Prevalence Of Hepatitis C Virus Seropositivity Research Articles

Hepatitis C virus care cascade for children in Moscow Region

Background. Children and adolescents with infection caused by the hepatitis C virus (HCV) have not been given sufficient attention due to mild forms of HCV and delays in approval of antiviral treatment regimens. Omissions in the studies of pediatric cohorts and shortcomings of management policies aimed at children should be eliminated by improving screening coverage and access to treatment.
 The aim of the study was to present the results of the cascade sequence of diagnostic testing, care and treatment of children with HCV in the Moscow Region (MR).
 Materials and methods. The study included all HCV seropositive children of MR (n = 175), who underwent screening tests, and it did not include patients living with HIV/HCV coinfection. Children were observed from 2017 to 2022. The HCV RNA was detected in 164 children and HCV genotypes were identified in 99 children. The stage of liver fibrosis was assessed in 73 children by transient elastography and by FIB-4 index calculation.
 Results. In MR, 93.7% of seropositive children were tested for HCV RNA; 71.2% of adolescents over 12 years of age received treatment. The prevalence of HCV seropositivity was estimated at 0.113/1,000 children population; the prevalence of chronic HCV infection was at least 0.059/1,000. The dominant HCV subtypes were GT 1b (43.4% [the 95% confidence interval, 33.553.8%]), GT 3a (23.2% [15.332.8%]) and GT 3a/3b (20.2% [12.829.5%]). The incidence of viremic HCV infection per 100,000 children was 3.3 among children under 3 years of age; 7.0 among children aged 36 years; 7.7 among children aged 711 years, 4.4 among adolescents older than 12 years. Natural HCV clearance was reported at the frequency of 19.5% [13.826.4%]. Extrahepatic manifestations were of rare occasion 2.9% [0.96.5%]. Vertical transmission was the primary route of HCV transmission (78.3% [71.484.2%]); infection is assumed to occur during medical invasive procedures 7.4% [4.012.4%], drug using 0.6% [0.013.10%], in the family household 0.6% [0.013.10%]. New cases of HCV infection were more frequently detected during routine examination of children prior to hospitalization or children born to mothers with HCV. Viremic HCV was confirmed in 90.2% [84.694.3%], including HCV infection in 53.4% [45.061.6%], chronic liver disease in 35.8% [28.144.1%] having low activity and occasional consequences (the fibrosis METAVIR score of F1 and F1-2 17.8% [9.828.5%]). No significant clinical and epidemiological differences between the natural course of chronic HCV infection and the liver disease caused by HCV have been found. The burden of pediatric HCV in MR is aggravated by a significant proportion of socially vulnerable patients and patients with comorbid conditions.
 Conclusion. One of the solutions for detection of new pediatric cases of HCV infection in MR can be offered by improvement of collaboration and continuity of care among healthcare organizations and early treatment of women of childbearing age. Further research is required to evaluate the effectiveness of routine testing of all socially vulnerable pediatric groups. Early application of pan-genotypic antiviral treatment regimens can contribute significantly to control of the HCV infection incidence in children.

Hepatitis C virus or hepatitis B virus coinfection and lymphoma risk in people living with HIV.

Chronic hepatitis C virus (HCV) and hepatitis B virus (HBV) infections are associated with increased risks of lymphomas in the non-HIV setting. Their impacts on HIV-associated lymphomas deserved further studies in the modern combined antiretroviral therapy (cART) era. We evaluated the associations between HCV, HBV and HIV-related lymphomas in the Lymphovir-ANRS-CO16 cohort. Prevalence of HCV seropositivity and chronic HBV infections were compared with those observed in the French Hospital Database on HIV (FHDH-ANRS-CO4). Between 2008 and 2015, 179 patients with HIV-related lymphomas from 32 French hospitals were enrolled, 69 had Hodgkin's lymphoma (39%), and 110 non-Hodgkin's lymphoma (NHL) (61%). The prevalence of HCV infection was higher in patients with NHL than in the FHDH-ANRS-CO4 [26 versus 14%, odd ratio (OR): 2.15; 95% confidence interval (1.35-3.32)] whereas there was no association between Hodgkin's lymphoma and chronic HCV infection. Chronic HBV infection was not associated with NHL in our cohort with a prevalence of 5 versus 7% in FHDH-ANRS-CO4 but tended to be associated with Hodgkin's lymphoma [prevalence of 14%, OR: 2.16 (0.98-4.27)]. Chronic HCV infection tended to pejoratively impact 2-year overall survival in patients with NHL: 72% [57%, 91%] versus 82% [74%, 91%], hazard ratio: 2.14 [0.95-4.84]. In contrast, chronic HBV infection did not correlate with outcome. In the modern cART era, chronic HCV infection is associated with an increased risk of NHL in PLWHIV and tends to pejoratively impact overall survival. HBV infection is not associated with the risk of NHL but with a borderline increase of Hodgkin's lymphoma risk.

