Presence Of Hepatitis C Virus Antibodies Research Articles

Hepatitis C Virus Infection in Pregnant Individuals with Opioid Use Disorder and Its Association with Preterm Birth.

Both hepatitis C virus (HCV) and opioid use disorder (OUD) have been associated with higher rates of preterm birth (PTB). It is unknown whether the higher prevalence of HCV in individuals with OUD may contribute to this association. The objective of this study is to evaluate the association between HCV and PTB in pregnant individuals with OUD. We conducted a retrospective cohort of pregnant individuals with OUD who participated in more than three visits in a co-located multidisciplinary program. Inclusion criteria were a diagnosis of OUD, participation in treatment/prenatal care program, and laboratory evaluation of HCV status. The primary exposure was the presence of HCV antibodies, and secondarily, a detectable viral load (viremia). The primary outcome was PTB, which was further classified as spontaneous or iatrogenic. Multivariable logistic regression was used to detect associations while adjusting for race, history of prior PTB, and tobacco use. A total of 941 individuals were included in the study, 404 with HCV and 537 without. Rates of PTB did not differ between those with compared to those without HCV (20.3 vs. 23.8%, adjusted odds ratio [aOR] = 0.75 [95% confidence interval (CI): 0.53-1.07]). There were similar rates of spontaneous PTB (13.1 vs. 16.2%, aOR = 0.79 [95% CI: 0.43-1.45]) and iatrogenic PTB (7.2 vs. 7.6%, aOR = 1.26 [95% CI: 0.69-2.30]). Comparing those with viremia to those without, there were also similar rates of overall PTB (21.6 vs. 17.9%, aOR = 0.86 [95% CI: 0.52-1.44]), spontaneous PTB (13.3 vs. 12.9%, aOR = 0.97 [95% CI: 0.52-1.87]), and iatrogenic PTB (8.3 vs. 5.0%, aOR = 1.83 [95% CI: 0.76-4.94]). HCV does not appear to be associated with spontaneous or iatrogenic PTB in pregnant persons with OUD who are engaged in treatment and prenatal care. The role of co-located multidisciplinary prenatal and addiction programs in the association between HCV and PTB warrants further investigation. · Hepatitis C antibodies are not associated with PTB in those with OUD.. · Hepatitis C viremia is not associated with PTB.. · Multidisciplinary treatment programs may contribute to these findings..

Pathological Consequences in Anti-HCV Antibody-Positive Organ Donation to an Anti-HCV Antibody-Negative Recipient

BackgroundThe need to expand the pool of available organs has meant that the use of marginal organs is increasingly widespread. With the advent of antiviral therapy for hepatitis C, it has made it possible to consider the donation of organs from HCV positive donors or even from viremic donors. MethodsIn HCV positive to HCV negative antibody donor transplantation, the development of antibodies to HCV is documented unevenly depending on the organ transplanted and with differences in the time of appearance and in some cases with subsequent disappearance that draws attention to the fact whether it is the development of antibodies or the transmission of immunity between donor and recipient. In transplantation from HCV infected donor to negative recipient the introduction pre-transplantation or a few days after transplantation of antiviral therapy into the recipient achieves sustained response in almost all cases. We wanted to deepen the argument by studying the literature data, focusing on kidney transplantation, in consideration of the fact that this could be of interest in particular for the possible long-term renal damage. ResultsHCV infection both ongoing and past but also the presence of HCV antibodies alone can be responsible for kidney damage. ConclusionsDAA therapy has revolutionized the history of HCV disease and the therapeutic possibilities of transplantation. However, we believ it is useful to keep in mind the pathophysiology of HCV-related damage especially in patients with long life expectancy, using all emerging strategies to minimize the risk of transmission of infection or development of viremia.

Low seroprevalence of hepatitis C among children at the Princess Marie Louis Children' s Hospital in Accra, Ghana.

