Positive Hepatitis C Virus Serology Research Articles

The Seroprevalence of Hepatitis C Virus (HCV) in Hemodialysis Patients in Oman: A National Cross-Sectional Study

BackgroundHCV infection in hemodialysis units is a significant cause of morbidity and mortality. The risk of HCV infection among dialysis patients is higher compared to the general population due to high potential blood exposures in hemodialysis settings. This study aims to assess the national HCV seroprevalence in selected dialysis units and to determine the risk factors for acquiring HCV infection.MethodsThis cross-sectional study was conducted from 1 January to 31 March 2021. A total of 734 patients from 11 hemodialysis centers in Oman were included. Samples were tested simultaneously for HCV antibodies and HCV RNA. HCV genotyping was determined in all viremic patients. Demographic and hemodialysis center related data were gathered and their association with the positive HCV serology were explored using univariate and multivariate logistic regression analysis.ResultsOut of 800 patients selected from 11 dialysis units for the study, 734 patients (91.8%) were included. The overall seroprevalence of HCV infection among hemodialysis patients was 5.6%. (41/734). HCV RNA was detected in 31.7% (13/41) of seropositive hemodialysis patients. The most common genotype was subtype 1a, followed by subtype 3. Variables associated with high HCV prevalence were family history of HCV and duration of dialysis.ConclusionThe prevalence of infection within hemodialysis patients in Oman has significantly decreased but remained higher than the general population. Continuous monitoring and follow-up, including periodic serosurvey and linkage to care and treatment are recommended. Additionally, practice audits are recommended for identifying gaps and ensuring sustainability of best practices and further improvement.

CHIME - A tailored HCV microelimination project in Viennese people who inject drugs at drug centralized substitution centers

BackgroundHepatitis C remains highly prevalent among people who inject drugs (PWIDs). We propose an integrated approach for screening/diagnostic testing and treatment in 6,665 Viennese PWIDs registered to access opioid agonist therapy (OAT). MethodsOAT prescriptions were required monthly at one of nine approved authorities, making them ideal platforms for hepatitis C virus (HCV) screening. All PWIDs attending these authorities between January 2019 and March 2020 were offered on-site HCV screening, and consecutive HCV RNA PCR in case of positive HCV serology. In HCV viremic PWIDs, offsite referral to HCV care and treatment according to directly observed therapy (DOT) alongside OAT were performed. Results4,327/6,665 (64.9%) individuals were contacted before the COVID-19-related project discontinuation. There were 1,538/4,327 (35.5%) individuals who had participated in the study. HCV serology was available in 1,510/1,538 (98.2%): 795/1,519 (52.6%) had a positive serology, among whom 632 (79.5%) were followed-up with a PCR test. In 8/1,538 (0.5%) additional study participants HCV RNA PCR was assessed without prior serological screening. 239/640 (37.3%) individuals were HCV viremic with 51 (21.3%) having started on direct-acting antivirals (DAAs). 48/51 (94.1%) had completed treatment, among whom 42 (87.5% according to ITT) had achieved sustained virologic response at 12 weeks after completing treatment (SVR12) and 6 (12.5%) had been lost to follow-up after completion of therapy (SVR12 according to mITT: 42/42, 100%). No treatment failures had occurred. ConclusionProviding integrated point-of-care HCV screening/diagnostic testing at central OAT approved centers, followed by DOT with DAAs, represents an effective HCV microelimination strategy. While some PWIDs were lost in the cascade to cure and the absolute number of SVR was limited by the COVID-19 pandemic, our approach will allow linkage to care in a large proportion of Viennese PWIDs.