The burden of hepatitis C virus in Cameroon: Spatial epidemiology and historical perspective.

Cameroon is thought to have one of the highest prevalences of hepatitis C virus (HCV) infection in the world (4.9% among adults). A marked cohort effect exists in several communities where ≈50% of the elderly are infected. Better assessment of HCV distribution is needed for planning treatment programmes. We tested for HCV antibodies 14150 capillary blood samples collected during the 2011 Demographic and Health Survey, whose participants were representative of the Cameroonian population aged 15-49 (both genders) and 50-59years (men only). Historical data on exposure to medical care were collected and factors associated with HCV assessed through logistic regression and geospatial analyses. To estimate prevalence in all persons aged ≥15years, we used data from the survey for the 15-59years fraction and modelled a cohort effect for older individuals. The nationwide HCV prevalence was 0.81% for the 15-49years group, and 2.51% for all individuals aged ≥15years. Only 0.2% of individuals aged 15-19 were seropositive. Among participants aged 15-44years, HCV was associated with age, rural residence and, for males, with ritual circumcision. For those aged 45-59years, HCV was associated with age and access to medical care in the late 1950s. Prevalence of HCV seropositivity in Cameroon is half of previous estimates. Nationwide surveys are essential to rationalize resources allocation. The high prevalence among older cohorts, a colonial legacy, has had little spillover into younger cohorts. HCV-free generations might be attainable in countries not plagued with intravenous drug abuse.

Assessment of hepatitis C virus infection in two adjacent Thai provinces with drastically different seroprevalence

Improved awareness of the hepatitis C virus (HCV) transmission has contributed to the overall decline in the HCV infection rate in some developing countries including Thailand. Chronic HCV infection in some rural Thai communities, however, presents a challenge in the efforts to treat and manage HCV-related diseases. Published and unpublished studies have suggested an unusually high incidence of HCV infection in a Thai province of Phetchabun compared to elsewhere in Thailand. To determine the magnitude of HCV infection and identify potential factors contributing to the higher rate of HCV infection in this province, we performed a population-based study in Phetchabun (n = 1667) and the neighboring Khon Kaen province (n = 1410) where HCV prevalence is much lower. Individuals between 30 and 64 years old completed detailed questionnaires designed to identify HCV risk factors and provided blood samples for anti-HCV antibody screening. The anti-HCV seropositive rates were 15.5% (259/1667) in Phetchabun and 3.6% (51/1410) in Khon Kaen. Positive samples were subsequently genotyped for HCV core gene sequence and assessed for the hepatitis B virus surface antigen (HBsAg) and human immunodeficiency virus antigen/antibody (HIV Ag/Ab). More individuals in Phetchabun possessed the combined presence of HBsAg (5.0%) and HIV Ag/Ab (0.4%) than those in Khon Kaen (3.9% HBsAg and 0.0% HIV Ag/Ab). While male gender, intravenous drug use (IVDU) and tattoos were significant HCV risk factors in both provinces (p <0.05), education less than high school and agriculture-related occupation were additionally associated with HCV in Phetchabun. HCV genotypes 6, 3, and 1 were identified in similar frequency in both provinces. We estimated that prevalence of HCV seropositivity and viremic carriers were higher in Phetchabun (143 and 111 per 1000) than in Khon Kaen (34 and 22 per 1000). Finally, we derived a simple risk factor-based scoring system as a useful preclinical tool to screen individuals at risk of chronic HCV infection prior to intervention. Knowledge gained from this study will assist in HCV screening and promote access to anti-viral treatment in high-risk groups.

Association Between Hepatitis C Virus and Head and Neck Cancers.