Hepatitis C is a leading cause of chronic hepatitis and causes severe health problems in areas where prevalence is high. Ghana is noted for a relatively high sero-prevalence of hepatitis C virus infection. However, there is very little data on prevalence of hepatitis C virus (HCV) among children in Ghana, and what data is available indicates very low prevalence rate. We conducted a cross-sectional study to determine the sero-prevalence and associated pre-disposing risk factor for HCV infection among children attending the Princes Marie Louis Children´s Hospital in Accra. Two hundred archived blood samples from a previous study were retrieved and tested for the presence of HCV antibodies using a dipstick test kit. Out of the 200 samples tested, one (1) tested positive for HCV antibodies giving a prevalence of 0.5% among the study group. The results show that there is potentially a very low prevalence of hepatitis C among Ghanaian children. Hence, the higher prevalence among adults usually seen is often due to infection later in life. Obtaining an appropriate vaccine early in life could thus help prevent people from getting infected in later life.

Screening a nation for hepatitis C virus elimination: a cross-sectional study on prevalence of hepatitis C and associated risk factors in the Rwandan general population

ObjectivesWe analysed data collected during programmatic screening activities conducted in 2017 to describe hepatitis C virus (HCV) seroprevalence in the general population and identify associated factors.DesignWe analysed data collected between...

Pharmacological interventions for acute hepatitis C infection.

Pharmacological interventions for acute hepatitis C infection.

Healthcare contact and treatment uptake following hepatitis C virus screening and counseling among rural Appalachian people who use drugs

BackgroundHepatitis C virus (HCV) remains a major contributor to morbidity and mortality worldwide. Since 2009, Kentucky has led the United States in cases of acute HCV, driven largely by injection drug use in rural areas. Improved treatment regimens hold promise of mitigating the impact and transmission of HCV, but numerous barriers obstruct people who inject drugs (PWID) from receiving care, particularly in medically underserved settings. Methods503 rural people who use drugs were recruited using respondent-driven sampling and received HCV screening and post-test counseling. Presence of HCV antibodies was assessed using enzyme immunoassay of dried blood samples. Sociodemographic and behavioral data were collected using computer-based questionnaires. Predictors of contacting a healthcare provider for follow-up following HCV-positive serotest and counseling were determined using discrete-time survival analysis. Results150 (59%) of 254 participants reported contacting a healthcare provider within 18 months of positive serotest and counseling; the highest probability occurred within six months of serotesting. 35 participants (14%) reported they were seeking treatment, and 21 (8%) reported receiving treatment. In multivariate time-dependent modeling, health insurance, internet access, prior substance use treatment, meeting DSM-IV criteria for generalized anxiety disorder, and recent marijuana use increased the odds of making contact for follow-up. Participants meeting criteria for major depressive disorder and reporting prior methadone use, whether legal or illegal, were less likely to contact a provider. ConclusionWhile only 8% received treatment after HCV-positive screening, contacting a healthcare provider was frequent in this sample of rural PWID, suggesting that the major barriers to care are likely further downstream. These findings offer insight into the determinants of engaging the cascade of medical treatment for HCV and ultimately, treatment-as-prevention. Further study and increased resources to support integrated interventions with effectiveness in other settings are recommended to mitigate the impact of HCV in this resource-deprived setting.

Pharmacological interventions for acute hepatitis C infection: an attempted network meta-analysis.

Pharmacological interventions for acute hepatitis C infection: an attempted network meta-analysis.

Review: Occult hepatitis C virus infection: still remains a controversy.

Occult hepatitis C virus (HCV) infection is characterized by the presence of HCV RNA in the liver cells or peripheral blood mononuclear cells of the patients whose serum samples test negative for HCV RNA, with or without presence of HCV antibodies. The present study reviews the existing literature on the persistence of occult hepatitis C virus infection, with description of the clinical characteristics and methods for identification of occult hepatitis C. Occult hepatitis C virus infection was detected in patients with abnormal results of liver function tests of unknown origin, with HCV antibodies and HCV RNA negativity in serum, and also in patients with spontaneous or treatment-induced recovery from hepatitis C. The viral replication in the liver cells and/or peripheral blood mononuclear cells was present in all clinical presentations of occult hepatitis C. The peripheral blood mononuclear cells represent an extra-hepatic site of HCV replication. The reason why HCV RNA was not detectable in the serum of patients with occult hepatitis C, could be the low number of circulating viral particles not detectable by the diagnostic tests with low sensitivity. It is uncertain whether occult hepatitis C is a different clinical entity or just a form of chronic hepatitis C virus infection. Data accumulated over the last decade demonstrated that an effective approach to the diagnosis of HCV infection would be the implementation of more sensitive HCV RNA diagnostic assays, and also, examination of the presence of viral particles in the cells of the immune system.

