Number Of HCV-infected Patients Research Articles

Identification of Risk Factors for Testing of Hepatitis C in Non-Birth Cohort Patients: Is Universal Screening Necessary?

CDC reported that 45% of Hepatitis C (HCV) infected people denied known risk factors. Electronic health record RF-based, non-Birth Cohort (born outside of years 1945-1965) screening is challenging as risk factors are often input as nonsearchable data. Testing non-Birth Cohort patients solely based on risk factors has the potential to miss a substantial number of HCV infected patients. The aim was to determine the HCV antibody positive prevalence who would have been missed had providers only followed risk factor based screening recommendations. A 1:3 case-control retrospective nested chart review was conducted. HCV risk factors and opioid prescriptions were manually abstracted from the Electronic Health Record; other variables were collected using Explorys. In July 2015 HCV screening data was collected on non-Birth Cohort patients who were HCV tested across MedStar Health, as a presumptive marker for high risk. Univariate and multivariate logistic regression models were utilized to determine HCV antibody positive predictors. Eighteen (23%) HCV antibody positive and 123 (49%) HCV antibody negative had no identified risk factors; 6 (33%) HCV antibody positive reported risk factors only after a positive test result. There was a significant interaction between age over 40 and opioid prescription use; these groups were 11× more likely to be HCV antibody positive (CI95 1.6-74.8). HCV testing solely based on presence of risk factors in non-Birth Cohort patients has the potential to miss a significant number of HCV antibody positive patients. Given patient- and provider-level barriers in elucidating risk factors, universal HCV antibody screening may be warranted.

Assisting the Non-invasive Diagnosis of Liver Fibrosis Stages using Machine Learning Methods.

Fibrosis is a significant indication of chronic liver diseases often due to hepatitis C Virus. It is becoming a global concern as a result of the rapid increase in the number of HCV infected patients, the high cost and flaws associated with the assessment process of liver fibrosis. This study aims to determine the features that significantly contribute to the identification of the stages of liver fibrosis and to generate rules to assist physicians during the treatment of the patients as a clinically non-invasive approach. Also, the performance of different Multi-layered Perceptron (MLP), Random Forest, and Logistic Regression classifiers are estimated and compared for the full and reduced feature sets. Decision Tree produced 28 rules in contrast with previous research work where 98002 rules had been generated from the same dataset with an accuracy rate of approximately 99.97%. The resulting rules of this study achieved a prediction accuracy for the histological staging of liver fibrosis of 97.45%. Among all the machine learning methods, MLP achieved the highest accuracy rate.

Elimination of hepatitis C virus in Germany: modelling the cost-effectiveness of HCV screening strategies

BackgroundChronic hepatitis C is a major public health burden. With new interferon-free direct-acting agents (showing sustained viral response rates of more than 98%), elimination of HCV seems feasible for the first time. However, as HCV infection often remains undiagnosed, screening is crucial for improving health outcomes of HCV-patients. Our aim was to assess the long-term cost-effectiveness of a nationwide screening strategy in Germany.MethodsWe used a Markov cohort model to simulate disease progression and examine long-term population outcomes, HCV associated costs and cost-effectiveness of HCV screening. The model divides the total population into three subpopulations: general population (GEP), people who inject drugs (PWID) and HIV-infected men who have sex with men (MSM), with total infection numbers being highest in GEP, but new infections occurring only in PWIDs and MSM. The model compares four alternative screening strategies (no/basic/advanced/total screening) differing in participation and treatment rates.ResultsTotal number of HCV-infected patients declined from 275,000 in 2015 to between 125,000 (no screening) and 14,000 (total screening) in 2040. Similarly, lost quality adjusted life years (QALYs) were 320,000 QALYs lower, while costs were 2.4 billion EUR higher in total screening compared to no screening. While incremental cost-effectiveness ratio (ICER) increased sharply in GEP and MSM with more comprehensive strategies (30,000 EUR per QALY for total vs. advanced screening), ICER decreased in PWIDs (30 EUR per QALY for total vs. advanced screening).ConclusionsScreening is key to have an efficient decline of the HCV-infected population in Germany. Recommendation for an overall population screening is to screen the total PWID subpopulation, and to apply less comprehensive advanced screening for MSM and GEP.

Current and Future Treatment of Chronic Hepatitis C Genotype 2 and 3

Hepatitis C genotype 2 and 3 accounts for a significant number of HCV infected patients around the world. The combination of peginterferon alpha and ribavirin (PEG-IFN/RBV) demonstrated favourable results in treatment of genotype 2 and 3 infected patients with sustained virological responses rates of up to 80 %. In 2011, the first direct acting antivirals (DAA) have been approved but so far only for genotype 1. Several other antivirals are currently tested in clinical trials. Two compounds demonstrated promising results in patients with genotype 2 and 3. Sofosbuvir (SOF), a NS5B polymerase inhibitor, proved to be effective even without PEG-IFN and approval of an interferon-free regimen is foreseeable. Alisporivir (ALV), a host-targeting antiviral demonstrated encouraging results in phase-I and -II trials in genotype 2 and 3 patients and offers a new mechanism of action. However, further trials are needed to prove long-term safety and the efficacy in difficult-to-treat patients.

