Positive Hepatitis C Virus Research Articles

Characteristics of Deceased Solid Organ Donors and Screening Results for Hepatitis B, C, and Human Immunodeficiency Viruses - United States, 2010-2017.

The ongoing U.S. opioid crisis has resulted in an increase in drug overdose deaths and acute hepatitis C virus (HCV) infections, with young persons (who might be eligible organ donors) most affected.*,† In 2013, the Public Health Service released a revised guideline to reduce the risk for unintended organ transplantation-associated hepatitis B virus (HBV), HCV, and human immunodeficiency virus (HIV) transmission (1). The guideline describes criteria to categorize donors at increased risk (increased risk donors [IRDs]) for transmitting these viruses to recipients (1). It also recommends universal donor testing for HBV, HCV, and HIV.§ CDC analyzed deceased donor data for the period 2010-2017 reported to the Organ Procurement and Transplantation Network for IRDs and standard risk donors (SRDs) (i.e., donors who do not meet any of the criteria for increased risk designation). During this period, the proportion of IRDs increased approximately 200%, from 8.9% to 26.3%; the percentage with drug intoxication reported as the mechanism of death also increased approximately 200%, from 4.3% to 13.4%; and the proportion of these donors with reported injection drug use (IDU) increased approximately 500%, from 1.3% to 8.0%. Compared with SRDs, IRDs were significantly more likely to have positive HBV and HCV screening results. These findings demonstrate the continuing need for identifying viral bloodborne pathogen infection risk factors among deceased donors to reduce the risk for transmission, monitor posttransplant infection in recipients, and offer treatment if infection occurs.

Hepatitis C virus infection in Australian psychiatric inpatients: A multicenter study of seroprevalence, risk factors and treatment experience

Screening and treatment for hepatitis C virus (HCV) infection were not prioritised in psychiatric patients due to adverse neuropsychiatric effects of interferon therapy despite reports of high prevalence. However, with the safe new antiviral drugs, HCV eradication has become a reality in these patients. The aim of this study was to report HCV seroprevalence, risk factors and treatment model in an Australian cohort. This prospective study involved patients admitted to four inpatient psychiatric units, from December 2016 to December 2017. After pretest counselling and consent, HCV testing was done; information on risk factors collected. A total of 260 patients (70% male), median age 44years (IQR 24), were studied. The HCV seroprevalence was 10.8% (28/260) with 95% CI 7-15. Independent predictors of HCV positivity were injection drug use (P<0.001, OR 44.05, 95% CI 7.9-245.5), exposure to custodial stay (P=0.011, OR 7.34, 95% CI 1.6-33.9) and age (P=0.011, OR 1.09, 95% CI 1.02-1.16). Eight of the 16 HCV RNA-positive patients were treated. Hepatitis nurses liaised with community mental health teams for treatment initiation and follow-up under supervision of hepatologists. Seven patients achieved sustained viral response, one achieved end of treatment response. The remaining eight patients were difficult to engage with. In conclusion, HCV prevalence was high in our cohort of psychiatric inpatients. Although treatment uptake was achieved only in 50% patients, it was successfully completed in all, with innovative models of care. These findings highlight the need to integrate HCV screening with treatment linkage in psychiatry practice.

Opportunistic assessment and treatment of people with hepatitis C virus infection admitted to hospital for other reasons: A prospective cohort study

BackgroundIt will be essential to find novel ways to access, diagnose and treat people with Hepatitis C Virus (HCV) infection in Australia to achieve HCV elimination. AimWe assessed the effectiveness of opportunistic HCV assessment and antiviral treatment in patients admitted to hospital for other reasons. MethodsPatients with HCV infection were referred from inpatient services at a tertiary referral centre in Sydney. Patients were assessed for HCV treatment with transient elastography (TE), HCV genotype and a clinical assessment and a summary letter was generated for all patients with a general practitioner (GP). Patients were offered treatment commencement at hospital discharge or after discharge with their GP, the infectious diseases clinic or with a gastroenterologist if they had cirrhosis. The primary outcome was the proportion of eligible patients who commenced treatment. We also undertook an intention to treat (ITT), modified intent to treat (mITT) analysis for virologic outcome (SVR12) and per protocol cure rates. An assessment of potential efficiency gains was undertaken. ResultsA total of 100 patients with a positive HCV antibody test were enrolled, of whom 70 were viraemic. The cohort included a high proportion of people who currently or previously injected drugs, indigenous patients and people previously lost to follow-up from other services. Treatment was initiated in 46 (66%) patients. The ITT was 80.4% (37/46) and mITT rate was 84.1% (37/44).The per-protocol SVR12 rate was 94.9%. Two subjects with genotype 3 and cirrhosis failed treatment, two subjects died and five were lost to follow up. The key barrier to uptake of DAA was incomplete assessment. Key inefficiencies of this model of care included referral of non-viraemic subjects, limited TE access and virologic test turnaround times. ConclusionThis model of care can complement the current efforts to increase HCV treatment in the community for those who do not access care elsewhere or are lost to follow-up.