Expanding the epidemiological understanding of hepatitis C in South Africa: Perspectives from a patient cohort in a rural town

The epidemiology of hepatitis C virus (HCV) in the general population of South Africa (SA) is incompletely understood. A high HCV prevalence in key populations is known, but data are limited in terms of a broader understanding of transmission risks in our general population.To investigate a patient cohort with HCV infection clustering in a rural SA town, in order to identify possible HCV transmission risks, virological characteristics, phylogenetic data and treatment outcomes.A cluster of patients with positive HCV serology, previously identified from laboratory records, were contacted by a local district hospital and offered confirmatory testing for HCV viraemia where needed. Those with confirmed HCV RNA were invited to a local hospital visit, where relevant demographic information was recorded, clinical assessment performed and a confidential questionnaire administered. HCV population-based sequencing was performed on HCV NS3/4A, NS5A and NS5B using polymerase chain reaction-specific or M13 universal primers, and sequences were aligned using BioEdit 7.2.5. Phylogenetic trees were constructed. Clinical assessments included liver fibrosis determination with FibroScan (cut-off ≥12.5 kPa = F4). Patients were offered treatment, and sustained virological response (SVR) was confirmed by undetectable HCV RNA at least 12 weeks after the end of treatment.Twenty-one patients, all from the same town, median (interquartile range (IQR)) age 64 (59 - 70) years, 57% female, were evaluated. Of these, 24% (n=5) were HIV co-infected, stable on antiretrovirals. The median (IQR) alanine aminotransferase level was 51 (31 - 89) U/L, with fibrosis distribution including 29% F1, 29% F2, 9% F3 and 33% F4 METAVIR fibrosis. Virologically, two genotypes were observed: 62% (n=13) genotype (GT) 1b and 38% (n=8) GT5a. No patient had ever used injecting drugs, 14% (n=3) had received blood products before 1992, and 9.5% (n=2) had undergone traditional healer-administered scarification. All (n=21) reported attendance at a single primary care clinic in the past, with most (n=20) recalling having received parenteral therapies at the clinic. Phylogenetic analysis of the HCV NS5A and NS5B regions confirmed GT1b and GT5a genotypes and formed two separate clusters within their respective genotypes, suggesting a common source for each genotype infection. Most patients received treatment with sofosbuvir/daclatasvir, 1 was treated with sofosbuvir/velpatasvir, and 1 was re-treated with sofosbuvir/velpatasvir/voxilaprevir. Per protocol SVR was 95%, with the non-SVR patient successfully re-treated.Data from a rural town cluster of patients suggest parenteral medical exposure as the probable common source of hepatitis C transmission risk. The cohort was of older age with a significant number having advanced fibrosis or cirrhosis, suggesting HCV acquisition in the distant past. Using a simplified care approach, treatment outcomes were very good.

Coordinated assistance plan for the elimination of hepatitis C virus at the centro de ayuda integral al drogodependiente (CAID (Comprehensive Care Centre for Drug Addicts))

Abstract Introduction The drug-injecting population has a high prevalence of hepatitis C virus (HCV) and high risk of transmission. It is a priority to establish an agile diagnostic and treatment plan. Objectives 1) Assess the effectiveness of a new coordinated care plan of referral from the Comprehensive Care Centre for Drug Addicts (CAID) to specialised care and 2) Determine the prevalence of HCV, clinical characteristics, effectiveness and safety of treatment in this population. Methods 1300 serologies requested by the CAID between 1998 and 2018 were retrospectively analysed, the seroprevalence of HCV was calculated and the efficiency of the traditional CAID-specialised care referral system was evaluated. A care plan was designed and coordinated among specialists involved in diagnosis and treatment. Since October 2018, 11 patients have been included in the new plan and the performance of both referral systems was compared. Results With the traditional system, 48.2% (83/172) of the patients were lost. 14.5% (172/1300) presented positive HCV serology, compared to the general population OR = 19; 95% CI 14.3−25. The prevalence of active infection was 80.3% (90/112). The prevalence of active infection was 80.3% (90/112). Of the 11 patients referred by the new plan, 76.9% (8/11) had active infection and 100% (8/8) were treated with Direct Antiviral Agents successfully. Conclusions The new coordinated CAID-specialised care plan presents high effectiveness in comparison with the traditional referral system. The seroprevalence and prevalence of active infection in the CAID population is very high. Treatments with Direct Antiviral Agents are effective and safe.

