Positive anti-HCV Antibodies Research Articles

Clinical Utility of Enzyme-Linked Immunosorbent Assay for Hepatitis C Core Antigen Quantification in Diagnosis and Monitoring Patients Treated with Direct-Acting Antivirals in A Resource Limited Setting

Background: Hepatitis C virus core antigen (HCV-cAg) assay has been proposed as a more economical alternative to HCV RNA detection. Aim of the work: To evaluate the clinical utility of ELISA for HCV-cAg quantification in diagnosis and monitoring treatment outcomes in patients treated with direct acting antivirals (DAAs) for chronic hepatitis C. Patients and Methods: A prospective study on 40 subjects recruited from hepatology department and outpatient clinic in Ain Shams University Hospitals. Group I included 20 patients with positive anti-HCV antibody. Group II included 20 healthy subjects. The patient group received a combination of sofosbuvir 400 mg and daclatasvir 60 mg once daily for 12 weeks. The levels for both HCV-cAg and HCV RNA were evaluated at baseline and 12 weeks after completion of therapy. Results: Baseline HCV-cAg levels showed good correlation with HCV viral load (r=0.808, p 8 IU/ml. Conclusion: ELISA for HCV-cAg can replace the high sensitivity HCV RNA molecular assay to confirm the presence of HCV infection and to monitor treatment outcome.

Clinical Utility of Enzyme-Linked Immunosorbent Assay for Hepatitis C Core Antigen Quantification in Diagnosis and Monitoring Patients Treated with Direct-Acting Antivirals in A Resource Limited Setting

Background: Hepatitis C virus core antigen (HCV-cAg) assay has been proposed as a more economical alternative to HCV RNA detection. Aim of the work: To evaluate the clinical utility of ELISA for HCV-cAg quantification in diagnosis and monitoring treatment outcomes in patients treated with direct acting antivirals (DAAs) for chronic hepatitis C. Patients and Methods: A prospective study on 40 subjects recruited from hepatology department and outpatient clinic in Ain Shams University Hospitals. Group I included 20 patients with positive anti-HCV antibody. Group II included 20 healthy subjects. The patient group received a combination of sofosbuvir 400 mg and daclatasvir 60 mg once daily for 12 weeks. The levels for both HCV-cAg and HCV RNA were evaluated at baseline and 12 weeks after completion of therapy. Results: Baseline HCV-cAg levels showed good correlation with HCV viral load (r=0.808, p 8 IU/ml. Conclusion: ELISA for HCV-cAg can replace the high sensitivity HCV RNA molecular assay to confirm the presence of HCV infection and to monitor treatment outcome.

Subclinical hepatitis C virus infection in Egyptian patients with rheumatic diseases: a multi-center study

BackgroundHepatitis C virus (HCV) infection is highly prevalent in Egypt. It was found to be 7.0% in a study done in 2015. There are some studies on the prevalence of HCV in rheumatoid arthritis, but to our knowledge, no previous study was done to detect it in other rheumatologic diseases. This study aims at detecting the prevalence of subclinical HCV infection in Egyptian patients with different rheumatic diseases. In the current study, eight hundred and three patients with different rheumatic diseases collected from five—geographically different—Egyptian rheumatology departments were studied. Patients with known current or previous HCV infection were excluded from the study. Screening for the positive anti-HCV antibodies was done for all patients. Screening for the presence of HCV ribonucleic acid (RNA) was done in patients with positive serology by reverse transcriptase-polymerase chain reaction.ResultsIn the studied population, 675 (84.1%) patients were women. The mean age [± SD] was 44.2 [± 12.9] years. Hepatitis C antibody positivity was found in 73 (9.1%) of the patients, while 67 (8.3%) were having positive HCV-RNA quantitative PCR tests. The highest prevalence of seropositive HCV was found in drug-induced vasculitis (DIV) and cryo-vasculitis (100%), while in RA, HCV antibodies and PCR were found to be positive in 9.1% and 8.3% of patients, respectively.ConclusionsDetection of the presence of HCV infection in 9.1 % of the studied middle-aged Egyptian patients with rheumatologic conditions points to the importance of screening for HCV in such population for early detection and intervention especially for those patients that are planned to start biologic therapy.