Prevalence of viral and non-viral hepatitis in Menoua Division, West Region, Cameroon: a retrospective hospital-based study

IntroductionThe paucity of data on hepatitis' epidemiology in Menoua Division, west region, Cameroon, prompted us to assess the prevalence of viral and non-viral hepatitis in this area.MethodsA retrospective exhaustive study based on records of patients from January 2008 to June 2014 was conducted in 9 health centres in Menoua Division. Targeted subjects were patients who did not receive hepatitis vaccines for the past year and have been screened for hepatitis B virus (HBV), hepatitis C virus (HCV) and/or a blood transaminase. Associations between variables were quantified with odd ratios (OR) and 95% confidence interval (CI). Cochran-Armitage test of linear trend was used for testing proportions of ordinal variables. Fisher's exact test was used for testing the association between 2 qualitative variables when expected counts were less than 5.ResultsThe overall prevalence were 9.6% and 6.7% for HBV and HCV respectively. HBV mostly infected people aged 21-30 (12.4%) while the prevalence of HCV increased with age up to 35.4% (p=0.03). A 0.6% co-infection was observed. Thirty percent of positive HBV or HCV had high transaminase while 13% of patients with elevated transaminase showed negative viral serology.ConclusionThese results show that hospital-based prevalence of HCV and HBV in Menoua Division is under the Cameroon's national range but point out the fact that non-viral hepatitis might be a serious case of concern in this area. There is therefore, a need to identify the risk-factors of non-viral hepatitis.

Effect of hepatitis C virus infection on patients with pulmonary tuberculosis

Background Tuberculosis (TB) and hepatitis C virus (HCV) remain major health problems in our country that affect health, economy, and development. Several studies have been done to show the correlation between TB and HCV coinfection and its effect on the patient’s outcome. Aim The aim was to assess the effect of HCV infection on the course and outcome of the patients with pulmonary TB. Patients and methods This retrospective (case–control) study was carried out on two groups of patients: group I: 20 patients with pulmonary TB and positive HCV infection; group II: 20 patients with pulmonary TB and seronegative HCV infection such as age-matched and sex-matched control group. Results There was no significant difference between the two studied groups regarding gender, age, and smoking; the mean age of 51.80±13.66 was in group I and the mean age of 45.70±16.86 was in group II (P>0.05). The number of retreatment cases was higher in group I (20%) and new diagnosed cases were higher in group II (90%). There was no significant difference between the two groups as regards conversion of their samples (P>0.05), but nonconversion and delay of conversion (at third month) of samples were higher in group I than in group II. Diffuse infiltration and cavitary lesion were the predominant findings in group I more than in group II. The failure of treatment was higher in group I than in group II. Regarding Child classification and HCV titer: 14 (70%) patients were of class A, five (25%) patients were of class B, and one (5%) patient was of class C. Twelve (60%) patients had low HCV titer and eight (40%) patients had high HCV titer. In group I, there was significant statistical difference between Child classification and HCV titer on one hand and outcome of treatment (P<0.05) on the other. Conclusion TB and HCV coinfection has an effect on the patients as there is an increase in the number of reactivation and retreatment cases. Negativity of sputum sample is common and there is a delay of sputum conversion. There are higher chances of multidrug-resistant (MDR) TB and treatment failure.

