Prevalence Of anti-HCV Antibodies Research Articles

Prevalence of hepatitis C infection and risk factors in hospitalized diabetic patients: results of a cross-sectional study

Although there may exist a nosocomial risk of hepatitis C virus (HCV) infection in patients with type 1 or type 2 diabetes, this risk has not been fully investigated thus far and its magnitude is unknown. The aim of this multicenter cross-sectional study was to evaluate the prevalence of, and risk factors for, hepatitis C infection in consecutive hospitalized patients with diabetes and to assess the nosocomial risk and magnitude of HCV infection in these patients. Consecutive hospitalized patients with diabetes seen in 11 French hepatogastroenterology and diabetology departments were studied. The prevalence of anti-HCV antibodies was compared with that observed in healthy blood donors and individuals seen during routine medical checkup. Diabetic patients with anti-HCV antibodies were compared with patients without anti-HCV antibodies for assessment of risk factors. In total 1561 patients were studied. Independent risk factors for HCV infection were assessed through multivariate analysis. Thirty-three patients (2.11%) had anti-HCV antibodies and 21 (63.70%) had HCV identified risk factors. The prevalence of HCV infection was higher in patients with diabetes than in blood donors (0.08%) or healthy controls (0.20%) (P<0.001). Multivariate analysis identified four independent risk factors for HCV infection: blood transfusion before 1991 [odds ratio (OR)=2.88, P=0.033], intravenous drug use (OR=21.37, P=0.012), treatment in a hepatogastroenterology center (OR=4.17, P=0.002) and a high number (>2) of previous admissions since the onset of diabetes (OR=2.52, P=0.039). A nosocomial source of HCV infection in hospitalized diabetic patients is suggested by the increased risk of HCV infection associated with the number of hospitalizations. This may account for at least 36% of cases of HCV infection.

Factors Influencing Hepatitis C Virus Sero-prevalence among Blood Donors in North West Pakistan

Hepatitis C virus infection is a major health problem worldwide. The current study estimated seroprevalence of Hepatitis C virus (HCV) and evaluated associated factors among volunteer blood donors of the Northwest Frontier Province (NWFP), Pakistan. Of 1,131 volunteer blood donors enrolled, 46 (4.1%) were positive for anti-HCV antibodies. Multivariate logistic regression analysis revealed that positive donors were more likely to be 27-32 years old or >32 years old, have had 1-2 injections or >2 injections in the past year, or 1-5 intravenous (IV) drips or >5 I/V drips in the past 5 years. Positive donors had a family history of jaundice and were more likely to have been shaved (facial and armpit) by barbers. There was high prevalence of anti-HCV antibodies among blood donors of the NWFP. Public awareness programs should target the identified risk factors to prevent HCV transmission. We highlight the weakness of the health care system for blood donation, as it does not offer any record management for donors.

High prevalence of hepatitis C virus infection in the largest province of Pakistan

To estimate the prevalence and spectrum of hepatitis C virus (HCV) infection in the general population of Pakistan. A total of 6817 blood samples were collected randomly from apparently healthy people in the Punjab, Pakistan from March 1999 to April 2001 and September 2006 to August 2007. Detailed socioeconomic information for each participant was recorded. All the samples were tested for anti-HCV antibodies and all seropositive samples were further tested for HCV RNA by polymerase chain reaction (PCR). Of the total 6817 serum samples tested, 998 (14.63%) were positive for anti-HCV antibodies. HCV RNA PCR was detected in 494 (49.50%) anti-HCV-positive samples. The prevalence of anti-HCV antibodies were significantly higher in males (15.09%) than in females (12.3%) (P < 0.009). A significant difference was also noted in the anti-HCV prevalence rate among different age groups tested (P < 0.01). In a multivariate logistic regression analysis, injected drug use (adjusted OR 6.6 [95%CI 4.1-9.9]), blood transfusion (adjusted OR 5.9 [95%CI 2.9-12.3]), pricked with a needle (adjusted OR 2.2 [95%CI 1.6-3.1]), re-use of syringes (adjusted OR 1.7 [95%CI 0.8-3.6]) and being over 35 years old (adjusted OR 1.3 [95%CI 0.9-1.9]) were independent risk factors for HCV infection. The study showed a high seroprevalence of anti-HCV antibodies in a general and apparently healthy population of the Punjab province of Pakistan. Drug injection, blood transfusion and needle stuck were the factors most strongly associated with HCV infection.