Epidemiological, Clinical and Virological Characteristics of Patients with Hepatitis C in Morocco

Objectives: In Morocco, the exact and recent prevalence of Hepatitis C Virus (HCV) infection is not well-known, due to the lack of recent epidemiological studies of the general Moroccan population. The objective of this study was to determine the prevalence of HCV and to describe the epidemiological, clinical and virological characteristics of patients infected with HCV diagnosed at the Mohammed V Military Teaching Hospital in Rabat, Morocco.
 Methods: This was a prospective study, spread over a period of 3 years (April 2015 - April 2018). All patients with a positive anti-HCV serology were included in the study except those on hemodialysis. In addition to HCV serology, all patients included benefited from HIV serology as well as the Hbs antigen by a Chemiluminescent type Microparticle Immuno-Assay technique (Architect®, Abbott). RNA viral load and HCV genotyping was carried out using a real-time polymerase chain reaction.
 Results: We collected 14,944 samples, of which 269 had positive anti-HCV antibodies (1.8%). The average age of patients with positive HCV serology was 61 years, the sex ratio (Male/Female) was 1.4. Dental care was identified in 53% of the cases. Viral hepatitis C was identified in 82% of cases during a systematic check up. The main clinical signs reported in our series were asthenia (25% of cases) and subicterus (7% of cases).
 Conclusion and Implications for Translation: In Morocco, the exact prevalence of HCV infection is not well known, due to the lack of recent epidemiological studies of the general Moroccan population. Our study showed a prevalence of about 1.8% which is in accordance with the World Health Organization (WHO) estimation of between 1% and 2.49%.Our Epidemiological study provides important on the extent of the problem in Morocco, it raises the interest of mass screening and describes the populations at risk that will need to be identified as a priority.
 Key words: • Epidemiology • Diagnosis • Hepatitis C • Morocco • Risk factor • Military Hospital • Virology
 
 Copyright © 2020 Tagajdid et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Impact of the Covid-19 pandemic on the elimination of hepatitis C virus in Duhok, Kurdistan, Iraq: A retrospective cross-sectional study

Background and Aim:Infection with hepatitis C virus (HCV) is a public health threat worldwide. The World Health Organization aims to eliminate HCV. However, the coronavirus disease (COVID-19) pandemic has led to a severe compromise in health services, and this has halted efforts to eliminate HCV. Herein, we report our experience with the initiative of HCV elimination in Duhok city, Kurdistan Region of Iraq, with a focus on the effect of the COVID-19 pandemic on the HCV elimination plan.Materials and Methods:An anti-HCV antibody test was used to screen subjects. All positive results were then confirmed by reverse-transcription polymerase chain reaction (RT-PCR) testing. All patients with current HCV infection were treated with direct-acting antiviral regimens.Results:During the study period, 459,015 subjects were tested for anti-HCV antibody positivity, with a monthly average of 9,562 tests for HCV. This number dropped to zero during the lockdown period between 1March and 31May 2020. Among the tested samples, 0.29% (1350/459015) tested positive for anti-HCV antibodies. RT-PCR testing of all positive samples revealed that 0.020% (93/459015) were positive. Of the 93 recruited subjects, 3 patients did not complete the treatment course due to the lockdown. All patients who finished the treatment course were cured as determined by sustained virologic response 12 (SVR12) weeks after finishing the treatment course.Conclusion:During the COVID-19 pandemic, reductions in health facility utilisation led to a significant decrease in services offered for HCV screening and treatment. Such a decrease in services has had a negative impact on HCV elimination. An urgent plan is needed to resume the services, and strict follow-up is needed for patients whose treatment was interrupted.