Peripheral blood mononuclear cells hepatitis C virus RNA as a predictor for the response to daclatasvir-containing oral antiviral regimen in chronic hepatitis C patients from the Damietta Governorate

Background Eradication of hepatitis C virus (HCV) infection is the goal of direct-acting antivirals with a high rate of sustained virological response (SVR). Currently, SVR is determined by negative serum HCV RNA by real-time (RT)-PCR that may not give any information about intracellular HCV replication. Aim To study peripheral blood mononuclear cells (PBMCs) HCV RNA as a predictor for the response to daclatasvir-containing oral antiviral regimen in chronic hepatitis C patients. Patients and methods In all, 150 patients with chronic HCV, classified into 100 easy-to-treat patients (group I) and 50 difficult-to-treat patients (group II), who achieved SVR to sofosbuvir plus daclatasvir with or without ribavirin were enrolled in the study. HCV RNA was evaluated in both sera and isolated PBMCs using the polymerase chain at 3 and 12 months from the end of treatment (EOT). Results As regards HCV RNA in peripheral blood mononuclear cells (PBMCs) we found that no case was positive in the easy to treat (group I). In difficult to treat (group II), six (4%) patients were positive at 3 months and 24 (16%) patients at 12 months after EOT. However, there is no virological, clinical, or biochemical relapse noted during the follow-up period among positive cases. All positive cases were cirrhotic, with significantly lower platelets count and albumen level but higher bilirubin than group I. Conclusion All easy-to-treat groups were HCV RNA in PBMCs negative at EOT and during the follow-up period (1 year). Follow-up of cirrhotic patients with positive HCV RNA in PBMCs showed no clinical, biochemical, or virological relapse.

Detection Of Hepatitis C Virus (Hcv) Infection And Its Genotype In Patients At Hepatology Outpatient Clinic, Dr Soetomo General Hospital, Surabaya.

Hepatitis C virus (HCV) is an RNA virus that can cause liver inflammation (hepatitis) and has the potential to become chronic and can progress to liver cirrhosis and hepatocellular carcinoma. Detection of HCV RNA infection, and genotype/subtype of HCV was performed on 70 blood sera of patients at the Hepatology Outpatient Clinic of Dr Soetomo General Hospital, Surabaya, Indonesia. Detection of HCV infection was carried out by Anti-HCV determination using enzyme immunoassay (EIA) technique, detection of HCV RNA by Reverse Transcription Polymerase Chain Reaction (RT-PCR) technique based on genome regions NS5b and 5’UTR, followed by electrophoresis with agarose gel. In positive PCR results, HCV genotype/subtype was determined by direct sequencing method using ABI 310 sequencer and sequencing results were analyzed by comparing the products with previously published HCV nucleotides. Sera were obtained from 41 (58.6%) male and 29 (41.4%) female patients. Anti-HCV was found positive in 17/70 (24.29%) patients and 16/17 (94.1%) was proved to contain HCV RNA when determined by RT-PCR technique. Patients with positive HCV RNA have the potential to transmit HCV infection. From the genotype/subtype analysis of sequencing results we obtained 2/16 (12,5%), 3/16 (18,75%) and 6/16 (37,5%), 1/16 (6,25%), 1/16 (6, 25%), 2/16 (12,5%), 1/16 (6,25%) HCV genotypes 1, 2, and HCV subtypes 1b, 1c, 2a, 3a, 3k respectively.Conclusion: In patients who went to the Hepatology Outpatient Clinic, Dr. Soetomo General Hospital Surabaya, we found positive Anti-HCV was 24,29%. In 94,1% of patients with positive Anti-HCV, HCV RNA was still detected and HCV genotype 1 with subtype 1b were still dominant HCV subtypes.

2212. Preliminary Screening Results Outside the 1945–1965 Birth Cohort: A Forgotten Population for HCV?

BackgroundHistorically, hepatitis C virus (HCV) infection was most prevalent among those born between 1945 and 1965. Current CDC guidelines recommend screening for HCV only among this birth cohort or in patients with known risk factors for HCV infection. However, recent epidemiologic data shows increasing HCV incidence among younger patients. Universal screening may facilitate earlier recognition of infected individuals.MethodsAt our center, the admission order set previously included a required prompt to order HCV screening for patients born between 1945 and 1965. In December 2017, we expanded the default order to include all patients above the age of 18. We compared rates of HCV screening and positivity during the first three months of this policy to similar months in the preceding year. We also reviewed the charts of HCV-positive patients to identify documented risk factors.ResultsFrom December 2017 to February 2018, a total of 11,118 patients were screened with 389 (3.5%) positive results, compared with 8,423 patients and 361 (4.3%) positives during the same months in 2016–2017. Outside the birth cohorts, 179 (1.1%) patients were HCV positive in 2017–2018 compared with 117 (2.3%) in 2016–2017. Thirty-five HCV-positive patients were born outside the birth cohort. Twenty-one (60%) had no documented risk factors. Among the cohort born after 1965, only three out of 17 (17%) patients had no known risk factors, compared with all 18 (100%) patients born before 1945.ConclusionDocumented substance use disorders and social vulnerability were highly prevalent in HCV-positive patients born after 1965 and rare in those born before 1945.Disclosures All authors: No reported disclosures.