Hemodialysis access surgery – Is there an increased risk of acquiring hepatitis C virus compared to other elective vascular interventions?

To evaluate whether dedicated access surgeons might have a significantly higher risk of acquiring hepatitis C infection compared to other vascular surgeons by assessing the prevalence of hepatitis C patients who are on chronic hemodialysis and to compare the frequency to patients undergoing elective vascular interventions. A retrospective chart and data analysis of all patients on chronic hemodialysis was conducted. As a comparative group, the prevalence of anti-HCV antibodies and positive HCV RNA PCR among patients admitted for elective vascular surgery was assessed. Of 285 patients on chronic hemodialysis, 202 (71%) were had both tests (antibody test for HCV and specific HCV RNA PCR testing). 5% (n = 11; CI 95 = 3-10%) were antibody positive, and 4% (n = 8; CI 95 = 2-8%) were also PCR positive and therefore infectious. One patient was acutely infected. Of 4963 vascular surgical patients, 1141 (23%) had an anti-HCV antibody ELISA test and specific HCV RNA PCR testing. 0.4% (n = 4; CI 95 = 0.1-1%) were antibody positive and 0.2% (n = 2; CI 95 = 0.03-0.7%) were also PCR positive and hence infectious. No acutely infected patient was detected in this population. The chance of operating on a HCV positive and infectious patient among hemodialysis patients was almost 27 times higher than among elective vascular surgical patients (P < 0.0001; OR = 26.56; CI 95 = 5.42-253.40). Dedicated hemodialysis access surgeons have a higher risk to acquire hepatitis C infection compared to vascular surgeons performing all other elective vascular surgical interventions. To identify early infected surgeons operating on high risk HCV patient collectives and to start rapid treatment, PCR testing at regular intervals would be advisable.

Patterns in the prevalence of hepatitis C virus infection at the start of hemodialysis in Japan

Although hepatitis C virus (HCV) infection is a persistent public health concern in hemodialysis patients, there seem to have been only a few reports on the prevalence of HCV at the start of hemodialysis. In this study we investigated whether patients starting on hemodialysis therapy are positive for anti-HCV antibody or not. The 400 patients who began regular hemodialysis between February 2003 and June 2007 were enrolled in this study. Clinical data such as age, anti-HCV antibody and primary cause of end-stage kidney disease (ESKD) were examined. As healthy controls we used 70,717 healthy blood donors in 2005 whose data were obtained from Tokyo Metropolitan Red Cross Blood Center. Anti-HCV antibody was used as an indicator of HCV infection. Since the prevalence of HCV infection is affected by age in Japan, we classified the patients by age group. The anti-HCV antibody prevalence rate among the patients who were new to hemodialysis was 7.3%, as opposed to 0.15% in the healthy volunteers. The prevalence of HCV in the 31-45-, 46-60-, and 61-year-old groups was significantly higher among the hemodialysis patients than among the healthy volunteers (P = 0.0209, <0.0001, and <0.0001, respectively). The prevalence rate of anti-HCV antibody was higher among men (10.0%) than among women (1.5%, P < 0.0001) in the hemodialysis patients. The anti-HCV-antibody-positive patients were significantly older than the anti-HCV-antibody-negative patients (66.4 +/- 14.3 years versus 58.6+/-16.6 years; P = 0.0152). Diabetic nephropathy was a more frequent cause of ESKD among the anti-HCV-antibody-positive patients (30.4%) than among the anti-HCV-antibody-negative patients (19.9%, P = 0.0122). Among the anti-HCV-antibody-positive patients, 55.2% had received a blood transfusion. The rate was significantly higher than that among the anti-HCV-antibody-negative patients (19.4%, P < 0.0001). The results showed a much higher rate of anti-HCV antibody positivity in patients new to hemodialysis than in healthy volunteers. Older age, blood transfusion, male gender, and diabetic nephropathy seemed to be risk factors for anti-HCV antibody positivity in Japan.

