversion. A separate analysis on each dialysis unit found common evidence that the duration of dialysis was significantly associated with hepatitis C infection among hemodialysis patients. Hepatitis C seroconversion among dialysis patients remains high. Factors related to the dialysis procedure itself played a major role in transmitting the virus.

A CURE FOR RECENTLY ACQUIRED HEPATITIS C

Chronic hepatitis C is a global health threat. Most individuals infected with the hepatitis C virus (HCV) will inevitably progress to chronic infection, leading to cirrhosis and hepatocellular carcinoma. The current use of direct-acting antiviral (DAA) agents has changed the outlook for the treatment resulting in a cure for a short time. Recently acquired hepatitis C, also known as acute hepatitis, should be treated with regimens similar to chronic hepatitis C. We report a case of recently acquired hepatitis C manifested with jaundice, confirmed by a positive HCV RNA result and seroconversion. The patient was referred to a gastroenterologist with his girlfriend with newly diagnosed chronic hepatitis C for further evaluation and treatment. Both underwent DAA treatment with glecaprevir/pibrentasvir for two months. Upon completion of the therapy and 12 weeks later, HCV PCR was undetected in both cases. We treated our patient long before the onset of chronic liver disease and long-term complications. The current case underscores the importance of asking about potential ongoing exposure to an HCV-infected person.

POS-089 POST KIDNEY TRANSPLANT UNUSUAL INFECTIONS- A DIAGNOSTIC CONUNDRUM

37yrs old male known case of CKD presumed CIN diagnosed in 2013. Biopsy was not done due to bilateral shrunken kidneys. He progress to ESKD and initiated on MHD May 2017. He had HCV seroconversion in 2018 and was initiated on directly acting antivirals. Sustained viral remission was achieved and his viral load reduced to < 65.He underwent Deceased donor renal transplantation on 29.01.2021. Donor was a 30 year old male same blood group as the recipient. His cause of death was road traffic accident.

Comparative evaluation of the Geenius HCV supplemental assay and Inno-LIA HCV score assay in detecting anti-HCV antibodies.

This study compared two assays aimed at confirming the presence of anti-HCV antibodies (Ab) after a positive screening: Geenius HCV supplemental assay (Bio-Rad, Marne la Coquette, France) and the Inno-LIA HCV score assay (Fujirebio, Les Ulis, France). A total of 180 archived samples were investigated including 119 samples collected at different stages of HCV infection in 25 hemodialyzed patients who underwent HCV seroconversion, 14 samples from 4 commercial seroconversion panels, 47 Ab positive/HCV-RNA positive blood donations of which 7 showing an single reactivity in confirmatory assays. Samples were investigated and results were interpreted with the two assays according to the manufacturers' instructions. Overall, Geenius and Inno-LIA were concordant for 84% (151/180) samples: 38 negative, 17 indeterminate and 96 positive. Of the 29 discrepant results, 26 were overclassified with Inno-LIA. HCV seroconversion was detected with Inno-LIA 4 and 7 days prior to Geenius in two panels. The high positive rate observed with Inno-LIA (64%) compared to Geenius (54%) was mainly due to low reactivities considered positive according to interpretation criteria, which could affect specificity. Although HCV supplemental assays are not recommended for the diagnostic of HCV infection, which is primarily based on HCV-RNA testing, both assays are suitable as second line anti-HCV tests when Ab screening is positive and RNA testing cannot be performed. Moreover, Geenius system provides an objective result in less than 30minutes, which is compatible when a rapid diagnostic is required.

Efficacy of Replacement and Anti-Platelet Therapies in a Patient with Severe Haemophilia A Undergoing Percutaneous Coronary Stent Implantation.

IntroductionSevere haemophilia A is characterized by serious factor VIII deficiency (biological activity <1%) resulting in frequent spontaneous haemorrhage and abnormal bleeding after minor injury, surgery or tooth extraction.Patient and MethodsWe report the case of a 58-year-old patient with severe haemophilia A without inhibitors but with other comorbidities (HCV and HIV seroconversion), who underwent coronary angioplasty and stent implantation after acute myocardial infarction.ResultsCompared with previous therapy, Nuwiq® led to a reduction of about 20% in drug consumption (360,000 IU vs 540,000 IU per year) and in the annualized bleeding rate (ABR) (5 vs 15).DiscussionPharmacokinetic-guided personalized prophylaxis with Nuwiq® provided bleeding protection with good tolerability and a satisfactory pharmacokinetic profile in a patient with severe haemophilia A and comorbidities whose replacement therapy had to be adjusted because of other contraindicated treatment.LEARNING POINTSHaemophilia A is characterized by frequent haemorrhage.Pharmacokinetic-guided personalized prophylaxis with Nuwiq® provided bleeding protection with good tolerability.Nuwiq® leads to a reduction of about 20% in both drug consumption and the annualized bleeding rate.