2202. The Hepatitis C Virus Cascade of Care at Stony Brook University Hospital: Risk Factors for Linkage to Care

BackgroundHuge efforts are being made to screen high-risk populations for Hepatitis C virus (HCV) infection, however linkage to care (LTC) rates remain low. The aim of this study was to assess the factors affecting LTC among HCV positives in a major tertiary academic medical center in eastern New York.MethodsA retrospective chart review was performed on all patients with ICD-9 or 10 diagnostic codes for HCV positive antibody over a period of 2 years (2016–2017) at Stony Brook Medicine. Data were collected for HCV RNA, LTC, demographics, type of insurance, employment status, psychiatric diagnosis, comorbidities, HIV or HBV coinfections, substance use disorder, and level of fibrosis. Univariate and multivariate analyses were performed to find associated factors with LTC.ResultsA total of 600 cases (62.6% male; 74% White; median age: 59 years) had a positive HCV antibody, 264 (44.4%) had a positive follow-up HCV RNA test and 138 (52.2%) were LTC. The average time for LTC was 1.5 months (50 days; interquartile range 21–121). In the univariate analysis, the following factors were significantly associated with LTC: older age (OR 1.022), having medicaid (OR 0.421), people who inject drugs (PWID) (OR 0.216), cocaine and marijuana use (OR 0.457), polysubstance use (OR 0.311), having a primary care provider (OR 2.290) and being a baby boomer (OR 1.718). The vast majority of patients came from three zip codes within south central Suffolk County, coinciding with the highest prevalence of heroin use.ConclusionIn this population insurance type, younger age and substance use (injection drugs, marijuana, cocaine, polysubstance) were associated with lower odds of LTC. Having a primary care provider and being a baby boomer were the only two independent risk factors associated with increased odds of LTC. Due to an increased number of HCV cases in younger populations, particularly PWID, further outreach efforts are urgently needed to spread HCV screening awareness and increase testing in high prevalence areas.Disclosures All authors: No reported disclosures.

Liver transplantation for hepatitis C virus (HCV) non-viremic recipients with HCV viremic donors.

In the context of organ shortage, the opioid epidemic, and effective direct-acting antiviral (DAA) therapy for hepatitis C virus (HCV), more HCV-infected donor organs may be used for liver transplantation. Current data regarding outcomes after donor-derived HCV in previously non-viremic liver transplant recipients are limited. Clinical data for adult liver transplant recipients with donor-derived HCV infection from March 2017 to January 2018 at our institution were extracted from the medical record. Ten patients received livers from donors known to be infected with HCV based on positive nucleic acid testing. Seven had a prior diagnosis of HCV and were treated before liver transplantation. All recipients were non-viremic at the time of transplantation. All 10 recipients derived hepatitis C infection from their donor and achieved sustained virologic response at 12weeks posttreatment with DAA-based regimens, with a median time from transplant to treatment initiation of 43days (IQR 20-59). There have been no instances of graft loss or death, with median follow-up of 380days (IQR 263-434) posttransplant. Transplantation of HCV-viremic livers into non-viremic recipients results in acceptable short-term outcomes. Such strategies may be used to expand the donor pool and increase access to liver transplantation.