Hepatitis C virus (HCV) infection is associated with hepatocellular carcinoma and non-Hodgkin's lymphoma. In 2009, MD Anderson established the first US clinic for treating HCV-infected cancer patients, where we observed an unexpectedly large number of patients with head and neck cancers (HNCs). We sought to determine whether HCV is associated with HNCs. In this case-control study, medical records of cancer patients tested for HCV antibodies at our center from 2004 through 2014 were identified. Case subjects had new-onset primary oropharyngeal or nonoropharyngeal (oral cavity, nasopharynx, hypopharynx, or larynx) HNCs. Control subjects had smoking-associated (lung, esophagus, or urinary bladder) cancers. Biopsy reports of oropharyngeal cancers tested for human papillomavirus (HPV) were reviewed. Patients with lymphoma were excluded. Multivariable logistic regression models were constructed. All statistical tests were two-sided. Of 34 545 cancer patients tested for HCV antibodies, 409 case subjects (164 oropharyngeal and 245 nonoropharyngeal) and 694 control subjects (378 lung, 168 esophagus, and 148 urinary bladder) were studied. The prevalence of HCV seropositivity was higher in oropharyngeal cancer patients (14.0%, 95% confidence interval [CI] = 8.7% to 19.4%, vs 6.5%, 95% CI = 4.6% to 8.3%), particularly HPV-positive oropharyngeal cancer patients (16.9%, 95% CI = 8.7% to 24.9%, vs 6.5%, 95% CI = 4.6% to 8.3%), and nonoropharyngeal HNC patients (20.0%, 95% CI = 14.9% to 25.0%, vs 6.5%, 95% CI = 4.6% to 8.3%) than in control subjects. Adjusted models showed a statistically significant association of HCV seropositivity with nonoropharyngeal (except nasopharyngeal) HNCs (odds ratio [OR] = 2.85, 95% CI = 1.38 to 5.88) and HPV-positive oropharyngeal cancers (OR = 2.97, 95% CI = 1.31 to 6.76). HCV is associated with nonoropharyngeal (except nasopharyngeal) and HPV-positive oropharyngeal HNCs. Further studies are required to explore the possible interaction between HCV and HPV, and the association between HCV and other HPV-related malignancies.

Time trends of seroepidemiology of hepatitis C virus and hepatitis B virus coinfection in human immunodeficiency virus-infected patients in a Super Specialty Hospital in New Delhi, India: 2012-2014.

Hepatitis viruses and human immunodeficiency virus (HIV) coinfection is a major cause of liver diseases worldwide. High prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) in Asia makes it important to understand HBV and HCV coinfection with HIV in this part of the globe. This study was done with the aim of assessing the time trends of seroepidemiology of HBV and HCV coinfection in HIV patients over the last 3 years. Year wise retrospective analysis of data between January 2012 and December 2014 was done. The prevalence of HIV infection among 0-20 years and >60 years age group decreased over the last 3 years (2012-2014), 8.4%, 6.4%, and 3.1% and 3.6%, 3.8%, and 1.5%, respectively. While increasing prevalence was seen among 21-40 years age group, 57.8%, 60.2%, and 67.1%, respectively in 2012, 2013, and 2014. There was no significant relationship between age/gender and HBV/HCV seropositivity among HIV-positive patients. The risk of acquiring HBV infection was more in HIV-positive patients who were >60 years of age (odds ratio = 3.3182; 95% confidence interval: 0.3669-30.005). The prevalence of HCV seropositivity is less in HIV-positive patients as only one case was anti-HCV antibody positive in last 3 years who was a male patient in the age group 21-40 years. A declining trend was observed for HIV positive cases over 2012-2014 while no significant trend change is seen in HBV/HCV seropositivity among HIV patients from 2012 to 2104. It is recommended to screen HIV patients routinely for concurrent HBV/HCV infection as hepatotropic viruses with HIV increase the risk of liver mortalities.