374: Universal hepatitis C virus testing as part of prenatal care

SMFM currently recommends anti-HCV antibody testing in pregnant patients with risk factors (RFs). However, due to HCV prevalence and 95-99% cure rates using antiviral treatments, universal testing is in question. Recently (2019), there have been 2 publications on universal HCV testing using simulation models both reporting cost-effectiveness. However, through a literature search, we did not find any large prospective study evaluating actual capture rates (& cost-effectiveness) comparing testing based on RFs vs. universal testing. Starting 2011, we began universal anti-HCV antibody testing in our prenatal clinic and also screened for RFs. Our objective was to analyze positive anti-HCV antibody rates based on RFs vs. universal testing & assess cost-effectiveness. Prospective observational cohort study analyzing positivity rates for anti-HCV antibody in our obstetrical clinic based on RFs compared with universal testing. RFs assessed included any IVDA history, use of any illicit drugs (opioid, amphetamine, benzodiazepine, cocaine, psychotropic, etc.), marijuana use, prior blood transfusion or dialysis need, attendance in a drug treatment program, or history of incarceration. 5,317 obstetrical patients were universally tested. Table 1 shows detection rates based on testing using only RFs, using RFs including marijuana use, and universal testing. A large number of HCV-antibody positive patients (18%) would be missed if testing were solely based on RFs and >90% of these 117 missed patients expressed concern over how they became infected, denying any history of IVDA. Based on a 5% neonatal transmission rate at delivery & cost of treating cirrhosis/hepatocellular carcinoma vs. cost of testing, universal screening would be cost-effective even if we only missed 5% of positive patients. This large prospective study reports detection rates of positive anti-HCV antibody in pregnancy --- testing only when RFs are present vs. universal testing. Based on the number of HCV-infected patients missed using risk factor testing only, universal testing is cost-effective and recommended.

A STUDY PROTOCOL ON RISK FACTORS FOR HEPATITIS C INFECTION AMONG ADULT PATIENTS AT TERTIARY HOSPITALS IN KEDAH STATE

Background: Hepatitis C virus is a bloodborne virus and commonly transmitted by contaminated blood mainly via clinical procedures and intravenous drug use. However, quality design study to explore the potential risk factor for hepatitis C infection in general local population is lacking. Thus, the present study is proposed to fill the gap in the body of knowledge of the related issue. Materials and Methods: A matched hospital-based, case-control study will be conducted to identify the risk factors for hepatitis C infection. Patients with positive anti-HCV antibodies recruited from two participating tertiary hospitals will be in the case group, and controls will be those with negative serology for HCV infection that attending other specialist outpatient clinic of the same hospital where the case will be recruited. All cases and controls will be matched by gender, age (within 5 years) and ethnicity, with a ratio of one case to one control. Information on patient risk exposure will be collected using a standardised questionnaire. This study requires 291 pairs of matched case-control. Conditional logistic regression will be used for data analysis using STATA software. Expected Outcome: The conduct of proposed study will help to identify common local practice that has an association with the hepatitis C infection. It is anticipated that the study results will inform the local health authorities and policy makers on key areas to formulate cost-effective preventive programs to reduce the incidence and transmission of this virus infection in Kedah state and Malaysia. Keywords: bloodborne, hepatitis C, infection, matched case-control, risk factors.

Seroreversion of positive anti-hepatitis C virus antibodies in left ventricular assist device recipients: Now you see them, now you don't.

The clinical significance of positive anti-hepatitis C virus (anti-HCV) antibody tests in recipients of left ventricular assist devices remains unclear. In light of emerging evidence suggesting the possibility of persistent low-level HCV infection in patients with positive anti-HCV antibody test but negative HCV ribonucleic acid, it is very important to distinguish the truly false positive HCV antibodies, in recipients of continuous flow left ventricular assist devices, from those suggestive of a prior clinically resolved infection or one where a low-level viremia may have persisted. We conducted a retrospective analysis of left ventricular assist device recipients at our institution. While the total incidence of positive HCV antibody with concomitantly negative HCV ribonucleic acid test (19.2%) was in keeping with the incidences reported in prior cross-sectional studies, we longitudinally followed our patients and observed a 100% seroreversion. Seroreversion, which has not been reported in other studies, occurred either during continued left ventricular assist device support (10 out of 26) or after heart transplant (7 out of 26). Hundred percent seroreversion strongly suggested that the anti-HCV antibodies were truly false positive.