Plan asistencial coordinado para la eliminación del virus de la hepatitis C en el centro de ayuda integral al drogodependiente (CAID)

IntroductionThe drug-injecting population has a high prevalence of hepatitis C virus (HCV) and high risk of transmission. It is a priority to establish an agile diagnostic and treatment plan. Objectives1) Assess the effectiveness of a new coordinated care plan of referral from the Comprehensive Care Centre for Drug Addicts (CAID) to specialised care and 2) Determine the prevalence of HCV, clinical characteristics, effectiveness and safety of treatment in this population. Methods1,300 serologies requested by the CAID between 1998 and 2018 were retrospectively analysed, the seroprevalence of HCV was calculated and the efficiency of the traditional CAID-specialised care referral system was evaluated. A care plan was designed and coordinated among specialists involved in diagnosis and treatment. Since October 2018, 11 patients have been included in the new plan and the performance of both referral systems was compared. ResultsWith the traditional system, 48.2% (83/172) of the patients were lost. 14.5% (172/1,300) presented positive HCV serology, compared to the general population OR = 19; 95% CI 14.3-25. The prevalence of active infection was 80.3% (90/112). The prevalence of active infection was 80.3% (90/112). Of the 11 patients referred by the new plan, 76.9% (8/11) had active infection and 100% (8/8) were treated with Direct Antiviral Agents successfully. ConclusionsThe new coordinated CAID-specialised care plan presents high effectiveness in comparison with the traditional referral system. The seroprevalence and prevalence of active infection in the CAID population is very high. Treatments with Direct Antiviral Agents are effective and safe.

Hepatitis B and C Viruses Infections Among Dialysis Patients in Saudi Arabia

Background: Viral Hepatitis is a global disease, affecting millions of patients around the world. Dialysis dependent patients used as an artificial kidney (hemodialyzer) to remove waste product from the blood in severe renal impairment patients. Hence they are more vulnerable to viral hepatitis. Aims:The aim of this study is to investigate the prevalence of hepatitis B and C infections among dialysis patients in the Qassim province, Saudi Arabia. We further examine their epidemiological profile, risk factors, prognostic factors, treatment course, and characterization of their liver disease stage. Methods: This study is a cross-sectional study. Hepatitis B and C positive patients receiving dialysis in Qassim Province were included in this study. We reviewed the data registry of dialysis centers where medical records of hepatitis B surface antigen (HBsAg) and hepatitis C virus (HCV) serology are reported from 18 affiliated dialysis centers across Al Qassim Region. The prevalence was calculated by dividing the number of patients with positive HBsAg or HCV serology to the total number of patients. Results: The prevalence of Hepatitis B Surfaces Antigen (HBsAg) positive cases among in-center hemodialysis patients was 20 (03.2%) with 12 (01.9%) of cases converting from HBsAg negative to positive during the previous 12 months. While the prevalence of Hepatitis C antibody positive cases was 40 (06.4%) with 2 cases converting from negative to positive during the previous 12 months. Conclusion: This study finds low intermediate prevalence HBV and high prevalence for HCV according to CDC classification. Funding Statement: The authors received no financial support for the research, authorship, and/or publication of this article. Declaration of Interests: The authors declare that they have no conflicts of interest. Ethics Approval Statement: This paper is approved by Qassim Research Ethics Committee.

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.

Chronic hepatitis C patients lost in the system: predictive factors of non-referral or loss of follow-up in Hepatology units.