Is diabetes a useful diagnostic clue to detect early stage of pancreatic cancer?

s / Pancreatology Patients&methods: We recruited 585 patients with cytological or/and pathologically confirmed PDAC in National Taiwan University Hospital from September 2000 to September 2013 and 1716 age-, gender-, and racematched controls who received a screening program in a community located in northern Taiwan. Blood samples were tested for the presence of HCV antibodies (anti-HCV), HBV surface antigen (HBsAg), antibodies against HBsAg (anti-HBs), and HBc (anti-HBc) in all cases and controls. The odds ratios (ORs) of PDAC was estimated by logistic regression analysis with adjustment DM and smoking. Results: HBsAg was positive in 73 cases (12.5%) and 213 controls (12.4%). Anti-HCV was positive in 22 cases (3.8%) and 45 controls (2.6%). Anti-HBs was positive in 338 cases (57.8%) and 1047 controls (61.0%). The estimated ORs of PDAC in multivariate analysis were as follows: diabetes mellitus, 2.08 (95% CI, 1.56-2.76, p<0.001), smoking, 1.36(95% CI, 1.02-1.80, p1⁄40.035), HBsAg+/Anti-HBc+/Anti-HBs-, 0.89 (95% CI, 0.89 to 1.68, p1⁄40.219), HBsAg-/Anti-HBc+/Anti-HBs+, 1.03(95% CI, 0.84 to 1.25, p1⁄40.802). Conclusion: The frequency of HBV and HCV infection was similar in PDAC patients and controls from general population. HBV infection and HCV infection are not associated with risk of PDCA after adjust age, gender, DM and smoking. DM and smoking were independent risk factors of PDAC.

Apoptosis and clinical severity in patients with psoriasis and HCV infection.

Background:It has been proposed that hepatitis C virus (HCV) antigens are involved in the pathogenesis of psoriasis and may contribute to severity of the disease. Increased expression of the apoptosis-regulating proteins p53 and tTG and decreased levels of bcl-2 in the keratinocytes of the skin of psoriatic patients have been reported.Aim:This study aims to identify the serum levels of apoptosis-regulating proteins in patients with psoriasis and without HCV infection and to study the relation between clinical severity of psoriasis and the presence of HCV infection.Materials and Methods:Disease severity was assessed by psoriasis area severity index score (PASI) of 90 patients with psoriasis grouped as mild (n = 30), moderate (n = 30) and severe (n = 30); 20 healthy individuals were used as controls. All groups were subjected for complete history taking, clinical examination, and tests for liver function and HCV infection. The serum levels of apoptosis related proteins: p53, tTG and bcl-2 were estimated by enzyme linked immune sorbent assay (ELISA).Results:There was a statistically significant (P < 0.001) correlation between clinical severity of psoriasis and presence of HCV antibodies and HCV-mRNA. In addition, significantly (P < 0.001) raised serum p53 and tTG, and reduced bcl-2 were observed among HCV-positive patients as compared to HCV-negative patients and control patients.Conclusion:These results conclude that clinical severity of psoriasis is affected by the presence of HCV antibodies and overexpression of apoptotic related proteins. In addition, altered serum levels of apoptosis-regulating proteins could be useful prognostic markers and therapeutic targets of psoriatic disease.

Prevalence of viral hepatitis (B and C) serological markers in healthy working population