Prevalence of anti-hepatitis C virus antibodies in pregnant women and their offspring in a tertiary hospital in Southwestern Nigeria

The aim of this prospective study was to determine the prevalence of HCV antibodies among pregnant women and their corresponding offspring in a tertiary medical centre in Southwestern Nigeria. Anti-HCV antibodies (anti-HCV antibodies) were analyzed in blood samples from mothers and cord samples from their corresponding offspring using the Enzyme Linked Immunosorbent Assay (ELISA) method. The results obtained from the study were expressed in simple percentages. Out of the 272 consenting pregnant women screened for anti-HCV antibodies, 25 (9.2%) of them were positive. As none of the pregnant women had multiple births, screening the 272 cord sera from their offspring for the same antibodies revealed that 3 (1.10%) of them were also positive. Thus, the prevalence of anti-HCV antibodies in the pregnant women and their offspring were 9.2% and 1.1% respectively. If vertical transmission of HCV were to be based on the acquisition of anti-HCV antibodies alone, the prevalence of vertical transmission from HCV infected mothers to offspring in the study was 12.0%. Further studies on vertical transmission are suggested to include analysis for HCV-RNA quantification in pregnant mothers and their offspring as well as a long-term follow-up of neonates seropositive for HCV markers. Such studies are necessary to justify any recommendations to be made for the purpose of reducing HCV infection through vertical transmission.

Aggressive use of diagnostic services is counterproductive

Background: Medical fraternity requisitions diagnostic tests for multiple reasons. More often than not, the tests lead to more tests either to exclude or to confirm doubts raised by the test results. These tests have an inherent morbidity, discomfort and cost. Growing expenditure on diagnostic tests without matching improvement in the health status warrants an internal audit of the laboratory utilization. Methods: A retrospective utility audit was done for certain routinely advised laboratory tests at a hospital. Blood urea estimation in annual / periodic medical examination (AME/ PME), bleeding and clotting time in pre-anaesthetic check-up and aspartate aminotransferase (AST) and antibodies to hepatitis C virus (anti-HCV) in diagnostic work-up of acute onset jaundice were included in the audit. Results: During the study period, 793 individuals underwent AME / PME and urea estimation did not provide any additional information in these cases which was not inferred by serum creatinine. Similarly, in diagnostic workup of acute onset jaundice, 6049 aspartate aminotransferase (AST) estimations in 1024 patients did not contribute anything more than what was inferred by alanine aminotransferase (ALT). Prevalence of anti HCV antibodies in acute onset jaundice in serving soldiers (11 out of 1225; 0.89%) though more than that in the blood donors from the same population (17 out of 4105; 0.41%) was less than anticipated false positives (18 out of 1225; 1.5%) as per the claimed specificity (98.5%) of the test kit. None of the 2766 bleeding and clotting time tests detected a bleeding or coagulation disorder. Conclusion: The study reveals significant overuse of the laboratory that may not be good for the patient and the organization in terms of direct and indirect costs due to false positive results. This laboratory overload adversely affects the quality and availability of laboratory results. Therefore, a test should only be advised, if positive or negative result would dictate a change in patient management.

Prevalence of Anti-HCV antibody in haemodialysis patients referring to haemodialysis centers in Jahrom

Prevalence of Anti-HCV antibody in haemodialysis patients referring to haemodialysis centers in Jahrom

Risk Factors for Intrahepatic and Extrahepatic Cholangiocarcinoma: A Hospital-Based Case?Control Study