Predictive value of rheumatoid factor titre in cryoglobulinemia in Hepatitis C positive patients

Background/objective: HCV viremia has been known to provoke a plethora of autoimmune syndromes as well as nonspecific rheumatologic manifestations. HCV is the most frequent cause of mixed cryoglobulinemia, which is characterized by endothelial deposition of rheumatoid factor containing immune complexes and endorgan vasculitis. Rheumatoid factor positivity is found to be more prevalent among patients with HCV infection compared to the general population. The aim of the study was to ascertain the relationship of rheumatoid factor titer with cryoglobuliemia in hepatitis C virus positive patients and to assess its relation with different disease characteristics. Methods: A cross sectional study was carried out through one year. Fifty patients known to suffer from HCV were subjects of the study. Patients were interviewed and demographic, clinical and serologic data were recorded. All patients were tested for cryoglobulins by crude method and rheumatoid factor titer was determined in all patients. Child-Pugh classification was used for assessment of liver cell failure. Data were analyzed by the Statistical Package for the Social Sciences (SPSS, version 17). Data analysis is done by using Chi-Squared test (χ2) test and Fisher’s exact test as appropriate. Associations between interval, ordinal and dichotomous variables were tested by Pearson`s Product Moment Correlation Coefficients (r). Results: Cryoglobulinemia was detected in 36 (72%) patients out of the 50 HCV patients. Rheumatoid Factor (RF) was positive in 38% patients (76%). All HCV patients who were positive for cryoglobulin had a positive RF. Presence of RF found to be positively significantly correlated with the presence of cryogloulins in HCV patients. Conclusions: HCV infection is a major contributing factor of mixed cryoglobulinemia with elevation in RF titre. Positive anti-HCV antibodies together with highly positive RF titre in the presence of musculoskeletal, neurological and cutaneous manifestations strongly suggest the diagnosis of mixed cryoglobulinemia.

Prevalence of hepatitis C virus infection in patients hospitalised for ischemic heart disease versus controls - PRO-CARDIO-C study.

Aim of the studyOngoing national screening programmes suggest that the prevalence of chronic hepatitis C (CHC) in Poland ranges between 0.5% and 1%. It has been recently noted that patients with confirmed coronary artery disease may be at higher risk for hepatitis C virus (HCV) infection.Material and methodsTesting for the presence of anti-HCV antibodies was performed in a group of patients admitted to the Cardiology Department with symptomatic ischemic heart disease (IHD) and in patients hospitalised in the Dermatology Department.ResultsA total of 1171 patients underwent anti-HCV testing: 672 patients in the Cardiology Department (K group) and 499 patients in the Dermatology Department (D group). Twenty-eight (2.4%) positive anti-HCV results were detected. The prevalence of positive anti-HCV antibodies in groups K and D was 2.23% and 2.61%, respectively (p > 0.05). Presence of HCV RNA was confirmed in 15 cases (1.28%) – 7 patients in group K and 8 patients in group D (1.04% and 1.6%, respectively; p > 0.05).ConclusionsOur findings suggest that this patient cohort has increased risk of HCV infection, which may influence screening strategies.

The Massachusetts Hepatitis C Testing Cascade, 2014-2016.