prevalence of viral hepatitis (B and C) changes geographically. Our aim was to determinate the prevalence of hepatitis B (HBV) and hepatitis C virus (HCV) serological markers in healthy working population and to describe the epidemiological characteristics associated to its presence. blood samples and epidemiological data of 5,017 healthy workers from Murcia and Madrid were recorded prospectively. a total of 5,017 healthy volunteers participated. Mean age 39 ± 11 years, men predominance (73 %). Prevalence of serological markers of HCV and HBV was 0.6 % and 0.7 %. Age of patients with HCV antibody was significantly higher (43 + or - 9 years vs. 39 + or - 11 years; p = 0.03). We observed significant differences in liver test values (alanine aminotransferase [ALT] 64 ± 56 IU/L vs. 28 ± 20 IU/L; p < 0.001; aspartate aminotransferase [AST] (51 + or - 45 IU/L vs. 23 + or - 12 IU/L; p < 0.001) and in gamma-glutamyltransferase(GGT) value (104 + or - 122 IU/L vs. 37 + or - 46 IU/L; p < 0.001. The presence of HCV antibody was related significantly to previous transfusion (13 % vs. 5 %; p = 0.03), tattoos (29 % vs. 13 %; p < 0.01), intravenous drug addiction (13 % vs. 0.2 %; p < 0.001) and coexistence with people with positive HCV antibody (16 % vs. 4 %; p < 0.001). In HBV no differences in basal characteristics were observed with exception in AST values (29 + or - 15 IU/L vs. 23 + or - 12 IU/L; p < 0.01). Hepatitis B surface antigen (HBsAg) was related significantly to previous transfusion (15 % vs. 5 %; p < 0.01), tattoos (26 % vs. 14 %; p = 0.04) and coexistence with people with positive HBsAg (17 % vs. 4 %; p < 0.001). Prevalence of serological markers in healthy working population is low. Risk factors for infection were previous transfusion and tattoos. Intravenous drug addiction was only a risk factor in HCV.

High prevalence but low awareness of hepatitis C virus infection among heroin users who received methadone maintenance therapy in Taiwan

BackgroundThis study investigates the prevalence and correlates of hepatitis C virus (HCV) infections among heroin dependent individuals who received methadone maintenance therapy in Taiwan. Also, we investigate users' awareness of HCV. MethodsParticipants were 773 heroin users entering the methadone maintenance treatment (MMT) program at Tsaotun Psychiatric Center in Taiwan. The presence of HCV antibodies was detected. Multivariate logistic regression was used to identify the relationship between HCV infection and correlates. ResultsThe prevalence of HCV infection was 90.8%. All participants who were HIV-positive were also infected with HCV. Multivariate logistic regression analysis showed that the route of heroin administration (injection), HIV-infection, and criminal records were significantly related to HCV infection. Few (34.8%) HCV positive heroin users were aware of their infection. ConclusionAn extremely high prevalence of HCV infection but low awareness of their infection status was found among MMT patients in Taiwan. These findings highlight the importance of education regarding risky behaviors and the necessity for HCV treatment for this population in Taiwan.

Ocular effects of combined therapy with pegylated interferon (PegINF) and ribavirin (RBV) in hepatitis C

AbstractPurpose To evaluate ocular effects of combined therapy with pegylated interferon and ribavirin in hepatitis C.Methods 18 patients (36 eyes) received combined therapy based on the presence of HCV antibodies in the serum and positive RT – PCR test results for HCV RNA. Patients were examined at baseline, months 1, 3, 6 after initiation and 6 months after completion of antiviral treatment. Primary outcome was best corrected visual acuity (BCVA) and secondary outcomes were slit lamp examination, intraocular pressure, foveal thickness, and P1 Multifocal Electroretinography( mfERG) amplitude.Results 13 patients (26 eyes) completed the study. 2 of 13 (15%) patients had exacerbation of dry eye syndrome and 2 of 13 (15%) developed retinopathy. Therapy was discontinued in patients with retinopathy with remission of retinal changes after 3 months. No significant changes in other parameters were observed.Conclusion Patients treated with PegINF‐RBV have a potential risk of ocular complications and require a regular ophthalmic examination. We suggest ocular examination and follow up protocol for patients treated with interferon‐ribavarin therapy to limit potential side effects.