Hepatitis C microelimination among people living with HIV in Taiwan

ABSTRACT To reach the WHO target of hepatitis C virus (HCV) elimination by 2025, Taiwan started to implement free-of-charge direct-acting antiviral (DAA) treatment programme in 2017. Evaluating the progress of HCV microelimination among people living with HIV (PLWH) is a critical step to identify the barriers to HCV elimination. PLWH seeking care at a major hospital designated for HIV care in Taiwan between January 2011 and December 2021 were retrospectively included. For PLWH with HCV-seropositive or HCV seroconversion during the study period, serial HCV RNA testing was performed using archived samples to confirm the presence of HCV viremia and estimate the prevalence and incidence of HCV viremia. Overall, 4199 PLWH contributed to a total of 27,258.75 person-years of follow-up (PYFU). With the reimbursement of DAAs and improvement of access to treatments, the prevalence of HCV viremia has declined from its peak of 6.21% (95% CI, 5.39–7.12%) in 2018 to 2.09% (95% CI, 1.60–2.77%) in 2021 (decline by 66.4% [95% CI, 55.4–74.7%]); the incidence has declined from 25.94 per 1000 PYFU (95% CI, 20.44–32.47) in 2019 to 12.15% per 1000 PYFU (95% CI, 8.14–17.44) (decline by 53.2% [95% CI, 27.3–70.6%]). However, the proportion of HCV reinfections continued to increase and accounted for 82.8% of incident HCV infections in 2021. We observed significant declines of HCV viremia among PLWH with the expansion of the DAA treatment programme in Taiwan. Further improvement of the access to DAA retreatments is warranted to achieve the goal of HCV microelimination.

Association Between Prescription Opioid Therapy for Noncancer Pain and Hepatitis C Virus Seroconversion

Initiation of injection drug use may be more frequent among people dispensed prescription opioid therapy for noncancer pain, potentially increasing the risk of hepatitis C virus (HCV) acquisition. To assess the association between medically dispensed long-term prescription opioid therapy for noncancer pain and HCV seroconversion among individuals who were initially injection drug use-naive. A population-based, retrospective cohort study of individuals tested for HCV in British Columbia, Canada, with linkage to outpatient pharmacy dispensations, was conducted. Individuals with an initial HCV-negative test result followed by 1 additional test between January 1, 2000, and December 31, 2017, and who had no history of substance use at baseline (first HCV-negative test), were included. Participants were followed up from baseline to the last HCV-negative test or estimated date of seroconversion (midpoint between HCV-positive and the preceding HCV-negative test). Episodes of prescription opioid use for noncancer pain were defined as acute (<90 days) or long-term (≥90 days). Prescription opioid exposure status (long-term vs prescription opioid-naive/acute) was treated as time-varying in survival analyses. In secondary analyses, long-term exposure was stratified by intensity of use (chronic vs. episodic) and by average daily dose in morphine equivalents (MEQ). Multivariable Cox regression models were used to assess the association between time-varying prescription opioid status and HCV seroconversion. A total of 382 478 individuals who had more than 1 HCV test were included, of whom more than half were female (224 373 [58.7%]), born before 1974 (201 944 [52.8%]), and younger than 35 years at baseline (196 298 [53.9%]). Participants were followed up for 2 057 668 person-years and 1947 HCV seroconversions occurred. Of the participants, 41 755 people (10.9%) were exposed to long-term prescription opioid therapy at baseline or during follow-up. The HCV seroconversion rate per 1000 person-years was 0.8 among the individuals who were prescription opioid-naive/acute (1489 of 1947 [76.5%] seroconversions; 0.4% seroconverted within 5 years) and 2.1 with long-term prescription opioid therapy (458 of 1947 [23.5%] seroconversions; 1.1% seroconverted within 5 years). In multivariable analysis, exposure to long-term prescription opioid therapy was associated with a 3.2-fold (95% CI, 2.9-3.6) higher risk of HCV seroconversion (vs prescription opioid-naive/acute). In separate Cox models, long-term chronic use was associated with a 4.7-fold higher risk of HCV seroconversion (vs naive/acute use 95% CI, 3.9-5.8), and long-term higher-dose use (≥90 MEQ) was associated with a 5.1-fold higher risk (vs naive/acute use 95% CI, 3.7-7.1). In this cohort study of people with more than 1 HCV test, long-term prescription opioid therapy for noncancer pain was associated with a higher risk of HCV seroconversion among individuals who were injection drug use-naive at baseline or at prescription opioid initiation. These results suggest injection drug use initiation risk is higher among people dispensed long-term therapy and may be useful for informing approaches to identify and prevent HCV infection. These findings should not be used to justify abrupt discontinuation of long-term therapy, which could increase risk of harms.