The risk factors for cholangiocarcinoma are poorly defined in the United States. We evaluated hepatitis C virus (HCV), hepatitis B virus (HBV), and liver cirrhosis as risk factors for intrahepatic cholangiocarcinoma (ICC) and extrahepatic cholangiocarcinoma (ECC). A case-control study in which cases were cholangiocarcinoma patients referred to the M.D. Anderson Cancer Center between 1992 and 2002 and controls were healthy individuals. Information about liver diseases, family history, diabetes, smoking, and alcohol consumption were collected on both groups. Blood from all participants was tested for HBV and HCV markers. We identified 246 cases (83 ICC and 163 ECC) and matched them to 236 controls. Compared with controls, ICC patients had a higher prevalence of anti-HCV antibodies (6.0%vs 0.8%, P=0.01), anti-HBc (9.6%vs 0%, P<0.0001), and heavy alcohol consumption (21.7%vs 3.8%, P<0.0001). The adjusted odds ratio and 95% confidence interval (CI) were 7.9 (95% CI 1.3-84.5), 28.6 (95% CI 3.9-1,268.1), and 5.9 (95% CI 2.1-17.4), respectively. Only heavy alcohol consumption was higher in patients with ECC than in controls (17.8%vs 3.8%, P=0.003). The prevalence of diabetes and smoking were not significantly different between cases (ICC or ECC) and controls. The prevalence of cirrhosis was higher in patients with ICC than those with ECC (24.1%vs 4.9%, P<0.0001). Liver cirrhosis and chronic HCV infection are possible risk factors for ICC but not ECC. Heavy alcohol consumption is a risk factor for both ICC and ECC.

Hepatitis C in a sample of pregnant women in Switzerland: seroprevalence and socio-demographic factors.

The aim of this study was to determine the prevalence of hepatitis C (HCV) infection in a sample of pregnant women living in Switzerland in 1990-1991, in order to complement existing data in various populations. Blood samples were collected from women from consecutive births in obstetric wards in public hospitals of 23 Swiss cantons over a one-year period. They were tested, among other things, for the presence of hepatitis C virus antibodies (anti-HCV). Statistical analyses were done to explore the association of demographic variables with anti-HCV. The study included a total of 9,057 women of whom 64 tested positive for anti-HCV, resulting in a crude prevalence of 0.71%. Prevalence varied by age and was highest in the 25-29-year age-group (0.90%). 43/5,685 Swiss women were HCV seropositive (0.76%) compared with 21/3,372 non-Swiss women (0.62%). Stratified analysis showed a significant association between anti-HCV and anti-HBc antibody positivity in Swiss (adjusted OR [aOR] 23, 95% CI 12-43) and non-Swiss nationals (aOR 3.3, 95% CI 1.3-8.3). The prevalence of anti-HCV antibodies in the early 1990s was <1% in this sample of pregnant women in Switzerland and was associated with age, nationality and the presence of anti-HBc antibodies, a marker of exposure to hepatitis B virus. These results are in accordance with those from other published European studies. If an effective intervention to prevent vertical transmission becomes available, information on the current prevalence of HCV in pregnant women would be needed in order to assess how screening recommendations should be modified.

Hepatitis C in a sample of pregnant women in Switzerland: seroprevalence and socio-demographic factors.

The aim of this study was to determine the prevalence of hepatitis C (HCV) infection in a sample of pregnant women living in Switzerland in 1990-1991, in order to complement existing data in various populations. Blood samples were collected from women from consecutive births in obstetric wards in public hospitals of 23 Swiss cantons over a one-year period. They were tested, among other things, for the presence of hepatitis C virus antibodies (anti-HCV). Statistical analyses were done to explore the association of demographic variables with anti-HCV. The study included a total of 9,057 women of whom 64 tested positive for anti-HCV, resulting in a crude prevalence of 0.71%. Prevalence varied by age and was highest in the 25-29-year age-group (0.90%). 43/5,685 Swiss women were HCV seropositive (0.76%) compared with 21/3,372 non-Swiss women (0.62%). Stratified analysis showed a significant association between anti-HCV and anti-HBc antibody positivity in Swiss (adjusted OR [aOR] 23, 95% CI 12-43) and non-Swiss nationals (aOR 3.3, 95% CI 1.3-8.3). The prevalence of anti-HCV antibodies in the early 1990s was <1% in this sample of pregnant women in Switzerland and was associated with age, nationality and the presence of anti-HBc antibodies, a marker of exposure to hepatitis B virus. These results are in accordance with those from other published European studies. If an effective intervention to prevent vertical transmission becomes available, information on the current prevalence of HCV in pregnant women would be needed in order to assess how screening recommendations should be modified.