Clinical factors related to brain structure in HIV: the CHARTER study

Despite the widening use of combination antiretroviral therapy (ART), neurocognitive impairment remains common among HIV-infected (HIV+) individuals. Associations between HIV-related neuromedical variables and magnetic resonance imaging indices of brain structural integrity may provide insight into the neural bases for these symptoms. A diverse HIV+ sample (n = 251) was studied through the CNS HIV Antiretroviral Therapy Effects Research initiative. Multi-channel image analysis produced volumes of ventricular and sulcal cerebrospinal fluid (CSF), cortical and subcortical gray matter, total cerebral white matter, and abnormal white matter. Cross-sectional analyses employed a series of multiple linear regressions to model each structural volume as a function of severity of prior immunosuppression (CD4 nadir), current CD4 count, presence of detectable CSF HIV RNA, and presence of HCV antibodies; secondary analyses examined plasma HIV RNA, estimated duration of HIV infection, and cumulative exposure to ART. Lower CD4 nadir was related to most measures of the structural brain damage. Higher current CD4, unexpectedly, correlated with lower white and subcortical gray and increased CSF. Detectable CSF HIV RNA was related to less total white matter. HCV coinfection was associated with more abnormal white matter. Longer exposure to ART was associated with lower white matter and higher sulcal CSF. HIV neuromedical factors, including lower nadir, higher current CD4 levels, and detectable HIV RNA, were associated with white matter damage and variability in subcortical volumes. Brain structural integrity in HIV likely reflects dynamic effects of current immune status and HIV replication, superimposed on residual effects associated with severe prior immunosuppression.

Elevated NT-pro-BNP levels are associated with comorbidities among HIV-infected women.

HIV infection is associated with left ventricular (LV) dysfunction and accelerated atherosclerosis. These conditions result in elevation of plasma natriuretic peptide (NP) levels. The present study compares N-terminal-pro-BNP (NT-pro-BNP) levels in HIV-infected and -uninfected women and identifies factors influencing NT-pro-BNP levels in HIV-infected women. A total of 454 HIV-infected and 200 HIV-uninfected participants from the Women's Interagency HIV Study (WIHS) had NT-pro-BNP determination. Elevated NT-pro-BNP level was defined using previously determined age stratified cut-off values of >164 ng/liter (age <60 years) and >225 (age > or = 60 years). HIV-infected women were older (41.6 +/- 8.9 vs. 38.9 +/- 10.5 years, p < 0.01) and were more likely to have anemia, hepatitis C virus (HCV) antibodies, and kidney dysfunction than HIV-uninfected women. HIV-infected women had significantly higher NT-pro-BNP levels (142.4 +/- 524.8 vs. 73.6 +/- 115.1 ng/liter, p = 0.01) and a higher prevalence of elevated NT-pro-BNP (12.1% vs. 7.5%; p = 0.08). In univariate analyses, elevated NT-pro-BNP was significantly associated with age, systolic BP, hypertension, anemia, triglyceride levels, kidney disease, and HCV seropositivity, but not HIV infection. In multivariate analysis, elevated NT-pro-BNP levels were significantly associated with anemia and kidney function, and had a borderline association with the presence of HCV antibodies. Among HIV-infected women, NT-pro-BNP levels were not independently associated with measures of severity of infection or with HAART use. Although HIV-infected women have higher NT-pro-BNP levels than HIV-uninfected women, the differences are due to non-HIV factors such as anemia, kidney disease, and HCV coinfection. These findings suggest that natriuretic peptide levels are a global marker of comorbidity in the setting of HIV infection.

Seroprevalence of hepatitis C and associated risk factors in urban areas of Antananarivo, Madagascar

BackgroundThe risk factors for the transmission of HCV vary substantially between countries and geographic regions. The overall prevalence in south and east Africa region has been estimated to be 1.6% but limited information about the epidemiology of HCV infection in Madagascar is availableMethodsA cross-sectional survey for hepatitis C antibodies was conducted in 2,169 subjects of the general population of Antananarivo to determine seroprevalence of hepatitis C and associated risk factors.ResultsThe overall seroprevalence was 1.2% (25/2,169). The prevalence did not differ significantly according to gender but it increased with age (Chi2 tendency test, p < 10-5). The variable history of hospitalization, previous therapeutic injections, dental treatment, intravenous drug use, and abnormal ALT and AST were statistically significantly related with the presence of HCV antibodies. No relationship with past history of blood transfusion was observed.ConclusionHCV prevalence in Madagascar seems to be similar to that in most other east African countries. Age appears to be an important risk factor. Iatrogenic causes of HCV transmission need to be further evaluated because all HCV cases had a history of receiving therapeutic injections and data suggested a cumulative effect in relation with therapeutic injections.