Time trends of seroepidemiology of hepatitis C virus and hepatitis B virus coinfection in human immunodeficiency virus-infected patients in a Super Specialty Hospital in New Delhi, India: 2012–2014

Background:Hepatitis viruses and human immunodeficiency virus (HIV) coinfection is a major cause of liver diseases worldwide. High prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) in Asia makes it important to understand HBV and HCV coinfection with HIV in this part of the globe. This study was done with the aim of assessing the time trends of seroepidemiology of HBV and HCV coinfection in HIV patients over the last 3 years.Materials and Methods:Year wise retrospective analysis of data between January 2012 and December 2014 was done.Results:The prevalence of HIV infection among 0–20 years and >60 years age group decreased over the last 3 years (2012–2014), 8.4%, 6.4%, and 3.1% and 3.6%, 3.8%, and 1.5%, respectively. While increasing prevalence was seen among 21–40 years age group, 57.8%, 60.2%, and 67.1%, respectively in 2012, 2013, and 2014. There was no significant relationship between age/gender and HBV/HCV seropositivity among HIV-positive patients. The risk of acquiring HBV infection was more in HIV-positive patients who were >60 years of age (odds ratio = 3.3182; 95% confidence interval: 0.3669–30.005). The prevalence of HCV seropositivity is less in HIV-positive patients as only one case was anti-HCV antibody positive in last 3 years who was a male patient in the age group 21–40 years. A declining trend was observed for HIV positive cases over 2012–2014 while no significant trend change is seen in HBV/HCV seropositivity among HIV patients from 2012 to 2104.Conclusion:It is recommended to screen HIV patients routinely for concurrent HBV/HCV infection as hepatotropic viruses with HIV increase the risk of liver mortalities.

Association of Hepatitis C and B Virus Infection With CKD in an Endemic Area in Taiwan: A Cross-sectional Study

Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections may lead to nephropathy. However, the association between different types of viral hepatitis and chronic kidney disease (CKD) is not well established. Cross-sectional study. A large-scale community study with 54,966 adults in a Taiwanese county endemic for HBV and HCV infection. HCV infection alone, HBV infection alone, HBV/HCV coinfection, and neither. Proteinuria (urine protein, >or=1+), low (<60 mL/min/1.73 m(2)) estimated glomerular filtration rate (eGFR), and CKD (proteinuria or eGFR <60 mL/min/1.73 m(2)). HBV and HCV infection were defined as a seropositive test result for hepatitis B surface antigen and HCV antibody. Proteinuria was assessed using a repeated dipstick method. eGFR was computed using the 4-variable Modification of Diet in Renal Disease (MDRD) Study equation. Mean age of the study group was 60.8 years. Prevalences of HCV infection alone, HBV infection alone, HBV/HCV coinfection, and neither were 9.4%, 9.9%, 0.9%, and 79.8%, respectively. 2,994 (5.4%), 7,936 (14.5%), and 9,602 (17.5%) participants had proteinuria, low eGFR, and CKD, respectively. Multivariate logistic regression analyses showed that HCV infection alone (OR, 1.26; 95% CI, 1.17-1.38), but not HBV infection alone (OR, 1.04; 95% CI, 0.96-1.14) or HBV/HCV coinfection (OR, 1.12; 95% CI, 0.87-1.45), was an independent risk factor for CKD. The prevalence of HCV seropositivity was higher in later CKD stages, changing from 8.5% in CKD stage 1 to 14.5% in CKD stages 4-5. Adjusted ORs for HCV infection alone were 1.14 (95% CI, 1.003-1.300) for proteinuria and 1.30 (95% CI, 1.20-1.42) for low eGFR. The definition of CKD status requires a 3-month duration of low eGFR or kidney damage; this was presumed, not documented, in this study. HCV infection, but not HBV infection, was associated significantly with prevalence and disease severity of CKD in this HBV and HCV endemic area.

Epidemiology of Hepatitis C Virus Infection in Punjab (India): A Community-based Pilot Study

Purpose: Epidemiology of hepatitis C virus (HCV) infection has not been evaluated in northern India. We studied the prevalence of and risk factors for HCV infection in a community in northern India. Methods: We conducted a 1-day community-based HCV screening program in a town of northern India in Punjab. Local newspapers were used to invite subjects to come in for free HCV testing. A questionnaire of various risk factors was also administered to each subject by trained staff. Results: Two hundred and twenty six subjects attended the screening program. The overall prevalence of HCV seropositivity was 50.8%. The prevalence of HCV infection was similar in men and women ((54.3% vs. 45.3%, P=0.21) and was highest in subjects between 30-39 years (30.4%) of age. Religion, alcohol intake, smoking, history of injections, surgery and blood transfusion were not associated with HCV infection. Age as well as the number of pregnancies did not correlate with the HCV infection. Conclusion: This community based screening program demonstrated high prevalence of HCV infection in this part of country. HCV infection was more prevalent in the age group between 30-39 years. HCV infection was not associated with any of the risk factors evaluated. However, a larger population based study is required to understand the various risk factors.