Objectives:To characterize hepatitis C testing in Massachusetts and guide stakeholders in addressing the needs of people living with hepatitis C.Methods:All persons with a positive laboratory report for anti-hepatitis C virus (HCV) antibody, between 2014 and 2016, were included in the testing cascade. Outcomes were HCV tests received after a positive anti-HCV antibody test: nucleic acid test or genotype test. Logistic regression analyses were performed to determine factors associated with progression through the HCV testing cascade.Results:Among those reported anti-HCV antibody positive, a total of 13 194 (61%) cases had a subsequent RNA-based test, and 79% (10 374/13 194) were confirmed with current, active HCV infection. For confirmed HCV cases, 44% (4557/10 374) had a genotype identified. The median time from an antibody-positive test to a RNA-based test was 29 days (interquartile range [IQR] = 7-151). Differences in moving through the testing cascade were observed by birth cohort and race/ethnicity.Conclusions:Improved surveillance capture of demographic information is needed to help public health agencies ensure equity in HCV diagnosis and linkage to care.

Prospective Study of Changes in Anti-HCV Immunoglobulin G Antibody Titers after Treatment with Direct Acting Antiviral Agents

Introduction: worldwide, approximately 180 million people are living with CHC, which corresponds to a global prevalence of 1.1% and millions more are newly infected each year. Annually, 700.000 people die from HCV-related complications, including cirrhosis and hepatocellular carcinoma (HCC). Aim of the work: the present study investigated the dynamics of change in various HCV antibodies in patients with CHC who achieved SVR after DAAs. Methodology: this was a prospective case-control study that was conducted on 150 patients. They were categorized into three main groups: Group I: included 100 patients with chronic HCV infection as diagnosed by SRT-PCR. They were submitted to treatment with DAAs for 12 weeks. Group II (positive control group): Included 25 patients who presented with CHC infection as diagnosed by positive anti-HCV IgG antibodies and positive HCV SRT-PCR, but either refuse or postpone HCV therapy or the treatment of HCV itself was contraindicated. Group III (negative control group): included 25 patients, apparently healthy individuals who test positive for anti-HCV IgG antibodies, but negative HCV SRT-PCR. HCV IgG Ab titers was assessed by commercially available third-generation enzyme-linked immunosorbent assay (ELISA) at base line, end of treatment and then at the 24th week (i.e. 12 weeks after the end of treatment). Results: as regard HCVAb, it showed a significant statistical difference (pvalue 0.05) between HCV Ab titer results at baseline, 12th week and 24th week in the studied positive control patients group II as HCV Ab titers were 3.1 ± 0.2 at baseline, 3.2 ±0.2 at 12th week and (3.2± 0.1) at 24th week week. Also, there was no statistical significant difference (p-value > 0.05) between HCV Ab titer results at baseline, 12th week and24th week in studied negative control patients group III as HCV Ab titers were 1.22 ± 08 at baseline, (1.23±0.08) at 12th week and 1.24± 0.07 at 24th week. Conclusion: HCV antibody titer appeared to continue to decrease after eradication of HCV by DAAs therapy.

Ushering a New Era in the Management of Hepatitis C in Children with Hematological Disorders.

Transfusion-transmitted hepatitis C is a major concern among thalassemia patients. Our aim isto estimate the prevalence of Hepatitis C infection among thalassemia patients and to assess the treatment response, adverse effects of Peg-interferon based regimen and the new direct-acting antiviral drugs. Patients with thalassemia receiving regular blood transfusions with positive anti HCV antibodies during a period from January 2012 to June 2017 were analyzed. Serial HCV viral load and genotype and liver function tests were performed. Peg interferon and Ribavirin were used in patients diagnosed before January 2016 and patients diagnosed after January 2016 were started on the combination of Ledipasvir/Sofosbuvir. Thirty-two patients aged between 2 and 28years were analyzed. Genotype 1 was the predominant type. Twenty-one patients were initiated on Peg Interferon with Ribavirin, and 14 achieved sustained virological response. All of them had increased blood transfusion requirements with significant compliance issues. Alleleven patients started on Ledipasvir and Sofosbuvir including 4 undergoing hematopoietic stem cell transplantation and 7 interferon failures showed sustained viral clearance with good compliance. Ledipasvir/Sofosbuvir combination can be safelyused inthalassemia patients and in young children. The cost of therapy is less compared to peg interferon based regimen with good compliance and superior efficacy.