Recently acquired hepatitis C virus infection among people living with human immunodeficiency virus at a university hospital in Taiwan.

BACKGROUNDLittle is known about the engagement in hepatitis C virus (HCV) care and completion of HCV treatment in people living with human immunodeficiency virus (HIV) (PLWH) who have HCV coinfection in the Asia-Pacific region. Examining the HCV care cascade can identify barriers to the completion of HCV treatment and facilitate achievement of HCV micro-elimination in PLWH.AIMTo investigate the care cascade of incident HCV infections among PLWH in Taiwan.METHODSPLWH with incident HCV infections, defined as HCV seroconversion, were retrospectively identified by sequential anti-HCV testing of all archived blood samples at National Taiwan University Hospital between 2011 and 2018. All PLWH with incident HCV infections were followed until December 31, 2019. The care cascade of HCV examined included all incident HCV-infected patients, the percentages of anti-HCV antibodies detected by HIV-treating physicians in clinical care, plasma HCV RNA load tested, HCV RNA positivity diagnosed, referral to treatment assessment made, anti-HCV treatment initiated, and sustained virologic response achieved. Those who had HCV seroconversion during the interferon (IFN) era (2011–2016) and the direct-acting antiviral (DAA) era (2017–2018) were analyzed separately. The duration of HCV viremia—from the date of seroconversion to viral clearance by treatments or until the end of observation—and the incidence of sexually transmitted infections (STIs) during the HCV viremic period were estimated.RESULTSDuring the study period, 287 of 3495 (8.2%) PLWH (92.3% being men who have sex with men) who were HCV-seronegative at baseline developed HCV seroconversion by retrospective testing of all archived blood samples. Of the 287 incident HCV infections, 277 (96.5%) had anti-HCV antibodies detected by HIV-treating physicians, 270 (94.1%) had plasma HCV RNA determined and 251 (87.5%) tested positive for HCV RNA. Of those with HCV viremia, 226 (78.7%) were referred to treatment assessment, 215 (74.9%) initiated anti-HCV treatment, and 202 (70.4%) achieved viral clearance. Compared with that in the IFN era, the median interval from HCV seroconversion by retrospective testing to detection of HCV seropositivity by HIV-treating physicians was significantly shorter in the DAA era {179 d [interquartile range (IQR) 87-434] vs 92 d (IQR 57-173); P < 0.001}. The incidence rate of STIs in the DAA vs the IFN era was 50.5 per 100 person-years of follow-up (PYFU) and 38.5 per 100 PYFU, respectively, with an incidence rate ratio of 1.31 (95% confidence interval 0.96-1.77), while the duration of HCV viremia was 380 d (IQR 274-554) and 735 d (IQR 391-1447) (P < 0.001), respectively.CONCLUSIONWhile anti-HCV therapies are effective in achieving viral clearance, our study suggests more efforts are needed to expedite the linkage of PLWH diagnosed with incident HCV infections to HCV treatment.

Rate of HCV Seroconversion And Its Associated Factors In Hemodialysis Patients

Background: CKD is a worldwide public health problem. HCV is the most frequent complication of patients on hemodialysis, it is very important to screen patients for HCV seropositivity, asit may lead to severe liver disease, complications in renal transplant and death. Aim: To find the incidence of HCV seropositivity and identify factors associated with hemodialysis patients at the Dialysis Center. Methodology: A Retrospective Cohort study conducted at Hemodialysis Unit, Sheikh Zayed Hospital, Lahore from January 2015 to December 2015. Secondary data was collected from all the record files of all the patients included in the study available at Sheikh Zayed hospital. Data was also collected by a questionnaire from patient to determine different variables. Data for age, gender, HCV seroconversion, number of transfusions, emergency dialysis at any other hemodialysis center, surgeries, previous history of HCV, dialyzer reuse and dental procedure etc. was collected and patients were divided in two groups according to HCV status at the end of study. Data for seroconversion was studied for relation with given risk factors using Chi-square test and odds ratios with 95% confidence interval. Binary logistic regression was used to see the adjusted odds ratio of various risk factors for seroconversion. P-value ≤0.05 was considered significant. Results: The mean age of the patients was 43.40±16.37 years. The frequency of previous transfusions was 120(48%) The frequency of emergency dialysis outside Shaikh Zayed Hospital was 76(30.4%). The frequency of surgeries was 126(50.4%). The frequency of dental procedures was 102(40.8%). The mean duration of dialysis was 17.6±5.73. The incidence of HCV seroconversion in hemodialysis patients was 124(49.6%). Conclusion: We concluded that the incidence of HCV seroconversion in hemodialysis patients was 8.2% per year and over a period of six years nearly 49.6% who were undergoing dialysis in our dialysis center. Keywords: HCV seroconversion, hemodialysis patients