2205. Mandatory Infectious Diseases or Hepatology Consult to Improve HCV Linkage to Care in the Inpatient Setting

BackgroundAt Hahnemann University Hospital, the prevalence of hepatitis C virus (HCV) infection is close to 17%, which is much higher than the estimated 2% prevalence in the United States general population. However, linkage to care from an inpatient setting is historically lower than for those diagnosed with HCV infection in the outpatient setting. In the era of effective HCV treatment, improving linkage to care is an essential step to cure HCV infection. Here we describe the impact of mandatory HCV consults on the success of linkage to care.MethodsWe performed a retrospective observational study of HCV patients who tested positive for HCV from July 2017 to December 2017 and were born between 1945 and 1965 at Hahnemann University Hospital, Philadelphia, PA. Once a patient was identified as having chronic HCV infection, either the Infectious Disease or Hepatology team evaluated the patient and an HCV navigator facilitated linkage to care. We defined linkage as a patient subsequently being seen at the Outpatient Hepatology Clinic or Infectious Disease Clinic within 3 months of discharge from the hospital.ResultsAmong 524 Baby Boomers tested, 106 (20%) had positive HCV antibody tests. Sixty-nine (65%) had chronic HCV infection and 7(9%) were already linked to care. Among 62 patients, 24 (39%) had an infectious disease (ID) or Hepatology consult. Patients who were seen by a consultant were more likely to be linked to care within 3 months (50% vs. Twenty-two%, P = 0.016). One of the main barriers that a consultant did not see a patient was that confirmatory HCV viral load result was not available at the time of discharge. If the viral load was available prior to discharge, a patient was more likely seen by a consultant. (54% vs. 7%, P < 0.0001)ConclusionMandatory HCV consults in the inpatient setting improved linkage to care for HCV-infected patients. One of the main barriers of HCV mandatory consults was HCV viral load result not being available at the time of discharge. In the era of effective direct-acting antiviral treatment, mandatory HCV consults should be implemented to improve the rate of linkage to care. Early routine lab testing for HCV antibody during a hospitalization and timely availability of results will be crucial to the success of such an intervention.Disclosures All authors: No reported disclosures.

932. Universal Hepatitis C Virus Screening in a Tennessee Tertiary Care Emergency Department

BackgroundDespite hepatitis C virus (HCV) age cohort and risk factor screening recommendations, many at-risk individuals remain undiagnosed. Current screening practices may not adequately capture those at high risk for infection, especially in regions with increasing injection drug use (IDU). Universal HCV screening in a Tennessee tertiary care emergency department (ED) was introduced to help define regional epidemiology and to improve diagnosis and linkage to care.MethodsThis screening program was implemented in the Vanderbilt University Medical Center ED. Adult patients who underwent phlebotomy for clinical purposes were offered HCV screening. Samples were initially tested for HCV antibodies; if positive, samples were reflexed for HCV RNA testing. Patients with positive HCV RNA tests (i.e., active HCV infection) were notified, counseled, and offered linkage to care.ResultsA total of 11,637 screening tests were performed between April 1, 2017 and March 31, 2018, with 1,008 (8.7%) HCV antibody positive and 488 (4.2%) RNA positive. Of note, 81 (0.7%) were HCV antibody positive but RNA testing could not be performed due to insufficient sample volume. Several notable populations had high rates of HCV (Table 1). Importantly, 3.9% of people not born between 1945 and 1965 were HCV RNA positive, and they were the majority (63.5%) of patients with active HCV (Table 2). A minority (31.6%) of those with active HCV had a known history of IDU (Table 2).ConclusionHCV is common among patients presenting for emergency care at a Tennessee tertiary care ED. Universal screening identified many infections that would have been missed using age cohort and risk factors alone. ED HCV screening may be a useful method to augment guideline-based testing and intervene among populations not consistently screened.Table 1:Notable Groups Screened for HCV (n = 11,537)DemographicsTotal ScreenedHCV Antibody + (%)HCV RNA + (%)People Born 1945–19653,670436 (11.9%)178 (4.9%)People Not Born 1945–19657,967572 (7.2%)310 (3.9%)Women Age 18–452,622156 (5.9%)77 (2.9%)Table 2:Demographics Among HCV RNA + (n = 488)Demographicsn (%)People Born 1945–1965178 (36.5%)People Not Born 1945–1965310 (63.5%)Women Age 18–4577 (15.8%)Known IDU154 (31.6%)People Not Born 1945–1965 With No Known IDU179 (36.7%)Disclosures C. A. Chastain, Gilead Sciences, Inc.: Grant Investigator and Research Contractor, Grant recipient and Research support. J. Johnson, Gilead Sciences, Inc.: Grant Investigator, Grant recipient. K. Miller, Gilead Sciences, Inc.: Grant Investigator, Grant recipient. J. H. Han, Gilead Sciences, Inc.: Grant Investigator, Grant recipient. W. H. Self, Gilead Sciences, Inc.: Grant Investigator, Grant recipient.