High Prevalence of Hepatitis C Virus Infection Among Immigrants From the Former Soviet Union in the New York City Metropolitan Area: Results of a Community-Based Screening Program

Inadequate sterilization and reuse of medical equipment likely contributed to hepatitis C virus (HCV) transmission in the former Soviet Union (FSU). Although New York leads the nation in the number of immigrants from the FSU, the epidemiology of HCV infection has not been evaluated in this population. The aims of this study were to determine the prevalence of and risk factors for HCV infection among immigrants from the FSU in the New York metropolitan area. We conducted a 3-day community-based HCV screening program in the two boroughs of the New York metropolitan area with the highest density of FSU immigrants (Brooklyn and Queens). Russian cable television was used to invite subjects to come in for free HCV testing. In the last 2 days of screening, each person also completed an HCV risk factor questionnaire. The overall prevalence of HCV seropositivity among the 283 subjects was 28.3% (95% confidence interval [CI] 23.0-33.5%). The prevalence of HCV infection was similar in men and women (30.3% vs 26.5%, P = 0.48) and was highest in subjects > or = 70 yr old (35.0%). HCV seropositivity was 11.1% in immigrants from Russia, 29.0% from Uzbekistan, 31.0% from the Ukraine, and 36.8% from other regions. Intramuscular injections (odds ratio 9.1, 95% CI 2.0-42.4) and blood transfusions (odds ratio 3.2, 95% CI 1.2-9.0) were the only variables that were significantly associated with HCV infection in the multivariable analysis. In this community-based screening program we found a high prevalence of HCV infection among immigrants from the FSU, and these infections likely resulted from inadequately sterilized medical equipment and blood transfusions. Universal HCV testing should be strongly considered for all FSU immigrants.

Racial disparity in liver disease: Biological, cultural, or socioeconomic factors

Chronic liver diseases are a major public health issue in the United States, and there are substantial racial disparities in liver cirrhosis-related mortality. Hepatitis C virus (HCV) is the most significant contributing factor in the development of chronic liver disease, complications such as hepatocellular carcinoma, and the need for liver transplantation. In the United States, African Americans have twice the prevalence of HCV seropositivity and develop hepatocellular carcinoma at more than twice the rate as whites. African Americans are, however, less likely to respond to interferon therapy for HCV than are whites and have considerably lower likelihood of receiving liver transplantation, the only definitive therapy for end-stage liver disease. Even among those who undergo transplantation, African Americans have lower 2-year and 5-year graft and patient survival compared to whites. We will review these racial disparities in chronic liver diseases and discuss potential biological, socioeconomic, and cultural contributions. An understanding of their underlying mechanisms is an essential step in implementing measures to mollify racially based inequities in the burden and management of liver disease in an increasingly racially and ethnically diverse population.

MULTILEVEL MODELING OF INTRA-HOUSEHOLD SPREAD OF HEPATITIS C VIRUS INFECTION, KARACHI, PAKISTAN

Several epidemiologic studies have reported the existence of nonsexual intrafamilial hepatitis C virus (HCV) transmission. However, actual routes and their relative efficiency have been controversial. The objective of this study was to investigate whether contacts of HCV seropositive index patient living in the same household have similar probabilities of being HCV seropositive with respect to any of the household-level variables, after taking into account the independent effects of individual-level variables. We analyzed cross-sectional serological data on 341 nonsexual household contacts of 86 HCV-seropositive index thalassemic patients with a multilevel logistic regression model using household contacts at the first level and household characteristics at the second level. Prevalence of HCV seropositivity among household contacts who were tested was 20.5% (70/341). Multilevel analysis of household-level fixed effects indicated that contacts living in families wherein the index thalassemic patient was RNA positive--compared with those contacts living in families wherein the index thalassemic patient was RNA negative--had higher odds of being HCV positive (OR=2.09; 95% CI: 1.02 to 4.28). Nonetheless, the effect of index patients' RNA status on the contacts' HCV serostatus was small in comparison with the unexplained between-cluster variation. The results of this study are pertinent for household members of HCV-infected patients; specifically, their close contact with objects that are contaminated with blood or perhaps saliva of the HCV-seropositive index patient may pose increased risk of HCV transmission. High household intercept variances in different analyses revealed that at there are still unrecognized nonsexual modes of HCV transmission at the household level that need further research.