Role of Hepatitis C Virus (HCV) core antigen in improving blood transfusion safety in high prevalence, resource limited countries, a step forward

ObjectiveThe aim of the present study was to evaluate the efficacy of hepatitis C virus [HCV] core Ag as an alternative affordable test in resource limited countries blood banks. BackgroundImplementing nucleic acid testing in developing countries with low resources is still unaffordable. Egypt has the highest prevalence of hepatitis C in the world and still in need to efficient affordable transfusion program that reduces the window period for the virus before implementing the complex high cost NAT. Study design and methodsHCV core Ag by ELISA in serum, in the presence or absence of anti-HCV antibodies was compared to HCV- RNA by PCR on total number of 1850 first time and repeat donations from Fayoum University Hospital and Badr University Hospital. ResultsAmong 1850 healthy voluntary donors, 143 donors with anti-HCV antibody positivity, 105 were determined as positive, 38 were negative for HCV core Ag, and 107 were positive for HCV RNA. ConclusionHepatitis C virus core antigen-ELISA can be a useful alternative in the developing nations and Greater consideration should be given to its implementation as an additional serological test for blood donors in Egypt as the most cost-effective measure for further improvement of transfusion safety.

Diagnosis and monitoring of HCV infection using the cobas® HCV test for use on the cobas® 6800/8800 systems

Background and objectivesAccurate, sensitive, and specific tests for detection and monitoring of hepatitis C virus (HCV) RNA concentrations are essential for diagnosis and management of HCV infections. We evaluated the next-generation reverse-transcription real-time PCR test, cobas® HCV test for use with the cobas® 6800/8800 systems (“cobas HCV”) by determining its analytical performance characteristics and clinical utility for the diagnosis and therapeutic monitoring of chronic HCV infections. MethodsThe limit of detection (LOD), linearity, precision, specificity, matrix equivalence of plasma and serum, and quantitative agreement with the COBAS® AmpliPrep/COBAS® TaqMan® HCV Test version 2.0 (“CAP/CTM HCV v2”) were evaluated. Clinical utility for the diagnosis of chronic HCV infection was demonstrated by testing plasma from HCV seropositive individuals and comparing results to a nucleic acid amplification test (NAAT) approved for use in the diagnosis of chronic hepatitis C. Clinical specificity was investigated by testing plasma from HCV antibody negative subjects with non-HCV related liver diseases. Utility for monitoring treatment response was defined by testing plasma collected during treatment of HCV genotypes (GT) 1, 2, and 3 and determining positive predictive value (PPV), negative predictive value (NPV) and the odds ratio (OR) for predicting cure (sustained virologic response 12 weeks after treatment cessation, “SVR12”). ResultsThe cobas HCV test demonstrated an LOD of at least 15 IU/mL and measurable range from 15 to at least 1.0E + 08 IU/mL (1.2–8.0 log10 IU/mL) for GT 1–6, with high accuracy (≤0.16 log10 difference) and precision (standard deviation 0.04–0.14 log10) throughout the linear range. Paired plasma and serum samples showed highly correlated performance (R2 = 0.97). Quantification was 100% specific for HCV in analytical studies. Correlation with CAP/CTM HCV v2 was high in patient samples (mean titer difference: 0.05 log10 with a 95% CI: 0.03–0.06 log10). For the diagnosis of chronic HCV, positive and negative percent agreement between cobas HCV and the comparator NAAT were 98.8–100% on the cobas 6800 and 8800 systems. Clinical specificity of cobas HCV using samples from HCV antibody negative subjects with non-HCV related liver diseases was 99.6% and 100% on cobas 6800 and 8800 systems. In therapeutic monitoring and SVR12 prediction during experimental treatment for chronic HCV GT 1 infections, undetectable HCV RNA by cobas HCV at different on-treatment weeks had a PPV 76.8%–79.4%, NPV 29.9%–100%, and OR 1.64–47.52. During therapy of HCV GT 2 and GT 3, treatment week 4 and 12 results were: PPV, 84.7% and 75.3%; NPV, 47.8% and 50.0%; OR, 5.09 and 3.05. ConclusionsThe cobas HCV test is highly sensitive, specific, and accurate HCV RNA test for GT 1–6. It demonstrates excellent correlation with the FDA-approved CAP/CTM HCV v2 test. It is useful clinically for detection of active HCV infection in individuals that have had a positive anti-HCV antibody test result and in monitoring treatment response.