Molecular detection of HCV infection in suspected liver disease patients of District Mardan, Khyber PuhktoonKhwa

Chronic hepatitis is a common cause of liver related problem due to different viruses concerned with liver, where Hepatitis C (HCV) has been documented as the major cause and lead to many complications. A total of 1500 (54% Male and 46% Female) suspected liver disease patients were selected for the study. Confirmation was carried out by ICT, ELISA and q-PCR. Age wise and gender wise and Tehsil wise distribution of the data was carried by statistical analysis. HCV RNA was detected in 438 (29.2%) samples out of total 1500 samples of suspected liver disease patients via q-PCR. Out of 438 patients, 210 (47.94%) were male and 228 (52.06 %) were female patients. In age group 41-60 years there were 210 (47.94%) HCV RNA positive patients. In age group 21-40 years it was 104 (23.74%), in >60 years it was 95 (21.68%) and in <20 years 29 (6.62%) was observed. In Tehsil wise distribution it was noted that 228 (52.05%) HCV RNA positive samples were from Tehsil Mardan and 115 (26.25%) and 95 (21.68%) from Takhtbhai and Kattlang respectively. This study concludes that the most specific, sensitive and reliable test use for detection of HCV is q-PCR. Female infectivity rate with HCV is relatively higher then male in District Mardan. Age group 41-60 years was found the most susceptible group to HCV infection in this study. Among the three Tehsil of District Mardan, the highest number of HCV infected patients was found in Tehsil Mardan with 228 (52.05%) patients.

HCV and Chemotherapy: Does Infection Change Management?

Hepatitis C infects 1.6% of the United States adult population, and the peak prevalence of infection is present in the Baby Boomer generation. HCV infection predisposed patients to both hepatic and non-hepatic malignancies, leading to an increasing number of HCV infected patients needing chemotherapy. Since the liver is the most important site of drug metabolism, it is critical to understand how HCV impacts chemotherapy. Clinical decisions regarding chemotherapy dosing are traditionally based on serum biochemical tests; however these do not measure liver function, and liver biopsy combined with the Child classification are better measures of true liver function. Fortunately, patients without cirrhosis have intact synthetic function. However, patients with cirrhosis, some of whom have normal liver function tests, may not. Not only can HCV infection increase the risk of hepatotoxicity from chemotherapy, but chemotherapy can accelerate the progression of HCV related liver disease.

Prevalence and Incidence of Hepatitis B Infection among Hepatitis C Virus-Infected Subjects in 6 Health Regions, Canada, 1998–2006

Purpose To determine the prevalence and incidence of hepatitis B virus (HBV) infection among hepatitis C virus (HCV)-infected subjects and compare sociodemographic and risk characteristics between HBV/HCV co-infected and HCV-monoinfected patients. Methods Data were collected through the Enhanced Hepatitis Strain Surveillance System from 6 sentinel regions in Canada. Univariate and multivariate logistic regression analysis were undertaken to investigate predictors of co-infection. Results During the period 1998-2006, the cumulative incidence of acute HBV among HCV-infected subjects was 490 per 100,000 (67 cases). Factors independently associated with acute HBV infection were injection drug use (odds ratio [OR] = 3.7, 95% confidence interval [CI]: 1.5, 9.1). An 8-year prevalence of HBV infection was 2.8% (95% CI: 2.5, 3.1). Independent association with baseline co-infection included being male (OR=2.0, 95% CI: 1.6, 2.6), being non-Canadian-born persons (OR=2.6, 95% CI: 1.9, 3.4), and being older age (OR=1.3, 95% CI: 1.0, 1.6). Of subjects with known information on HBV vaccination, ≥1 dose of HBV vaccine was 27%. HBV rates were much higher in the HCV-infected people than in the general population, and HBV vaccination coverage levels were low. Conclusions There were a sizable number of HCV-infected patients co-infected with HBV, particularly male and non-Canadian-born patients. Since combined chronic hepatitis B and C is associated with more severe liver disease and an increased risk of hepatocellular carcinoma, the need for outreach HBV vaccination programs is emphasized not only in the target high-risk population but also in HCV-infected patients.