several barriers remain in the hepatitis C care cascade, which need to be removed in order to eliminate chronic hepatitis C. These barriers include deficiencies in screening and confirmatory diagnosis as well as difficulties in accessing treatment. to identify factors associated with the non-referral of patients with positive hepatitis C virus (HCV) antibodies and to identify factors associated with loss of follow-up or non-attendance of these patients to specialist consultation after referral. observational and retrospective single-center-study, including all positive HCV serology tests performed between January 2013 and May 2018, in the Virgen Macarena health area (Seville, Spain) before implementing the one-step diagnosis. Non-referred patients and patients who were lost to follow-up after being referred were identified. a total of 54 (77.4 %) patients diagnosed in Primary Care (PC) and 54 (22.2 %) from hospital specialists were not referred (p < 0.001). Predictors for non-referral were: stay in prison/institutionalization (p = 0.04), suffering chronic obstructive pulmonary disease (COPD) (p = 0.07), a normal AST value (p = 0.034) or test requested by Primary Care physician (PCP) (p = 0.004). Patients referred from PC were more likely to be lost to follow-up than those referred from hospital specialists (p < 0.001). Predictors of follow-up loss included: opioid replacement therapy (p = 0.034), absence of high blood pressure (p = 0.039) and test requested by PCP (p = 0.049). a high percentage of patients with positive HCV serology were not referred or were lost to follow-up, mainly those belonging to high risk social groups or those with associated comorbidities. Patients with average values of transaminases or those diagnosed in PC were also less frequently referred.

Point-of-care Hepatitis C virus testing and linkage to treatment in an Australian inner-city emergency department

BackgroundIn Australia, Hepatitis C Virus (HCV) treatment is declining, despite broad access to direct-acting antiviral medication. People who inject drugs are proportionally over-represented in emergency department presentations. Emergency department assessment of people who have injected drugs for HCV presents an opportunity to engage this marginalised population with treatment. We describe the outcomes of risk-based screening and point-of-care anti-HCV testing for emergency department patients, and linkage to outpatient antiviral treatment. MethodsDuring the three-month study period, consecutive adult patients who presented to the emergency department during the study times were screened for risk factors and offered the OraQuick oral HCV antibody test. Those with reactive results were offered venepuncture in the emergency department for confirmatory testing and direct-acting antiviral treatment in clinic. The main outcome measures were the number and proportion of viremic participants that were linked to the hepatitis clinic, commenced treatment and achieved a sustained viral response. Secondary outcome measures were the proportion (%) of presentations screened that were oral antibody reactive, and the prevalence and type of HCV risk factors. ResultsDuring the study period, 2408 of the 3931 (61%) presentations to the emergency department were eligible for screening. Of these 2408 patients, 1122 (47%) participated, 307 (13%) declined participation and 977 (41%) could not be approached during their time in the emergency department. Among the 1122 participants, 378 (34%) reported at least one risk factor. Subsequently, 368 (97%) of the 378 participants underwent OraQuick anti-HCV test, and 50 (14%) had a reactive result. A risk factor of ever having injected drugs was present in 44 (88%) of participants who were sero-positive. Of the 45 that had blood tested, 30 (67%) were HCV ribonucleic acid (RNA) positive. Three participants died. Of the 27 remaining participants, 10 (37%) commenced treatment and 7 of these 10 (70%) obtained a cure. There was a high rate of homelessness (24%) among anti-HCV positive participants. ConclusionAmong emergency department participants with a risk factor for HCV, positive serology was common using a rapid point-of-care test. A history of injecting drug use was identified as the risk factor with highest yield for positive HCV serology, and is suitable as a single screening question. However, linkage to care post ED presentation was low in this marginalised population. There is a need for new pathways to improve the care cascade for marginalised individuals living with HCV infection.

Predictive factors for not undergoing RNA testing in patients found to have hepatitis C serology and impact of an automatic alert.

The process of diagnosis and linkage to care in cases of hepatitis C virus (HCV) infection remains an obstacle to disease control. The aims of this study were to evaluate predictive factors for not undergoing RNA testing among patients with positive HCV serology and impact of incorporating an automated electronic alert with recommendations in clinical practice. We collected HCV antibody tests requested from October 2011 to September 2014 to evaluate the rate of RNA testing and predictive factors for not undergoing RNA testing. Since October 2014, an automated alert notification has been implemented to remind physicians for testing RNA after a positive HCV test and referral to specialist care. 41403 HCV antibody tests were requested from 34073 patients. 870 (2.55%) patients tested positive. After a median of follow-up of 57.0months (range 45.6-82.1), 37.6% did not have RNA testing. The independent predictors for not undergoing RNA testing were primary care serology requests (P<0.001), no history of drug use (P=0.005) and a lack of social support (P=0.015). The intervention impact was evaluated in a pre-alert cohort (October 2011-September 2014) and a post-alert cohort (October 2014-September 2015). After the incorporation of the alert, the rate of RNA testing increased from 62.4% to 77.7% (P<0.001). Incomplete assessment of HCV infection is a challenge in primary care. The implementation of an automated alert for recommending RNA testing after a positive HCV antibody test is feasible in clinical practice and increases the rate of patients with RNA testing.