A hiddenly high hepatitis C virus related liver disease burden among Chinese patients with non-liver disease complaints: A hospital based study from 2013 to 2017

Objective: To determine the frequency of anti-HCV antibody positivity in patients with non-liver disease complaints, to explore whether anti-HCV positive patients had been properly advised and visited hepatologists for further assessments, and to investigate their clinical characteristics as well as the HCV treatment status. Methods: A hospital based survey of non-liver disease patients with anti-HCV positive and their attending physicians was conducted to determine: 1. were the patients adequately advised of the implication of anti-HCV positive finding; 2. to what extent the patients were aware of potential chronic liver disease associated with HCV infection and whether they sought for further assessments and care of hepatologists. Results: A total of 295 294 non-liver disease patients were tested for anti-HCV antibody, and 2 778 of them were found to be positive (0.94%). However, only 45.10% (1 253/2 778) of the anti-HCV antibody (+) patients were referred to hepatologists and received HCV RNA test. In addition, 34.10% (312/915) and 1.42% (13/915) of them had already advanced to cirrhosis and hepatocellular carcinoma (HCC), respectively. Further analysis showed that the patients who declined antiviral therapy were older, with lower education and lower income, possessed poorer knowledge on the risk of chronic hepatitis C, and had more severe liver diseases. Surprisingly, 65% of the surveyed physicians did not know the genotype-guided treatment duration suggested by the guidelines. Alarmingly, 22% of the surveyed physicians did not know the standard assays for the diagnosis of HCV infection. Conclusions: Our findings highlight the challenge and hidden enormous burden of chronic HCV infection among patients with non-liver disease complaints in China.

The rs738409 polymorphism of the PNPLA3 gene is associated with hepatic steatosis and fibrosis in Brazilian patients with chronic hepatitis C

BackgroundProspective studies have shown that 80% of acute hepatitis C virus (HCV) cases progress to chronic infection; approximately 10-20% of patients with these conditions will develop liver cirrhosis within 2 to 3 decades, and 1-5% will develop liver cancer. Some studies have indicated that the rs738409 polymorphism of the PNPLA3 gene is associated with steatosis and the progression of advanced fibrosis. This study assessed the contribution of the PNPLA3 rs738409 polymorphism with regard to the steatosis and degree of liver fibrosis in Brazilian patients diagnosed with chronic hepatitis C.MethodsA total of 290 patients were evaluated at the Clinics Hospital of the School of Medicine, University of São Paulo, between 2010 and 2015. The inclusion criteria were age ≥ 18 years and positive anti-HCV antibody and HCV RNA tests. The participants were evaluated based on medical consultation, blood tests, and liver biopsies conducted before specific antiviral therapies were applied. The associations between the rs738409 PNPLA3 gene polymorphism and steatosis and advanced fibrosis were tested under a recessive inheritance model using logistic regression analysis, including age, gender, BMI, ethnicity/color, HOMA-IR, alcohol intake, HCV genotype 3, and the rs58542926 TM6SF2 gene polymorphism as covariates.ResultsThe mean age of the patients was 54.9 years old (range, 28 to 82 years), and 124 (42.8%) patients were male; 226 (77.9%) were white, 43 (14.8%) were pardo, and 21 (7.2%) were black Brazilians. Of the patients included in this study, 133 (45.9%) presented with the CC genotype, 63 (21.7%) with the CG genotype, and 94 (32.4%) with the GG genotype of the PNPLA3 gene I148M variant. We observed that the associations between PNPLA3 rs738409 GG genotype and steatosis was significant (OR: 2.16; 95% CI 1.26-3.72). The same genotype was associated to advanced fibrosis too (OR:2.64; 95% CI 1.26-5.53).ConclusionsAssociations between the rs738409 polymorphism of the PNPLA3 gene genotype GG and hepatic steatosis and advanced fibrosis were observed. Studies are still needed to clarify the influence of these polymorphisms on hepatic steatosis and degree of fibrosis among individuals diagnosed with chronic hepatitis C.