Drug Misuse and Hepatitis C Virus Infection Profiles for Three Generations of Patients Being Monitored for Prescription Drug Adherence.

Objectives:Two epidemics in the United States are related: opioid drug injection and hepatitis C virus (HCV) infection. This study quantifies the relationship between illicit/prescription drug misuse and HCV infection in 3 population generations: baby boomers (born 1945–1965, inclusive), pre-baby boomers, and post-baby boomers.Methods:This retrospective study included prescription drug consistency (March–December 2015) and HCV (2011–2015) patient test results performed at a large national clinical reference laboratory. HCV positivity, drug use consistency/inconsistency with prescribed drug information, type of inconsistent use, and inconsistent use of individual drug classes were assessed.Results:This study evaluated 39,231 prescription drug monitoring and HCV sets of test results from 18,410 patients. Of these patients, 25.1% tested positive for HCV and 57.3% demonstrated drug test results that were inconsistent with the prescribed medication(s). The types of drug test inconsistency differed substantially between HCV-positive and -negative patients, particularly testing positive for both non-prescribed drugs and prescribed drugs. Specimens from HCV-positive baby boomer and post-baby boomers demonstrated non-prescribed use of opioids and many other drug classes more often than from HCV-negative patients.Conclusions:The rates of inconsistent drug test results and types of drugs misused suggest that HCV-positive patients are more likely than HCV-negative patients to display high-risk behavior, even beyond opioid use. This difference is most pronounced in the post-baby boomer generation. Healthcare professionals should consider these patterns and how they differ by generation when monitoring for both prescription and illicit drugs, the results of which can impact treatment decisions including prescribing analgesics.

Improving Hepatitis C Screening Rates in a Resident Clinic: A Quality Improvement Project

Introduction: Hepatitis C virus (HCV) is the most common chronic blood-borne pathogen in the US. HCV is a viral liver disease that can result in cirrhosis, hepatocellular carcinoma, liver transplantation or death. CDC and USPSTF recommend HCV screening for all those born between 1945 and 1965- the baby boomer population. We designed a quality improvement project seeking to improve HCV screening rates in our ambulatory resident practice. Methods: We educated all residents and clinical staffs at ambulatory clinic by lectures, emails and weekly meetings about the importance of HCV screening in the baby boomers. All residents were asked to order a HCV Antibody profile as a screening test if the patient had never been tested. In case resident forgot to order it, then staff would order at the time of check out. If the test was positive, then patients were called and informed about the result and referred to hepatitis care clinic for further work up. Results: We screened 300 patients and 10 patients had a positive HCV screening test (3.3%). Only two patients had a positive viral load (20.0%). 5 out of 10 positive HCV positive patients had an intravenous drug abuse history (50.0%). No patient had undergone previous treatment for HCV infection. All 10 patients were referred to hepatitis care center for further monitoring. Conclusion: HCV screening is recommended in the baby boomer population (born between 1945-1965), history of illicit injection drug use or intranasal cocaine use and receipt of contaminated blood products or tissue. The initial screening test for chronic HCV infection in adults is an HCV antibody test. A reactive antibody test should be followed by a HCV RNA test. A nonreactive antibody test generally indicates the absence of chronic HCV infection. HCV screening can be increased by education and appropriate follow ups. Primary care clinics can successfully increase HCV screening in a relatively short time period. Incorporating a lecture about the new HCV screening guidelines to the ambulatory educational curriculum may be a more effective and sustainable strategy to increase HCV screening rates among residents.

Reduced Incidence and Better Liver Disease Outcomes among Chronic HCV Infected Patients Who Consume Cannabis.