Failure to diagnose recent hepatitis C virus infections in London injecting drug users.

Hepatitis C virus (HCV) infection results in chronic liver disease in a substantial proportion of those infected. Most new cases of HCV infection in the UK are associated with intravenous drug use. It is important to identify these infections because of the implications for the future health of the individuals concerned and for the control of further spread of infection. However, as hepatitis C infection is characterised by a relatively long asymptomatic period of seronegative viraemia, a laboratory diagnostic protocol that does not test HCV seronegative samples for the presence of HCV RNA may wrongly designate HCV viraemic seronegative individuals as uninfected. Amongst 424 injecting drug users whose serum was sent to our diagnostic laboratory for "HCV screening" over a 14-month period, the prevalence of HCV seropositivity was 48.4%. We retrospectively identified seven individuals for whom there was evidence of recent acquisition of HCV infection. Three of these infections were identified using our routine diagnostic protocol: testing for the presence of HCV-specific antibody and performing HCV RNA testing only on seropositive and seroindeterminate specimens. However, four cases were only identified by HCV RNA testing of HCV seronegative serum. On the basis of these observations, we estimate the incidence of HCV infection amongst London injecting drug users as being 14.3 per 100 person-years. We advocate that all HCV seronegative blood samples obtained from injecting drug users should be tested for the presence of HCV RNA, and suggest that this could be done efficiently by nucleic acid testing the specimens in small pools. .

Cost-effectiveness of treatment for chronic hepatitis C infection in an evolving patient population.

Approximately 2.7 million US individuals are chronically infected with the hepatitis C virus (HCV). As public health campaigns are pursued, a growing number of treatment candidates are likely to have minimal evidence of liver damage. To examine the clinical benefits and cost-effectiveness of newer treatments for chronic hepatitis C infection in a population of asymptomatic, HCV sero-positive but otherwise healthy individuals. Cost-effectiveness analysis using a Markov model of the natural history of HCV infection and impact of treatment. We used an epidemiologic model to derive a range of natural history parameters that were empirically calibrated to provide a good fit to observed data on both prevalence of HCV seropositivity and time trends in outcomes related to HCV infection. Cohorts of 40-year-old men and women with elevated levels of alanine aminotransferase, positive results on quantitative HCV RNA assays and serologic tests for antibody to HCV, and no histological evidence of fibrosis on liver biopsy. Monotherapy with standard or pegylated interferon alfa-2b; combination therapy with standard or pegylated interferon plus ribavirin. Lifetime costs, life expectancy, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios. The probability of patients with chronic HCV developing cirrhosis over a 30-year period ranged from 13% to 46% for men and from 1% to 29% for women. The incremental cost-effectiveness of combination therapy with pegylated interferon for men ranged from 26 000 dollars to 64 000 dollars per QALY for genotype 1 and from 10 000 dollars to 28 000 dollars per QALY for other genotypes; and for women ranged from 32 000 dollars to 90 000 dollars for genotype 1 and from 12 000 dollars to 42 000 dollars for other genotypes. Because the benefits of treatment were realized largely in the form of improvements in health-related quality of life, rather than prolonged survivorship, cost-effectiveness ratios expressed as dollars per year of life were substantially higher. Results were most sensitive to assumptions about the gains and decrements in health-related quality of life associated with treatment. While newer treatment options for hepatitis C appear to be reasonably cost-effective on average, these results vary widely across different patient subgroups and depend critically on quality-of-life assumptions. As the pool of persons eligible for treatment for HCV infection expands to the more general population, it will be imperative for patients and their physicians to consider these assumptions in making individual-level treatment decisions.

HIV-1 prevalence and herpes simplex virus 2, hepatitis C virus, and hepatitis B virus infections among male workers at a sugar estate in Malawi.