Screening campaign of hepatitis C among underprivileged people consulting in health centres of Lyon area, France

A screening campaign for hepatitis C virus (HCV) infection was carried out in eight health centres of Lyon from June 2003 until March 2004. The population targeted for screening was underprivileged individuals without any social insurance, protected by Couverture Mutuelle Universelle or Aide Médicale Etat (AME), to estimate the prevalence of anti-HCV antibodies in this population and to identify associated risk factors. After training in HCV infection and screening, 43 general practitioners participated in the campaign. Information about patient socio-demographics and risk factors was collected prior to proposing screening serology. Blood samples were often taken in health centres. Follow-up of positive cases was organised via the Reference Centre of HCV Infection in Lyon with possible specialised consultations in health centres. The average age of the 988 individuals in the campaign was 37 years; 51% were women; 54% had a foreign nationality; 21% lived in sheltered accommodation; 19% were lodged in third-party accommodation; 9% were homeless; and 57% possessed less than euro562 (Revenu Minimum d'Insertion level). Screening was not proposed to nine patients because of medico-psychological problems. The acceptance rate for screening was 98.8% (967/979), and testing was carried out on 97.6% of these subjects (944/967). The prevalence of anti-HCV antibodies in the sample was 4.7% (44/944) (95% CI = 3.4-6.2). Nearly 80% of positive cases were unknown prior to the campaign. Multivariate logistic regression modelling identified lifetime injection drug use [odds ratios (OR) = 15.99; P < 0.0001], lifetime medical care in a foreign country (OR = 4.46; P = 0.001), and wearing tattoos (OR = 2.75; P = 0.048) as significant risk factors for carrying anti-HCV antibodies. Characteristics independently associated with HCV seropositivity were age between 40 and 49 years, AME benefits, and no social insurance. Wide acceptance of screening, high prevalence of anti-HCV antibodies (much higher than in the French population in general), a high proportion of positive cases unknown beforehand, and satisfactory follow-up of seropositive patients are all factors which support the need for a screening campaign targeting HCV infection in underprivileged persons living in France.

The risk of transfusion-acquired hepatitis-C virus infection among blood donors in Port Harcourt: the question of blood safety in Nigeria.

This study was undertaken to establish the sero-epidemology of Hepatitis C Virus (HCV) antibodies among blood donors in Port Harcourt, Nigeria. One Thousand Five Hundred consecutive blood donors presenting to the blood transfusion unit of the University of Port Harcourt Teaching Hospital between January and April, 2003 comprising of 1481 males and 19 females were screened for hepatitis C antibodies using the commercially available Clinotech anti-HCV test strips. All initially positive samples were subsequently tested using a second-generation Trinity Biotec enzyme linked immunosorbent assay. HCV antibodies were detected in 7 (0.5%) of donors. Although statistically not significant, the overall sero prevalence of HCV antibodies was higher in males 7 (0.5%) compared to zero prevalence among females. (chi-squared = 1.94, p = 1.000). Commercial remunerated donors had a higher prevalence of anti-HCV anti-bodies 5 (0.8%) compared to family replacement donors (0.2%) (chi-squared = 1.25, p = 0.26). The highest infection rate occurred in the 18 - 27 years age group 7 (0.7%). This study shows a 0.5% prevalence of HCV antibodies among blood donors and describes their demographic characteristics. This calls for urgent implementation of a universal donor screening for HCV antibodies and setting up of a national blood transfusion service run on the basis of voluntary, non-remunerated low risk donors.