Background and Aim The effect of cannabis use on chronic liver disease (CLD) from Hepatitis C Virus (HCV) infection, the most common cause of CLD, has been controversial. Here, we investigated the impact of cannabis use on the prevalence of CLD among HCV infected individuals. Methods We analyzed hospital discharge records of adults (age ≥ 18 years) with a positive HCV diagnosis. We evaluated records from 2007 to 2014 of the Nationwide Inpatient Sample (NIS). We excluded records with other causes of chronic liver diseases (alcohol, hemochromatosis, NAFLD, PBC, HBV, etc.). Of the 188,333 records, we matched cannabis users to nonusers on 1:1 ratio (4,728:4,728), using a propensity-based matching system, with a stringent algorithm. We then used conditional regression models with generalized estimating equations to measure the adjusted prevalence rate ratio (aPRR) for having liver cirrhosis (and its complications), carcinoma, mortality, discharge disposition, and the adjusted mean ratio (aMR) of total hospital cost and length of stay (LOS) [SAS 9.4]. Results Our study revealed that cannabis users (CUs) had decreased prevalence of liver cirrhosis (aPRR: 0.81[0.72-0.91]), unfavorable discharge disposition (0.87[0.78-0.96]), and lower total health care cost ($39,642[36,220-43,387] versus $45,566[$42,244-$49,150]), compared to noncannabis users (NCUs). However, there was no difference among CUs and NCUs on the incidence of liver carcinoma (0.79[0.55-1.13]), in-hospital mortality (0.84[0.60-1.17]), and LOS (5.58[5.10-6.09] versus 5.66[5.25-6.01]). Among CUs, dependent cannabis use was associated with lower prevalence of liver cirrhosis, compared to nondependent use (0.62[0.41-0.93]). Conclusions Our findings suggest that cannabis use is associated with decreased incidence of liver cirrhosis, but no change in mortality nor LOS among HCV patients. These novel observations warrant further molecular mechanistic studies.

Prevalence and sociodemographic disparities of Hepatitis C in Baby Boomers and the US adult population.

The US Baby Boomer (BB) generation is associated with high rates of Hepatitis C virus (HCV) infection. There is limited literature detailing age-specific risk factors for HCV infection. Using a nationally representative sample, this study examines US adult HCV prevalence and age-specific risk factors for chronic HCV infection. We analyzed data from National Health and Nutrition Examination Survey (NHANES) for years 1999-2012. Age was divided into three categories: BB, younger than BB (YG) and older than BB (OG). HCV status was determined by the presence of a positive HCV antibody and a positive HCV RNA. Sociodemographic variables were analyzed by HCV status. Multivariable logistic regression models adjusting for sociodemographic variables were fitted to identify age-specific risk factors for HCV positivity. The overall prevalence of chronic HCV was 1.19% with a US population estimate of 2,347,852 US adults. BB had the highest prevalence at 2.23%, accounting for over 74% of all chronic HCV cases. HCV prevalence was highest among all ages (1.83%) and BB (2.71%) in 2001-2002 survey cycle. Among BB, males, non-Hispanic blacks, positive blood transfusion history, current and former smoker, and living below the poverty line were significant predictors of chronic HCV positivity. This study highlights the elevated prevalence of chronic HCV among BB and identifies age-specific risk factors for chronic HCV infection. As the BB population ages, it is important to use these generation-specific risk factors that can guide health professionals in targeted screening and public health prevention efforts.

Hepatitis C prevalence and associated risk factors among individuals who are homeless and diagnosed with mental illness: At Home/Chez Soi Study, Vancouver, BC.

There is scarce evidence on prevalence of hepatitis C virus (HCV) infection among individuals who are homeless and diagnosed with severe mental illness. We aimed to investigate the prevalence of HCV infection and associated risk factors in a representative sample of adults from At Home study. The Vancouver At Home study is part of the At Home/Chez Soi (AH/CS) project-a pragmatic randomized controlled trial of a Housing First intervention among homeless persons with mental illness in five Canadian cities between 2009 and 2013 with a 2-year follow-up period. Of 497 participants, 28% reported positive HCV serostatus. Educational level equal or less than eighth grade (AOR: 2.3, 95% CI: 1.1, 4.8), history of incarceration (AOR: 2.1, 95% CI: 1.2, 3.5), substance dependence (AOR: 2.0, 95% CI: 1.1, 3.7) and injection drug use during one month prior to the recruitment (AOR: 7.8, 95% CI: 4.0, 15.0) were associated with an increased risk of HCV infection. Having a psychotic disorder (AOR: 0.6, 95% CI: 0.3, 1.0) and age < 25 (AOR: 0.2, 95% CI: 0.0, 0.7) were associated with a lower risk. Blood tests performed on 30 participants agreed with self-report in 97% of cases [Kappa = 0.9 (95% CI: 0.6, 1.3), PABAK = 0.9]. The high prevalence of HCV among individuals who were homeless with mental illness underlies the importance of prevention and treatment of HCV in this population, especially those with concurrent substance use disorders. Self-report seems to be a valid tool for evaluation of the HCV status in this population.