Ethnicity and Spontaneous Clearance of Hepatitis C in HIV‐HCV Coinfected Patients

To the Editor: There are limited reports suggesting that ethnic populations differ in their immunological response to infection with hepatitis C virus (HCV), and that host factors influence spontaneous clearance (1). Canadian data (2–5) suggest that Inuit and First Nations people appear to have a higher rate of spontaneous HCV clearance based on the presence of HCV antibody and the absence of HCV RNA. An epidemiological review (6) has demonstrated a high prevalence of HCV coinfection in HIV-infected populations; we wondered whether there may be evidence of a differential rate of spontaneous HCV clearance depending on ethnicity and, specifically, Aboriginal origins in this coinfected population. After obtaining ethics approval through the Health Research Ethics Board of the Faculty of Medicine and Dentistry at the University of Alberta (Edmonton, Alberta), the Northern Alberta HIV Program database was examined to identify all living HIV-infected patients found to be HCV-seropositive between January 2001 and December 2006. In the HIV database, 120 charts of 181 individuals meeting our study entry criteria were accessible and reviewed by one of the two authors. Of the 120 patients reviewed, 74 were men (mean age 43 years; range 23 to 67 years of age). Of HIV-HCV coinfected patients, 52.5% had self-identified as Aboriginal. Of the 120 reviewed charts, 84 contained results of HCV RNA testing, with 46% of these patients being Aboriginal compared with 31% of the total HIV clinic population self-identified as Aboriginal. Assuming that HCV RNA-negative test results reflected spontaneous clearance in the face of HCV seropositivity, 13 of 84 (15%) patients appeared to have had spontaneous clearance of HCV. Of these 13, seven were of Aboriginal origin. This difference was not statistically significant (P=0.17; OR=0.7; 95% CI 0.128 to 8.2). Of the 84 available HCV RNA test results, 71 were positive and interpreted as indicative of ongoing HCV replication. Thirty-two of these positive test results were in self-identified Aboriginal patients, and 39 in non-Aboriginal patients. Of these 71 patients potentially eligible for antiviral therapy, only 10 received antiviral therapy for HCV and only two had a clinical response. Both of these were non-Aboriginal patients, and had genotypes 3A and 1B. The single Aboriginal patient who received anti-HCV therapy had genotype 1A, and did not respond. Spontaneous HCV viral clearance in populations not known to be HIV-infected has ranged from 15% to 45%, with significantly lower rates in those who are HIV-HCV coinfected (7). Because of literature (2–5) suggesting population differences in rates of spontaneous clearance and specifically in the Canadian Aboriginal and Inuit populations, we thought it would be of interest to examine this in Northern Alberta’s HIV population. Unfortunately, the study was retrospective, relatively small in patient number and incomplete in terms of ascertainment of outcome. Nonetheless, we believed the results were of interest. The relatively low uptake of anti-HCV therapy in this population has suggested the potential merits of a systematic, proactive approach in our population. Studies addressing genetic factors suggest a role for immunological host factors being important in HCV clearance, but these differences may be overshadowed by significant immune deficits as seen in patients with HIV infection.

Hepatitis C como factor de riesgo de diabetes mellitus tipo 2

Hepatitis C virus (HCV) has been implicated as a risk factor for the development of diabetes mellitus, type 2 (DM2). Our aim is to check if HCV infection in our patients is a risk for the development of DM2. In that case, we study if the possible pathogenic mechanism could be related with an increase in iron deposits. A consecutive series of 305 patients that attended to our service for measurement of anti-HCV antibodies was collected. HCV-antibodies were identified by second generation ELISA and confirmed by immunoblot. We detected viral RNA in 56% of these patients by polymerase chain reaction. The control group was made up of 137 patients. In every case, we analyzed the plasma levels of glucose, ferritin and other biochemical parameters. We found 13% of diabetics in the patient with viral RNA, 9.3% in the infected patients without RNA and 3.9% in the controls. The average of the ferritin level for the infected patients was 256 mg/l and for the controls was 151 mg/l (p = 0.01). The diabetic patients had ferritin levels of 346 mg/l and non-diabetic patients had 218 mg/l (p = 0.038). The presence of HCV-antibodies showed a 2.78 odds ratio for diabetes risk. Our results showed a relationship between HCV infection and diabetes mellitus type 2, so that the percentage of diabetics increased parallelly with the degree of viral activity and the variable "presence of HCV-antibodies" was the one that most contributed to the risk. Although our results would support the role of the iron metabolism in the development of diabetes, follow-up studies of a cohort of patients infected by HCV would be necessary to contrast this statement.