Seroprevalence of hepatitis C in patients with type 2 diabetes mellitus and non-diabetic on haemodialysis

Type 2 diabetes mellitus (DM) has emerged as the commonest cause of end-stage renal disease. Haemodialysis (HD) treatment constitutes a high-risk environment for the transmission of hepatitis C virus (HCV). The aim of this study was to establish a potential relationship between type 2 DM and HCV infection in HD patients. Of the 267 HD patients, 67 (25.1%) had type 2 DM and 200 (74.9%) were with diverse aetiology for end-stage renal disease. The serum markers of HCV infection were tested by a second-generation enzyme-linked immunosorbent assay test for antibodies and by qualitative reverse-transcription polymerase chain reaction technique for viral RNA. The overall prevalence of anti-HCV antibodies and HCV RNA was found to be 12.7% (34/267) and 10.1% (27/267), respectively. Patients with type 2 DM were found to have a higher HCV prevalence compared with non-diabetic patients [20.8% (14/67) vs. 10% (20/200)] (p < 0.05). The mean period on dialysis of anti-HCV-positive patients with type 2 DM was shorter than that observed for anti-HCV-positive non-diabetic patients (43.9 +/- 9.8 months vs. 59.7 +/- 28.4 months) (p < 0.05). This study has shown that although the period on dialysis of diabetic patients are shorter than non-diabetic patients, the prevalence of HCV in HD patients with type 2 DM is higher than that detected in non-diabetic HD patients.

Prevalence and risk factors for hepatitis C virus infection in Mongolian children: Findings from a nationwide survey

Although the hepatitis C virus (HCV) infection is one of the major causes of chronic hepatitis and hepatocellular carcinoma (HCC) in Mongolia, its prevalence among children and routes of transmission are largely unknown. The aim of the study was to determine the prevalence of anti-HCV antibodies and the possible risk factors for transmission among school children using representative national data. A nationwide cross-sectional survey among elementary school children was conducted in four main geographical regions and the metropolitan area of Mongolia, through multistage, stratified, random cluster sampling. Serum samples from 1,145 children (response rate, 93%; 592 boys and 553 girls; age range, 7-12 years), which represented nearly 2% of the second grade population in Mongolia, were tested for HCV antibodies with a third-generation immunoradiometric assay (IRMA). Positive samples were further evaluated by a third-generation immunoblot assay (RIBA). A standardized questionnaire concerning the socio-demographic characteristics and potential risk factors was used. Overall, seven subjects were confirmed to be anti-HCV seropositive, giving a prevalence of 0.6% (95% CI: 0.15-1.0%). The prevalence of anti-HCV increased with age. In the multivariate logistic regression analysis, adjusted for age, sex, and residence, the history of dental manipulation (odds ratio [OR] = 15.4; 95% CI: 1.4-164.8) and surgery (OR = 8.3; 95% CI: 1.5-45.6) were associated independently with the presence of anti-HCV. These findings suggest that contaminated equipment used in the dental and surgical manipulations probably played a predominant role in HCV transmission among Mongolian children. Strict guidelines on disinfection and sterilization procedures of medical instruments have to be introduced and should be followed to improve the control of HCV infection in Mongolia.

Incidence and prevalence of hepatitis C virus infection in Chile: Original Article

Chronic hepatitis C is a major cause of liver-related morbidity and mortality. Epidemiological data regarding this infection in developing countries is scanty. Methods: Prevalence of hepatitis C (HCV) infection was investigated in a random sample of Chilean general adult population older than 20 years of age. Additionally, frequency of HCV infection was assessed in group of native Chilean Amerindians (Mapuche Indians) living in an isolated locality of the Southern Chile. Incidence of HCV infection was estimated using serum samples separated by 7 years (1993-2000). Results: Among 959 subjects, prevalence of anti-HCV antibodies was 1.15% (95% CI 0.48-1.82%) and 0.83% when only RIBA-confirmed cases were considered. Among these subjects, 62.5% had detectable HCV RNA in serum and 40% of them had a history of blood transfusion. Age distribution of cases showed a steadily increasing prevalence with age. Estimated incidence of new HCV infections was 15 per 100,000 subjects per year in the period 1993-2000. No cases were detected among the 145 Mapuche subjects studied. Conclusions: HCV infection is a prevalent disease in the Hispanic population of Chile with a low incidence in the last decade, whereas it was not detected in an isolated Mapuche Indian community. Age distribution of prevalence suggests that the peak of infection in Chile occurred 30 to 50 years ago.