HIV-1 prevalence is approximately 23% among men working at a sugar estate in Malawi. Given the scale of the HIV epidemic in this country, it is important to determine possible cofactors of infection. The authors investigated associations between HIV-1 prevalence and herpes simplex virus 2 (HSV-2), hepatitis C virus (HCV), and hepatitis B virus (HBV) infections (indicated by anti-HSV-2, anti-HCV and HBsAg positivity, respectively) in a nested case-control study of 279 HIV-positive and 280 HIV-negative male workers. The prevalence of HSV-2 infection was 88.1% among HIV-positive persons and 64.3% among HIV-negative control subjects (p <.01). This difference persisted after adjusting for sexual behavior and history of sexually transmitted diseases (OR = 4.12; 95% CI, 2.21-7.68). The prevalence of HCV seropositivity was 12.7% among HIV-positive persons and 10.0% among control subjects (p =.31), whereas that of HBV infection was 16.9% among HIV-positive persons and 14.4% among control subjects (p =.46). HSV-2 infection is significantly associated with prevalent HIV-1 infection in this population. Therefore, preventive measures for HSV-2 and HIV infection should be emphasized.

Lack of interference between ribavirin and nucleosidic analogues in HIV/HCV co-infected individuals undergoing concomitant antiretroviral and anti-HCV combination therapy.

HIV and hepatitis C virus (HCV) share parenteral routes of transmission through exposure to contaminated blood. The prevalence of HCV seropositivity among HIV-infected homosexual/bisexual men and intravenous drug users has been reported to be 10 and 80%, respectively [1]. Co-infection with HIV alters the clinical course of hepatitis C by inducing a more rapid progression to fibrosis and cirrhosis [2]. The morbidity and mortality rate from liver disease is thus higher in co-infected patients than in immunocompetent patients infected with HCV alone [3], emphasizing the need for active therapeutic intervention to treat HCV infection in co-infected patients [4]. On the basis of the promising results of combination therapy with IFN-α and ribavirin for chronic hepatitis C in immunocompetent individuals [5], we have recently engaged in an open prospective trial of this combination therapy in patients co-infected with HCV and HIV [6]. As ribavirin, zidovudine (ZDV) and stavudine (D4T) are metabolized to their triphosphate active forms by thymidine kinase, ribavirin has been suggested to reduce the intracellular phosphorylation of nucleosidic reverse transcriptase inhibitors [7]. No data are, however, available at this time on the clinical relevance of this putative antagonistic interaction. We have investigated the changes in plasma HIV-RNA levels during and after combination therapy with IFN and ribavirin in the first 38 HIV/HCV co-infected patients of our cohort undergoing stable antiretroviral therapy to reach 6 months of follow-up after discontinuation of a 6 or 12 month course of IFN and ribavirin. Nineteen of the 38 patients had been treated with a combination of two nucleosidic analogues, D4T and lamivudine (3TC) (n = 15) or ZDV and 3TC (n = 4) for a mean duration of 20 ± 10 months before the initiation of IFN and ribavirin. The remaining 19 patients had been treated with a triple combination antiretroviral regimen including a protease inhibitor with D4T and 3TC (n = 13) or ZDV and 3TC (n = 6) for a mean duration of 24 ± 8 months. The patients did not change their antiretroviral regimen throughout the period of the study. Seven patients received IFN (3 MU three times a week) and ribavirin (1000 mg per day) combination therapy for 6 months and 31 patients were treated for 12 months, depending on the severity of histological lesions in the pretreatment liver biopsy. The mean duration of HIV and HCV-targeted therapies was similar in the group of patients treated with double combination nucleosidic antiretroviral therapy and in the group receiving triple combination antiretroviral therapy. The plasma levels of HIV RNA were measured using the Quantiplex HIV-RNA 2.0 assay (Chiron, Emeryville, CA, USA.) with a threshold of detection of 500 copies/ml. The number of CD4 T cells was assessed by conventional cytofluorometric methods. Statistical evaluation was performed using the Wilcoxon signed-rank test. As shown in Table 1, the mean plasma HIV-RNA levels did not differ between baseline (before initiation of IFN and ribavirin), the time at which IFN and ribavirin were discontinued and at 6 monrths after discontinuation of IFN and ribavirin. As described previously by others in patients receiving IFN alone, the absolute number of CD4 cells decreased significantly during IFN treatment and returned to baseline values thereafter, suggesting that CD4 cells are trapped in extravascular sites during therapy with IFN [8]. Our observations strongly argue against the in-vivo relevance of the in-vitro competition between ribavirin, D4T and ZDV for intracellular phosphorylation. Ribavirin may thus be initiated in HIV/HCV co-infected patients receiving ZDV or D4T without switching reverse transcriptase inhibitors.Table 1: Changes in CD4 cell counts and plasma HIV viral load in HIV/hepatitis C virus co-infected patients treated with antiretroviral drugs and IFN in combination with ribavirina. Alain Landaua Dominique Batisse Christophe Piketty Raymond Jiana Michel D. Kazatchkine