The Prevalence and Predictors of Elevated Serum Aminotransferase Activity in the United States in 1999-2002

The presence of elevated serum aminotransferase activity is a sign of possible underlying liver disease. We aimed to describe the prevalence and associations of elevated serum aminotransferase activity in a recent, nationally representative U.S. survey. We described the prevalence and predictors of elevated alanine aminotransferase (ALT >43 IU/L) or elevated aspartate aminotransferase (AST >40 IU/L) activity among 6,823 participants of the National Health and Nutrition Examination Survey (NHANES) conducted between 1999 and 2002. We compared our findings to the results already published based on the NHANES conducted between 1988 and 1994. In NHANES 1999-2002, the prevalences of elevated ALT, AST, or either ALT or AST were 8.9%, 4.9%, and 9.8%, respectively, in the entire population and 7.3%, 3.6%, and 8.1%, respectively, after excluding participants who tested positive for hepatitis C virus (HCV) antibody or reported excessive alcohol consumption. Strong predictors of elevated ALT activity included increasing waist circumference and body mass index, alcohol consumption, male sex, Mexican American ethnicity, decreasing age, and presence of HCV antibody. In NHANES 1988-1994, which employed a different assay methodology, the prevalences of elevated aminotransferases were approximately half of the prevalences we describe in NHANES 1999-2002, but the predictors of elevated ALT activity were similar. The current prevalence of elevated ALT activity in the United States (8.9%) is more than double that of previously available estimates. This prevalence is very high (7.3%) even among persons without viral hepatitis C or excessive alcohol consumption and is strongly associated with risk factors for nonalcoholic fatty liver disease.

Role of Hepatitis C Virus (HCV) Viremia and HCV Genotype in the Immune Recovery from Highly Active Antiretroviral Therapy in a Cohort of Antiretroviral-Naive HIV-Infected Individuals

The roles of hepatitis C virus (HCV) viremia and HCV genotype in the immune response to highly active antiretroviral therapy (HAART) are poorly understood. Our aim was to assess the CD4+ cell count recovery after HAART in human immunodeficiency virus (HIV)-infected patients with HCV viremia and HIV-infected patients who tested negative for HCV antibody (HCV-Ab). We also aimed to assess whether the response to HAART in these patients varied according to HCV genotype. The analysis focused on 1219 HCV-Ab-negative patients and 284 HCV-viremic patients from a cohort of HIV-infected subjects that includes persons who were antiretroviral naive before initiating HAART after cohort enrollment. HCV RNA load and HCV genotype were determined in plasma specimens obtained and stored during the 6-month period preceding the initiation of HAART. The chance of achieving a CD4+ cell count increase of > or = 100 cells/microL from the pre-HAART level tended to be poorer in HCV-viremic patients than in patients who tested negative for HCV-Ab (adjusted relative hazard [RH], 0.82; 95% confidence interval [CI], 0.66-1.01; P = .06). In contrast, a comparison of patients who had a HCV RNA load >1 x 10(6) IU/mL with patients who had a HCV RNA load of 5-1 x 10(6) IU/mL revealed no significant association between HCV RNA load and achievement of an increased CD4+ cell count (adjusted RH, 0.97; 95% CI, 0.75-1.27; P = .83). There was no clear association between HCV genotype and the probability of achieving a CD4+ cell count increase. An association between the presence of HCV-Ab and immune reconstitution after HAART has been shown elsewhere. Results of our large, prospective study support a direct role of HCV viremia in the CD4+ cell count response to HAART. Moreover, our results underline the fact that, in individuals coinfected with HIV and HCV, the goal of treating HCV infection is to eradicate HCV, to both slow the rate of HCV progression and limit potential interference with the response to HAART.