Pattern and risk factors of sharp object injuries among health care workers in two tertiary hospitals, Al Taif-Kingdom of Saudi Arabia 2016–2018

Occupational exposure of healthcare workers to blood and body fluids following skin injury constitutes a risk for transmission of blood-borne pathogens. The risk of exposure is greater as well. The present study aimed to determine the burden and risk factors of sharp object injuries in two tertiary hospitals in the Taif City KSA. Retrospective review of needle stick injury records was included from the two hospital's staff clinics. A Total of 131 health professionals (employees) recorded as exposed to sharp object injuries from both hospitals were enrolled during period 2016–2018. The collected data was cleaned, reviewed and analyzed using Statistical Package of Social Sciences SPSS ver. 25. The result of the study revealed that, the mean age for the 131 enrolled participants was 31 ± 6.6, Male to Female Ratio was 1:3. The most affected age group was 20–30 years (55.7%). Females were more affected 98 out of 131 (74.8%) than male (33out of 131 (25.2%). And there is increasing incidence rates of exposure from 2.89 /10.000 patient/day in 2016 to 3.42/ 10.000 patients'/day in 2017, with highest exposed nationalities; Filipino 42 (32.1%), Saudi 31 (23.7%), and Indians 26 (19.8%), the remaining 24.5% were from 10 mixed nationalities. The frequent affected divisions were: ER, surgical ward, operation room, ICU, laboratory, Medical W, Medical waste facilities (19.8%, 15%, 12.2%, 9.2%, 92% respectively). The most affected HCWs categories were nurses 74(56.5%), doctor 23(17.6%) and housekeeping 18 (13.7%). And the needle prick 104(79.4%) and cut wound 15(11.5%) constitute the highest type of injuries and were during operation 23 (17.6%), waste collection 15 (11.5%), cannulation 12 (9.2%) and giving injection 12 (9.2%). The common devices caused injuries were bore hole needle 63(48.1%), suture needle **(13.7%), cannula and insulin syringe 13 (9.9%) each. This study concluded that, as from 2016−2018, there was an increasing rate of reported accidental exposure to sharp needle injuries amongst HCWs from 3.0 to 3.4/10.000 patient/day, and the younger and nurses were mostly impacted. Workplace, distress, work types and load had influences on injuries rates and types. Fortunately, no exposure among employee with HBV, HCV and HIV seroconversion were documented.

High prevalence and genotype distribution of hepatitis C virus in people living with HIV in Kathmandu, Nepal

Background Hepatitis C virus (HCV) co-infection is still a significant cause of morbidity and mortality among HIV-positive individuals in many resource-limited countries. As prevalence rates of co-infection using the serological diagnosis of HCV infection might be imprecise, estimates of prevalence using polymerase chain reaction (PCR) confirmed diagnosis is needed to guide HCV treatment efforts among HIV-positive individuals in resource-limited countries. Methods We conducted this community-based cross-sectional study among 280 HIV-positive individuals recruited through the networks of five non-government organizations working with HIV-positive individuals in Kathmandu, Nepal. We collected blood samples from each participant and tested all the anti-HCV positive samples for HCV-RNA and genotypes. We calculated the prevalence of HCV/HIV co-infection and examined factors associated with it using multivariable logistic regression analysis. We also calculated the proportion of infection by different HCV genotypes and investigated HCV seroconversion. Results The prevalence of HCV/HIV co-infection was 29.6% (95% CI 24.25–34.95). History of a lifetime injecting drug use was associated with a higher likelihood of HCV/HIV co-infection (p < .001). Of the 81 individuals whose serum samples were available for genotype assessment, 55.7% tested positive for genotype 3A, 36.7% for genotype 1A and the remaining samples' genotype was undetermined (7.6%). Of the 100 anti-HCV positive samples, 17 (17.0%) tested negative for HCV RNA. Conclusions High prevalence of HCV/HIV co-infection, distribution of prevalent HCV genotype 1A and 3A and HCV seroconversion rate have important implications for the public health system in guiding HCV treatment and control efforts among HIV-positive individuals.