Biochemical markers and levels of physical activity related to the hepatic condition of patients infected by the hepatitis C virus

Summary Study aim: The study is quantitative, with a cross-sectional comparison design, and aimed to verify the association between physical activity (PA) levels and biochemical markers linked to liver function of patients infected with hepatitis C virus (HCV). Material and methods: The following biochemical variables were analyzed: alanine aminotransferases (ALT), gamma-glutamyl transpeptidase (γGt), and alkaline phosphatase (FA), these being good markers for hepatic damage, besides glycemia, HDL, LDL, and triglycerides. The International Physical Activity Questionnaire (IPAQ), short version, was used to evaluate the lev­els of physical activity, being classified as active and physically inactive. Results: The sample consisted of 84 individuals aged 56.2 ± 11.6 years; there was a predominance of males, patients with dif­ferent socioeducational patterns and those followed up for more than 6 months in the hepatology service with positive serology for HCV and HCV (RNA+), attending the Institute of Liver and Transplants of Pernambuco (IFP). The results obtained in this study indicate smaller values of the median with maximum and minimum scores of the analyzed parameters in patients consid­ered to be physically active (ALT: p = 0.43, FA: p = 0.86 and γGt: p = 0.15, glycemia: p = 0.22, LDL: p = 0.58, HDL: P = 0.004, triglycerides: p = 0.47), in comparison with the physically inactive patients. It is concluded that patients who have a higher level of physical activity present lower values of biochemical markers, positively affecting their hepatic condition. Conclusions: There was only a significant difference in the HDL variable, but the patients with a lower level of physical activ­ity showed greater values in general, less in the triglyceride variability. In order to test these and other important variables and improve the quality of life and health by a more direct method.

Hepatitis C virus infection in southwestern Saudi Arabia: Are we still in the plateau phase?

The aim was to study the seroprevalence of Hepatitis C virus (HCV) infection and related risk factors in Aseer region in southwestern Saudi Arabia, the region known to be of the highest endemicity of viral hepatitis. In a cross-sectional study, all participants were interviewed using structured questionnaire. HCV infection was diagnosed using fourth-generation ELISA. All positive and equivocal HCV serology results were further confirmed by using a qualitative confirmatory RT-PCR. The study enrolled 10,234 participants. A seroprevalence of 2.2% (95%CI: 1.9-2.5%) was found. In multivariate logistic regression analysis, the study showed that males had significantly more risk to become seropositive for HCV (aOR = 1.437, 95%CI: 1.071-1.927) compared to females. Similarly, participants having history of blood transfusion had more than two times the risk of becoming seropositive for HCV (aOR = 2.079, 95%CI: 1.037-4.149). HCV infection in the study area is still high in the plateau phase. It is recommended to have an active educational and media campaign about the risks of HCV infections. Workshops and training of qualified laboratory staff related to blood banking seem mandatory. J. Med. Virol. 89:867-871, 2017. © 2016 Wiley Periodicals, Inc.

Long-term outcomes of lung transplant recipients with hepatitis C infection: a retrospective study of the U.S. transplant registry.