Epidemiologie der chronischen Hepatitis C in Deutschland

D Background and Purpose: Little is known about the epidemiology of hepatitis C in Germany and in particular about the route of infection. The current study prospectively analyzed epidemiologic and clinical data of patients with chronic hepatitis C virus (HCV) infection. D Methods: A structured questionnaire was sent to primary care physicians in Germany. Of 13,287 questionnaires, 5,837 were sent back for analysis. D Results: Although the number of questionnaires sent out was proportional to the number of subjects living in the new and old states of Germany, only 9% were sent back from the new states; thus, the prevalence of hepatitis C is probably considerably lower in the new states compared with the old ones. The HCV-infected subjects originated from 92 different countries throughout the world: 63% were born in Germany, but 21% were from one of the former states of the USSR. Intravenous drug abuse was the most prevalent risk noted; there was a strong bias whereby physicians who cared for a large number of HCV-infected patients had a much higher proportion of subjects with i.v. drug abuse when compared to those who only cared for a few hepatitis C patients. In the latter group a history of infusion of blood products was approximately as frequent as a history of drug abuse. There was a high proportion of patients who had no risk factor for hepatitis C (25-42%). Fatigue was the most frequent symptom (nearly 60%), followed by loss of concentration and abdominal pain. The number of symptoms increased with a higher aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio and thus presumably with the stage of liver fibrosis. D Conclusion: Hepatitis C should be excluded in all patients with elevated liver enzymes. In risk groups with a high prevalence of hepatitis C, the infection should be looked for even when liver enzymes are normal.

Liver TX for hepatitis C cirrhosis in a low prevalence population: Risk factors and status at evaluation

Objective. Hepatitis C virus (HCV) cirrhosis is the most common indication for liver transplantation (LTX) world-wide. The prevalence of HCV infections is much lower in Norway than in most other countries from which data on HCV infection and liver transplantation have been published. Material and methods. Patients with HCV infection referred for evaluation of a possible LTX between 1990 and 2005 were included in the study. Their clinical status, biochemical parameters and risk factors were recorded. All patients were followed until 1 January 2005 irrespective of transplantation status. Results. Fifty-one patients were included; 80% were males and 18% were non-Caucasians. Previous intravenous drug abuse (28%) and exposure to contaminated IgG products (15%) were the most common routes of infection. In 45/51 (88%) of the evaluated patients at least one risk factor for rapid progression of HCV disease was identified. Twenty-seven patients were accepted on the waiting list. The MELD (model for endstage liver disease) score for the accepted patients was significantly higher than that for the patients who were not listed because they were found to be too healthy (18.4 versus 12.1, p<0.01). Twenty-four patients (89% of those listed) received a liver allograft; their 1-, 3- and 5-year survival rates following LTX were 81%, 68% and 68%, respectively. Two patients needed a second transplantation. Conclusions. A low number of HCV-infected patients have so far been evaluated for LTX in Norway. The present study demonstrates that almost all of the HCV patients progressing to cirrhosis and being evaluated for LTX in Norway have additional risk factors for development of cirrhosis.

The natural history of hepatitis C in African Americans

Background Hepatitis C (HCV) infects 1-3% of the United States population. African Americans(AA)are disproportionately infected with this virus (5%) and predominately infected with genotype 1 HCV. The natural history of this disease in AA has not been analyzed in a large number of HCV infected patients. Aim To analyze demographic, virolgical, biochemical and histological data in order to determine the natural history of liver disease in AA versus non-African Americans (non-AA). Methods We retrospectively reviewed the records of 289 patients with HCV seen at our institution from 1996 through 1999. We included patients who had adequate histological data to assess HAl and the degree of hepatic fibrosis. The following data were collected: age, gender, race, weight, baseline ALT, genotype, HCV RNA levels, mode and duration of infection. The duration of infection was estimated from earliest potential exposure to the virus. Liver biopsies were reviewed (blindly) and graded for histologic activity using the Knodell scoring system (HAl). Results There were 93 AA and 196 non-AA patients. There were no significant differences in mean baseline HCV RNA and weight. Although not significant, only 23% of AA's compared to 31% of non-Ax's were cirrhotic. There was a significant difference between AA and non-AA patients in piecemeal necrosis (PN)(2.5 vs. 3.1, p=.04), mean baseline ALT(86.55 vs. 112.41, p=.Ol), age (49 vs. 45, p=.OOI), and duration of infection(27 vs. 23, p=.(02). AA patients were more often infected with genotype 1 HCV (87.7% vs. 70.9%, p=.02) No AA patients were infected with genotype 3 HCV. When analyzing the data according to the duration of infection, AA patients had a lower ALT(56 vs. 134, p=.03), total HAI(3.1 vs. 4.8, p=.05), as well as portal inflammation(1.4 vs. 2.4,p=.02), PN(.8 vs. 3.1, p=.05), and HAl without fibrosis(3.5 vs. 6.6, p= .04) during the second decade of exposure (years 10-19). There were no AA patients with cirrhosis by the second decade compared to 26% of non-AA patients with cirrhosis, although this was not statistically significant. By the third decade (years 20-29), 18% of AA patients vs. 31% of non-Ax's were cirrhotic. The degree of fibrosis was significantly greater in non-AA patients (2.1 vs. 2.6, p=.04). Summary AA's are more likely to be infected with genotype 1 HCV and tend to progress more slowly to cirrhosis. In addtition, early in their exposure, AA's had lower HAl, baseline ALT, and percentage of cirrhosis, although mean baseline HCV RNA levels and weight were not significantly different.