Treatment of Hepatitis C in HIV-Infected Patients

IN THE MODERN ERA OF HIGHLY ACTIVE ANTIRETROVIRAL therapy (HAART), hepatitis C virus (HCV) has emerged as a major cause of morbidity and death in human immunodeficiency virus (HIV) infection. An estimated 15% to 30% of HIV-infected individuals are coinfected with HCV, representing 150000 to 300000 patients in the United States alone. The prevalence of anti-HCV antibodies in HIVinfected persons differs significantly according to the HIVexposure risk category, ranging from less than 10% in homosexual men to more than 85% in injecting drug users. In the vast majority of immunocompetent non–HIVinfected persons, chronic hepatitis C usually takes a relatively mild course, leading to liver cirrhosis in 2% to 25% after 20 to 25 years depending on the individual risk factor profile. Liver-related death is only slightly more frequent in HCV-infected individuals. In contrast, hepatitis C may take a much more severe course in HIV-infected patients. In men with hemophilia, the prevalence of cirrhosis as well as liver-related deaths is significantly higher in HCV-HIV– coinfected individuals than in patients infected with HIV alone. However, these findings may not necessarily reflect the situation in other cohorts in which HCV infection has not been shown to increase the risk of death. Since antiretroviral therapy can be associated with significant hepatotoxicity, there has been some concern that HAART, specifically protease inhibitors, may promote progression of fibrosis in HCV-RNA–positive patients. Fortunately, this has not been the case, and antiretroviral therapy has even been shown to reduce long-term liver-related mortality in HIV-HCV–coinfected patients. In contrast, HCV infection appears to influence the natural history of HIV disease. In the Swiss HIV cohort, among more than 3000 HIVinfected individuals, those also infected with HCV had a modestly increased risk for developing AIDS and a less robust increase in CD4 cell counts after initiation of antiretroviral therapy compared with patients infected with HIV alone. On the other hand, a study from Baltimore found that HCV coinfection had no influence on developing AIDS or response to HAART. These differences highlight the problem that different cohorts may be difficult to compare because both HIV and HCV disease may have different trajectories depending on the route of infection (eg, blood transfusions vs community acquired) and other factors. Interactions between HCV and HIV are difficult to investigate. Although the primary site of replication differs (for HCV, the liver; for HIV, T cells, monocytes, and dendritic cells), HCV may also replicate in dendritic cells and monocytes, while HIV can cause hepatitis. Thus, both viruses may directly interact with the other’s replication and influence the host’s immune response to the other virus. Hepatitis C virus replication is much more rapid in HIV-infected patients than in patients infected with HCV alone, indicating decreased immune function. On the other hand, HCV proteins may directly inhibit the function of dendritic cells and natural killer cells and thus alter the anti-HIV–specific immune response. Thus, coinfection with HIV and HCV may influence viral load and immune responses and thereby affect efficacy of antiviral treatment against both HIV and HCV. Treatment options for patients infected with hepatitis C have significantly improved only in recent years. Acute hepatitis C as well as chronic HCV genotype 2 or 3 infection is now considered a curable disease in immunocompetent patients. Even patients infected with the more difficult-to-treat HCV genotypes 1 and 4 can achieve sustained clearance rates of HCV-RNA in about 50%. Three