Association between visceral obesity and hepatitis C infection stratified by gender: a cross-sectional study in Taiwan

ObjectivesThe global prevalence of hepatitis C virus (HCV) is approximately 2%–3%, and the prevalence of the positive anti-HCV antibody has been increasing. Several studies have evaluated regional adipose tissue distribution...

Liver toxicity of chemotherapy and targeted therapy for breast cancer patients with hepatitis virus infection

BackgroundChemotherapy has greatly improved the prognosis of breast cancer patients. However, it may also result in undesirable side effects such as hepatitis virus reactivation. Little information is available on the liver toxicity of chemotherapy and targeted therapy for breast cancer patients with hepatitis virus (HBV/HCV) infection. MethodsWe performed a retrospective survey of 835 patients diagnosed with breast cancer between January 2010 and December 2015 at our institution. All patients had been screened for HBV/HCV infection at the time of breast cancer diagnosis. We retrospectively investigated the toxicity of chemotherapy and the changes in HBV/HCV load based on a medical record review. Results52 patients with positive anti-HBV antibody test and 21 patients with positive anti-HCV antibody tests received chemotherapy. 762 patients without HBV and HCV infection served as the control group. The morbidity of liver toxicity and disruptions in chemotherapy attributable to liver toxicity were not significantly different among control group, HBV group and HCV groups (27.7% vs 34.6% vs 42.9%, P = 0.189 and 5.0% vs 9.6% vs 9.5%, P = 0.173, respectively). No patients presented with HBV/HCV reactivation. ConclusionBreast cancer patients with HCV can be treated with chemotherapy and targeted therapy with trastuzumab. Breast cancer patients with HBV who accept antiviral therapy can be treated with chemotherapy and targeted therapy with trastuzumab and patients can benefit from prophylactic antiviral therapy before chemotherapy. However, a multidisciplinary cooperation and closely monitoring liver function during the course of chemotherapy may benefit patients.

Effects of hepatitis C virus infection on the safety of chemotherapy for breast cancer patients.

Hepatitis C virus (HCV) is one of the major pathogens of chronic viral hepatitis, and approximately 38 million patients are infected with HCV in China. However, little information is available on the effect of HCV infection during chemotherapy for breast cancer and the impact of HCV infection on the toxicity of chemotherapy and targeted therapy. We performed a retrospective survey of 835 patients who were diagnosed with breast cancer between January 2010 and December 2015 at our institution. All patients had been screened for HCV infection at the time of breast cancer diagnosis. We retrospectively investigated the toxicities of chemotherapy and the changes in HCV load based on a review of the medical records. A total of 21 patients with positive anti-HCV antibody tests received chemotherapy. The median patient age was 46.3±11.2years. Four (19.0%) patients exhibited abnormal liver function at baseline. The morbidity of abnormal liver function at baseline was higher in HCV-infected patients (19.0% vs. 0, P=0.000). Four patients received trastuzumab therapy. Five (23.8%) patients who received chemotherapy developed hepatitis. No patients presented with HCV reactivation. The morbidity of hepatitis and the rate of disruption of chemotherapy were not significantly different between breast cancer patients without HCV infection and those with HCV infection (23.8 vs. 14.2% P=0.342, 9.5 vs. 5.0% P=0.619, respectively). HCV infection had no adverse impact on chemotherapy in breast cancer patients. However, consulting a gastroenterologist and closely monitoring liver function during the course of chemotherapy may benefit patients.