Chronic hepatitis C patients in need of a lung transplant are often considered ineligible due to their infection. To assess the association of hepatitis C virus (HCV) infection with long-term outcomes of lung transplants. From the Scientific Registry of Transplant Recipients (1995-2011), we selected all adults with and without HCV infection who underwent lung transplantation. A total of 17 762 lung transplant recipients were included (55.5% bilateral). Of those, 319 (1.83%) had positive HCV serology. The HCV-positive recipients were 1.6 years younger, less Caucasian and more African-American, and had a significantly higher rate of co-infection with hepatitis B virus (all P < 0.001). Post-transplant patients were discharged alive at similar rates regardless of HCV status: 88.4% in HCV+ vs. 90.3% in HCV- (P = 0.25). The mortality rates were also similar at 1 and 2 years after transplantation (20.7% in HCV+ vs. 19.2% in HCV- and 31.6% in HCV+ vs. 28.9% in HCV-, respectively; both P > 0.05), but at post-transplant year 3 year, mortality rate in HCV+ became significantly higher (42.5% vs. 36.4%, P = 0.04) and remained higher for the duration of the follow-up (mean 9.1 years, max 18.4 years). In multivariate survival analysis, after adjustment for confounders, being HCV+ was associated with higher mortality: adjusted hazard ratio 1.24 (1.04-1.46), P = 0.01. No association of HCV infection with time to graft loss was found (P = 0.92). Chronic HCV infection is associated with a moderate increase in post-lung transplant mortality. Treatment of HCV in lung transplant recipients may, therefore, result in improvement of post-transplant outcomes.

Incidence and prevalence of hepatitis B and hepatitis C viruses in hemodialysis patients in Lebanon.

To determine the incidence and the prevalence of hepatitis B and C viral infections in patients on hemodialysis (HD) across Lebanon. We reviewed the data registry at the Lebanese Ministry of Public Health where records of monthly hepatitis B surface antigen (HBsAg) and hepatitis C virus (HCV) serology are reported from 60 affiliated HD centers across Lebanon. All patients who were on HD or who started HD between October 2010 and July 2012 were included in the study. Patients from seven HD centers were excluded due to inadequate and incomplete results reporting. During the selected period, HBsAg and HCV serology were available for 3769 patients from 53 HD centers distributed at all Lebanese governorates. The prevalence was calculated by dividing the number of patients with positive HBsAg or HCV serology to the total number of patients. The Incidence was calculated by dividing the number of newly acquired infection to number of patients-years (p-y). Incidence rates at different governorates were compared to each other using two tailed Z test and a P value of < 0.05 was considered significant. Sixty out of 3769 HD patients were found to have positive HBS Ag and 177 out of 3769 were positive for HCV Antibodies. The prevalence of hepatitis B virus (HBV) and HCV in HD patients across Lebanon was 1.6%, and 4.7%, respectively. The comparison of prevalence according to geographic distribution could not be done accurately due to the frequent shift of patients between dialysis centers at different governorates. The incidence rate was 0.27 per 100 p-y for HBV and 0.37 per 100 p-y for HCV. There was no significant difference concerning the incidence of HBV between HD centers at different governorates (all P values > 0.1), but this difference was highly significant concerning the incidence rates of HCV which occurred predominantly in the southern centers (1.47 per 100 p-y) with a P value of 0.00068 and 0.00374 when compared to Mount Lebanon (0.21 per 100 p-y) and the Northern centers (0.19 per 100 p-y), respectively. The incidence rate of HBV and HCV is very low in the Lebanese HD centers and their prevalence is decreasing over the last two decades.

Retrospective Study of Hepatitis C Virus Genotypes and its Association with Lymphoma

Hepatitis C virus (HCV) involves both the liver and extra hepatic organs. The aim of this study was to retrospectively evaluate the association between HCV genotypes and lymphomas. Lymphoma cases were retrieved from our surgical pathology and hematopathology archives from January 2005 to April 2012. Patients who had positive HCV serology with subsequent viral genotyping were selected. Patients with positive Human immunodeficiency virus (HIV)serology were excluded. We identified 17 lymphoma cases with associated HCV infection. Eleven out of 14 (79%) patients had genotype 1 HCV. Diffuse large B cell lymphoma (DLBCL) was the most common lymphoma (6 out of 17 cases) and all cases of DLBCL had genotype 1. Genotype 2 was detected in only three patients (21%) with the diagnoses of follicular lymphoma, splenic marginal zone lymphoma, and classical Hodgkin lymphoma (CHL). CHL was diagnosed in three cases and peripheral T-cell lymphoma in one case.Twelve of 17 (71%) patients were incarcerated in the Texas Department of Criminal Justice system. All 11 genotype 1 patients were male, 4 of 11 (36%) were African American, 4 of 11 (36%) were Caucasian and 3 of 11 (27%) were Hispanic.We concluded that HCV genotype 1 was more common than genotype 2 while no other genotype was detected.