Prevalence and risk factors for hepatitis C antibodies in volunteer blood donors in Brazil.

Little is known about the prevalence, risk factors, and transmission of hepatitis C virus (HCV) in a nontransfused population, particularly in developing countries. To investigate the association between HCV seropositivity and some demographic variables, a case-control study was conducted on 138 seropositive donors among 4762 consecutive volunteer blood donors and 1101 seronegative controls in Rio de Janeiro, Brazil. Donors were initially screened by interview for male homosexuality, use of illicit drugs, tattoos, previous transfusions, venereal diseases, and jaundice. Eligible donors were then tested for HCV antibodies by enzyme-linked immunosorbent assay. A multivariate analysis was performed on age, ethnic group, gender, and prior donation. The overall prevalence of HCV seropositivity was 2.89 percent. An increased risk of seropositivity was demonstrated for nonwhite donors at an odds ratio of 2.11 (95% CI, 1.43-3.13), for males at 2.39 (95% CI, 1.01-5.7), and for prior donors at 1.66 (95% CI, 1.09-2.52). The risk of anti-HCV positivity increased markedly with age. Those at highest risk were the group 40 to 49 years old, with an odds ratio of 4.37 (95% CI, 2.39-7.99) versus the group 20 to 29 years old. The group under 20 years old showed an odds ratio of 0.50 (95% CI, 0.06-3.87) compared to the group 20 to 29 years old. These findings were equally significant in a univariate analysis. Our results suggest that HCV seropositivity is strongly associated with male sex, nonwhite ethnicity, and greater age. A significant number of seropositive donors were not detected by screening interview.

Hepatitis C-Related Hepatocellular Carcinoma

In reports from worldwide sources, antibodies to hepatitis C virus (HCV) have been observed in patients with primary hepatocellular carcinoma (HCC). The current survey is designed to analyze the prevalence and significance of the relationship of HCV infection to HCC. A MEDLINE search terminating on October 1, 1991, produced 15 reports from eight nations in which the frequency of antibodies to HCV by an enzyme-linked immunosorbent assay test in HCC and control groups was obtained. Patient gender, occurrence of cirrhosis, role of alcoholism and transfusion history, and seropositivity for HCV and hepatitis B viral (HBV) markers were recorded. Among 1930 patients with HCC, antibodies to HCV were found in 47% (95% confidence interval [CI], 37% to 57%), while HBV markers occurred in 59% (95% CI, 27% to 91%) of subjects studied; hepatitis B surface antigen (HBsAg) positivity was noted in 37% (95% CI, 18% to 56%). The odds ratio (OR) for HBV markers relative to HCV antibodies was 1.73 (95% CI, 1.52 to 1.96) and for HCV antibodies relative to HBsAg, 1.40 (95% CI, 1.23 to 1.59). Among HBsAg-positive subjects, 25% had seropositivity for HCV, but for HBsAg-negative patients, 59% were HCV antibody positive (P < .001). Male gender and cirrhosis were prominent factors (92% +/- 7% and 88 +/- 6%, respectively). The OR for HCC in patients with antibody to HCV compared with controls was 25 (95% CI, 18 to 33). The OR comparing HCC with chronic liver disease with respect to HCV antibodies was 0.81 (95% CI, 0.65 to 1.01). We applied chi 2 tests to each report to detect, if present, a pattern of dominance favoring HCV, HBV markers, or HBsAg; none was observed. The prevalence of HCV seropositivity in HCC is substantial and virtually comparable with HBV. Hepatocellular carcinoma is usually associated with chronic liver disease, which may be required for tumor transformation. Both HCV and HBV may function independently in the pathogenesis of HCC.