Seroprevalence of hepatitis C virus among the newcomer students, Kafrelsheikh University, Egypt.

Hepatitis C virus (HCV) constitutes a global public health problem in Egypt, as it has the highest worldwide prevalence. This study aimed at determining the seroprevalence of HCV among the newcomer students of Kafrelsheikh University, Egypt. A cross-sectional serosurvey was conducted including 9049 students. Medical examination, ultrasonography, and laboratory investigations were done. Liver function tests and HCV antibody testing were carried out for all students who gave an informed consent; HCV-RNA polymerase chain reaction was performed for students with positive HCV antibody testing. The mean age of screened students were 18.6 ± 0.39 years. In total, 4233 (46.8%) were males and 4816 (53.2%) were females. Using HCV antibody testing, only 25 students (0.0028%) had positive antibodies; among them, 24 students (0.0026%) had HCV RNA positive; the study showed none statistically significant higher percentage of HCV infection among males (13 out of 24, 54.2%) than females (11 out of 24, 48.5%), P > 0.05. The results of liver function tests were not significantly different between the HCV-positive and HCV-negative students. However, the liver transaminase enzymes were significantly higher ( P < 0.0001) in HCV positive students compared to the negative ones, despite its mean values did not exceed the upper normal level. HCV infection among young Egyptian generations showed a marked decline. Prevalence of HCV infection among young Egyptian generations had markedly decline, indicating the start of successful control of HCV infection.

CARDIOVASCULAR EFFECTS OF ORAL ANTIVIRAL TREATMENT FOR NON-CARDIAC HCV PATIENTS

Background: The prevalence of hepatitis C virus (HCV) in Egypt is quite high, and the combined oral direct-acting antiviral agents (DAAs) may have impressive results. Objectives: To assess the cardiovascular effects of oral antiviral treatment in non-cardiac HCV patients. Paitents and Methods: The study enrolled 100 patients with positive HCV who were enrolled for the new oral antiviral therapy in the form of Sofosbuvir and dclatsavir with or without ribavirin for 3 or 6 months. All patients on our study were subjected to follow up pre-and post-oral antiviral course, and the end point of the study was the development of a major cardiovascular event, e.g. congestive heart failure, echocardiographic evidence of left ventricular dysfunction, occurrence of significant arrhythmias, or acute coronary syndrome. The following parameters were accomplished: medical history and clinical examination, electrocardiogram, Echo-Doppler study, and laboratory investigations. Results: No significant differences were found between the patients regarding demographic criteria. None of the patients had developed any major cardiac event. No significant changes were observed regarding ST segment and T wave abnormalities, arrhythmias, or QT interval. None of patients developed echocardiographic regional wall motion abnormalities at baseline or at study end. Systolic function parameters showed minute non-significant changes over study visits. Diastolic function parameters showed non-significant changes between baseline and post oral antiviral course visit. Conclusion: The DAAs used in combination regimen didn’t significantly affect the cardiovascular system.

Association between coronary artery disease and hepatitis C virus seropositivity.

Coronary artery disease (CAD) is one of the leading causes of death worldwide. Predisposing factors include some infectious aetiologies that have a systemic effect like hepatitis C virus. The aim of this study was to explore the association between hepatitis C viral infection and coronary artery disease. This case-control study was designed to include 100 patients attending the Cardiology Department in Tanta University Hospital, Gharbia Governorate, Egypt, for diagnostic angiography. A consecutive sample of 50 patients with abnormal angiographic findings was matched with another 50 consecutive patients with normal angiographic findings regarding age, sex, and major risk factors for coronary artery disease (diabetes mellitus, hypertension and smoking). Patients were investigated for hepatitis C virus (HCV) infection. We found that 46% of abnormal angiography were HCV-positive compared to 28% of patients with normal angiography; this difference was not statistically significant. On studying the number of vessels affected among patients with abnormal angiography it was noted that one vessel affection was found mainly among HCV-negative patients (59.3% compared to 17.4% among HCV-negative and -positive patients). Multi-vessel affection was found mainly among HCV-positive patient (47.8% compared to 22.2% among HCV-positive and -negative respectively). The possible association between HCV positivity and extension of coronary artery disease may refer to the role of HCV in coronary artery disease pathology. Further studies on a large scale to investigate this association are recommended.