PTH-083 Management Outcomes For Patients With Positive Hepatitis C Serology Over A Three Year Period In York Hospital

IntroductionThe majority of patients with Hepatitis C Virus (HCV) in England remain undiagnosed. There are an estimated 1298 patients infected with HCV in North Yorkshire,1 but a fraction of these...

THU0298 Are Anti-La Antibodies A Potential Protection for Hepatitis C Virus Infection in SjÖGren Syndrome? Analysis in 663 Patients

BackgroundA close association between hepatitis C virus (HCV) chronic infection and Sjögren syndrome (SS) was reported 10 years ago. Recently, human La protein has been implicated in facilitating the internal...

Incidence of Post-Transplantation Lymphoproliferative Disease in Andalusia (1990–2009)

BackgroundPost-transplantation lymphoproliferative disease (PTLD) is a severe complication of renal transplantation (RT) but information about its incidence and predisposing factors is diverse, varying according to geographic area and study period. MethodsWe analyzed the incidence of PTLD after all RT performed at adult transplantation centers in Andalusia from January 1, 1990 to December 31, 2009, recorded in the Andalusian Transplant Co-ordination Information System (SICATA) regional computerized database (n = 5577). We calculated the risk of PTLD using the Kaplan-Meier curve, censoring for organ failure and incidence rate per patient-year of exposure. Log-rank comparisons were made by center (n = 5), decade (1990–1999 vs 2000–2009), age group, recipient gender, hepatitis C virus (HCV) serology, transplantation number, and duration of pre-RT replacement therapy (per quartiles). ResultsWe identified 60 cases of PTLD. The pre-RT treatment time was 48.2 ± 60 months; 11.7% were retransplantations, and 10.4% had a positive HCV serology. The median post-RT time before diagnosis of PTLD was 5.98 years. At the time of the database analysis, only 11 patients (18%) were alive with a functioning transplant; 10% had returned to dialysis and 72% had died. The actuarial incidence of PTLD at 1, 5, 10, and 20 years post-RT was 0.2%, 0.5%, 1.6%, and 2.9%, respectively; the exposure rate was 14.71 PTLD/10,000 patient-years (95% confidence interval [CI], 12.3–17.1). Although the incidence tended to be higher in 1990–1999 than 2000–2009 (16.8 vs 12.1 cases/10,000 patient-years), in the actuarial study the difference was far from significant (at 7.5 years, 1.2 vs 0.8%; P = .4). Nor were there significant differences in the curves of incidence per RT center (1%–1.2% of patients) or recipient characteristics. ConclusionsThe cumulative incidence of PTLD in Andalusia in patients with a functioning kidney transplant during 1990–2009 was 2.9% at 20 years. There was no significant variation between the RT centers or over time. No associated factors were identified among the basic recipient variables studied.

EBV-DNA In Peripheral Blood Of Patients With Diffuse Large B Cell Lymphoma: Associations With Patient Characteristics and Outcome