Hepatitis C virus infection and B-cell non-Hodgkin's lymphoma

The role of hepatitis C virus (HCV) infection in the pathogenesis of non-Hodgkin's lymphoma (NHL) is controversial. A high prevalence of HCV infection in patients with NHL has been reported in Italy and Japan. By contrast, several studies in Northern Europe and Canada have not found any increased prevalence of HCV in B-cell NHL, suggesting a possible geographic variation. We sought to determine whether such an association could be found in patients treated in the Rhone-Alpes region in south-east France. Our main interest was to identify histological subtypes preferentially linked to HCV. We determined the prevalence of anti-HCV antibodies in 212 consecutive patients with B-cell NHL diagnosed in our institution between January 1997 and December 1998. The comparison group comprised 974 patients tested for HCV before transfusion at the same hospital during the same period. Anti-HCV antibodies were found in six (2.8%) NHL patients. The distribution by histopathological category was as follows: three gastric mucosa-associated lymphoid tissue (MALT) lymphomas, one marginal lymphoma and two diffuse large-cell lymphomas. Anti-HCV antibodies were found in 20 (2%) of 974 comparison patients. Overall, there was a positive but non-significant trend towards an association between NHL and HCV infection (odds ratio 1.31; 95% confidence interval 0.51-3.36). However, the prevalence of HCV antibodies was significantly higher in MALT lymphoma patients than in the comparison group (odds ratio 9.87; 95% confidence interval 2.59-37.69). To our knowledge, this is the first French study to show an association between HCV and MALT lymphoma. These results, although derived from a small number of patients, suggest a possible role of HCV in gastric MALT lymphomagenesis.

Prévalence et incidence élevées de l’infection par le virus de l’hépatite C chez les hémodialysés dans la région Centre-Est de la Tunisie

Hemodialysed patients are recognised as a group at increased risk of infection with hepatitis C virus (HCV). The aim of this study was to determine the prevalence and incidence of HCV infection among dialysis patients of the east-centre part of Tunisia. Two hundred and seventy-six patients dialysed until 2001 were recruited within seven hemodialysis units located in the cities of Sousse, Monastir and Mahdia. The serum markers of HCV infection were tested over the period of March 2000–December 2002, by a 3rd generation ELISA test for antibodies and by qualitative RT-PCR technique for viral RNA. The prevalence of anti-HCV antibodies and of HCV RNA was 32.6% (90 patients) and 25.7% (71 patients), respectively. Between 1998 and 2002, 20 new infections were documented in five of the seven dialysis units corresponding to an incidence of 2.34% per year, with an average time of contamination after the beginning of dialysis of 4.6 years. If all the infections are assessed to have occurred during dialysis, the density of incidence of HCV contamination was 4.4% per year of dialysis. A high correlation was noticed between the presence of HCV markers in serum and the duration of dialysis ( F = 34.15, P < 0.0001). In the absence of other risk factors (transfusion, drug-addiction), these results plead for the nosocomial transmission of the observed HCV infections. A phylogenetic analysis of the E2 hypervariable region of the viral genome is in progress to confirm this assumption.

Intranasal cocaine use does not appear to be an independent risk factor for HCV infection.

To determine the prevalence of HCV infection among intranasal cocaine users and evaluate underlying parental risk factors. A cross-sectional study evaluated prospectively 60 patients admitted to a chemical dependency unit. A standardized questionnaire was designed to obtain epidemiological data. Aminotransferases and anti-HCV antibodies were determined. Anti-HCV antibody positivity was confirmed by polymerase chain reaction (PCR). Fifteen (25%) patients of 60 tested intranasal cocaine users were anti-HCV positive. Ten (75%) of them had detectable HCV-RNA. Comparison between 15 anti-HCV positive and 45 anti-HCV negative patients showed significant differences in mean age (35 versus 27 years), estimated time of drug use (10 versus 4 years), rate of elevated ALT and/or AST (60% versus 16%) and presence of parenteral risk factors (100% versus 7%). Comparison between patients with and without elevated aminotransferases showed significant difference in mean duration of drug use (8 versus 5 years) and rate of anti-HCV positivity (56% versus 14%). Among 15 anti-HCV positive patients, HCV-RNA was detectable in all with elevated aminotransferases and only one of six with normal aminotransferases (100% versus 17%). While there was a high prevalence of anti-HCV antibodies in this sample of intranasal cocaine users, the infection was highly correlated with the presence of intravenous (i.v.) drug use and duration of drug use. In this sample, therefore, intranasal cocaine use alone was not an important risk factor for HCV infection.