Infection of EBV has been linked to the etiology of a number of lymphoproliferative diseases, and EBV+ diffuse large B cell lymphoma (DLBCL) of the elderly has been more recently described as a distinct entity. The viral load of EBV-DNA in plasma can be an indicator for EBV-association in some lymphoma types, as NK/T-cell lymphoma and Hodgkin lymphoma, and a marker for disease activity associated with negative prognosis. Here, we studied whether EBV-DNA in whole blood (WB), mononuclear cell fraction (MNC) and plasma of patients with DLBCL at diagnosis could be an indicator for EBV-association and a prognostic marker in patients treated with immunochemotherapy (R-CHOP).We analysed 247 patients with DLBCL (median age 64 years, range 15-92 years; 118 females, 129 males), diagnosed between 2006 and 2013. All patients were HIV-negative. EBV was detected using a commercial real-time PCR kit (BioQuant EBV, Biodiversity, Brescia, Italy) in peripheral blood (PB) compartments (WB n=240, plasma n=55, and MNC n=52). Lymph node samples from 61 DLBCL patients were analyzed for EBV infection through in situ hybridization for EBV-encoded small RNAs (EBER).EBV was detected in 58 of 240 WB samples (24%). The copy number varied between 2 x 102 and 4.9 x 106 copies/ml. The presence and copy number of EBV in WB and MNC were correlated (p<0.01, respectively), while there was no correlation to the detection of EBV in plasma. We did not find any association between the presence or viral load of EBV-DNA in any blood compartment and the presence of EBV in the lymphoma cells of 61 patients studied with EBER–ISH (11 patients EBER positive). Elderly patients (>60 years of age) had more often EBV in peripheral blood (30% vs 17%), and the viral load was higher in patients aged > 60 years (p<0.01). The presence of EBV-DNA in PB was also strongly associated with a positive serology for Hepatitis C virus (HCV): 20/221 patients (8.8%) were HCV+, and 11/20 patients (55%) harbored EBV-DNA in PB, while in the HCV- patients the frequency of EBV-positivity in PB was 21% (42/201) (p=0.002). As a positive serology for HCV is associated with age > 60 years (p=0.02), we performed a logistic regression analysis including age and HCV serology as parameters determining the EBV viral load in PB. In this analysis, HCV serology, but not age remained a significant factor for EBV viral load (p=0.004). Presence and viral load of EBV in PB was not related to other characteristics as gender, stage, performance status, LDH level, and IPI. In an univariate analysis including 201 patients treated with R-CHOP, the presence of EBV-DNA in WB was associated with a significantly shorter event-free survival (EFS): 67% (50%-79%, 95% C.I.) versus 80% at 2 years (p<0.04). Correcting for IPI and HCV serology in a multivariate Cox analysis, the presence of EBV-DNA in PB retained its prognostic significance (HR 1.9; 95% C.I., 1.07-3.43; p<0.03).Our findings suggest that EBV can be frequently detected in peripheral blood at DLBCL diagnosis, that is not a surrogate marker for EBV-status in DLBCL, but associates with a worse outcome. Further studies are needed to explore the mechanisms of expansion of EBV-positive cells in patients with DLBCL. Disclosures:No relevant conflicts of interest to declare.

Harmful Effects of Viral Replication in Seropositive Hepatitis C Virus Renal Transplant Recipients

Seropositivity for hepatitis C virus (HCV) predicts lower patient and graft survival after renal transplantation (RT). However, the influence of viral replication at transplantation on long-term outcome remains to be determined. This was a retrospective study conducted in four Spanish hospitals, from 1997 to 2006. Data of all patients with RT, who displayed HCV+ (enzyme-linked immunosorbent assay), and with negative viremia at RT (NEG group) were collected (n=41). For each NEG patient enrolled, data of two patients with RT nearest in time, HCV+, and positive viremia (POS group) were also collected (n=78). The POS group showed a higher incidence of long-term liver disease (56.4% vs. 24.4%, P=0.0009) and episodes of transaminase elevation (38.5% vs. 7.3%, P=0.0003) and worse renal function (serum creatinine [sCr], 3.0 [2.7] vs. 1.9 [1.6] mg/dl, P=0.032; glomerular filtration rate, 43.7 [22.4] vs. 56.9 [27.9] ml/min, P=0.075). Noteworthy, 24.4% of NEG patients reactivated after RT, showing a worse patient survival (P=0.039). Active viral replication at RT and dialysis requirement in the first week remained as independent predictors of lower graft survival (death censored): hazards ratio, 3.11 (95% confidence interval, 1.34-7.19; P=0.009) and hazards ratio 3.13 (95% confidence interval, 1.53-6.37; P=0.002). This study shows that active viral replication at transplantation is an independent risk factor for graft failure in patients with positive serology for HCV.