Rate Of Hepatitis C Virus Infection Research Articles

Prevalence of selected sexually and blood-borne infections in Injecting drug abuser inmates of bandar abbas and roodan correction facilities, Iran, 2002

Human Immunodeficiency Virus (HIV) and other blood borne viral infections like hepatitis B virus (HBV) and hepatitis C virus (HCV) are major health issues especially in young and growing population of developing countries. All around the globe correctional facilities are known as potential source of spreading such disease. During summer 2002, HIV, HCV antibodies, hepatitis B surface (HBs) antigen and rapid plasma reagin (RPR) test were checked in venous blood samples of 252 injecting drug abuser prisoners from correctional facilities in southern Iran. Overall HIV, HCV and HBV infection rate was 15.1% (38/249), 64.8% (163/249), and 4.7% (12/249), respectively. HCV infection rate of HIV positive cases was 94% (35/38). All RPR results were negative. Duration of previous drug abuse and imprisonment were correlated with HIV and HCV infection (p value = 0.0003 and 0.015 & p value =0.02 and 0.02). Considering the higher prevalence of HIV and HCV infection in correctional facilities compared to general population of Iran, warrants immediate multidisciplinary approaches targeted at controlling further spread of these infections primarily among prisoners and secondarily preventing them to act as carrier to general population.

Prevalence of Hepatitis B, Hepatitis C, and HIV Infections Among Patients in a Psychiatric Hospital in Greece

Prevalence of Hepatitis B, Hepatitis C, and HIV Infections Among Patients in a Psychiatric Hospital in Greece

HIV, hepatitis C virus, and hepatitis B virus co-infections among injecting drug users in Tehran, Iran

To assess the prevalence of HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV) infections and co-infections among injecting drug users (IDUs) in Tehran. A sample of 899 IDUs (861 male and 38 female) was recruited in Tehran from treatment and harm reduction facilities and from drug user hangouts in public areas in equal proportions. ELISA testing for HIV, HCV antibody (HCV-Ab), hepatitis B surface antigen (HBsAg), and hepatitis B core antibody (HBcAb) was carried out. Positive HIV tests were rechecked by Western blot. The prevalence of HIV was 10.7%, HCV infection was 34.5%, and past or current HBV infection was 50.7%. Infection with all three viruses was seen in 6.5% (95% confidence interval 4.9-8.2) of participants. HIV/HCV, HIV/HBV, and HBV/HCV co-infections were seen in 8.7%, 7.8%, and 21.0% of participants, respectively. The rate of HCV infection among HIV-positive cases was significantly higher than in HIV-negative IDUs (80.6% vs. 28.7%, p<0.0001). There was no significant association between these infections and co-infections with gender and source of sampling. In general, co-infection with these three blood-borne viruses is common among IDUs. Since co-infection increases the morbidity and mortality of all infections, the observed level of co-infection in the high number of IDUs in Iran necessitates a serious comprehensive response.

Prevalence of human immunodeficiency virus and its association with hepatitis B, C, and D virus infections among incarcerated male substance abusers in Taiwan

Taiwan has been facing a rising epidemic of human immunodeficiency virus (HIV) infection since 2004. Injection drug users comprised 38.5% of accumulated HIV cases by 2007. This cross-sectional study investigated the seroprevalence of hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis D virus (HDV), and HIV infection in 753 male substance users who were detained in a detoxification center in Taoyuan, Taiwan. The subjects were enrolled into the study consecutively between February and October, 2005. The seroprevalence rates of HIV antibodies, HCV antibodies, and HBV surface antigens among all subjects, and HDV antibodies among HBV carriers were 6.9% (95% confidence interval [CI]: 5.19-8.95), 30.5% (95% CI: 27.23-33.93), 16.9% (95% CI: 14.24-19.71) and 13.7% (95% CI: 8.19-21.04), respectively. Subjects in the heroin injection group had significantly higher rates of HIV infection, HCV infection and HDV superinfection (25.5%, 89.6%, and 38.7%) than those in the heroin non-injection group (0.9%, 24.5%, and 6.25%), the methamphetamine group (0.3%, 8.1%, and 6.7%), and the club drug group (1%, 3%, and 0%; P < 0.001). The odds of HCV, HIV, or HDV infection were 74.7, 63.8, and 11.1 higher, respectively, for heroin injection drug users than for non-injection drug users (P < 0.0001). Compared to HIV-negative individuals, the odds of being a heroin injector and the odds of HCV co-infections were 64-fold and 149-fold higher, respectively, in HIV-positive individuals. The impact of HBV, HCV, and HDV infection on the HIV epidemic in Taiwan should be monitored closely.

Hepatitis C Infection and Related Factors in Hemodialysis Patients in China: Systematic Review and Meta-Analysis

Background and Aims. To provide a comprehensive and reliable tabulation of available data on the epidemiological characteristics and risk factors for hepatitis C virus (HCV) infection in maintenance hemodialysis (HD) patients in China, and to help inform prevention programs and guide future research. Methods. A systematic review was constructed based on the computerized literature database by two reviewers independently. Ninety-five percent confidence intervals (CI) of infection rates were calculated using the approximate normal distribution model. Odds ratios and 95% CI were calculated by fixed or random effects models. Results. Forty-three studies met our inclusion criteria. The pooled prevalence of HCV infection among HD patients in China was 41.1% (95% CI 39.5–42.6%). No significant difference was found in HCV infection rates between male and female HD patients (OR = 0.75, 95% CI 0.52–1.07, p = 0.11). HD patients with blood transfusion were 5.65 times more likely to be infected with HCV than HD patients without blood transfusion. A longer duration of HD was associated with increased HCV prevalence. Co-infection with hepatitis B virus did not increase the probability of HCV infection among HD patients (OR = 1.19, 95% CI 0.34–3.20, p = 0.73). Conclusions. Viral hepatitis is still one of the main complications in HD patients, with hepatitis C being the most common one. The key to reducing the incidence of viral hepatitis in HD patients is to control contagion and reduce the frequency of blood transfusion and cross-infection.

Hepatocellular Carcinoma Prevalence and Mortality in a Male State Prison Population

The incidence of hepatocellular carcinoma (HCC) in the United States has increased dramatically over the last two decades, largely because of an increase in the number of people with advanced hepatitis C virus (HCV) infection. U.S. prisoners are at high risk for HCC, given their elevated rates of HCV infection, comorbid hepatitis B virus (HBV) infection, and alcoholic liver disease. The purpose of our study was to examine the prevalence and mortality of HCC in the nation's largest state prison system. The study population consisted of 325,477 male Texas Department of Criminal Justice (TDCJ) inmates who were incarcerated between January 1, 2003, and July 31, 2006. Information on medical conditions and demographic characteristics was obtained from an institution-wide medical information system. During the 3.5-year study period, 176 male TDCJ inmates (54 per 100,000) were diagnosed with HCC and 108 (33 per 100,000) died as a result of HCC. Inmates who were Hispanic, older, and infected with HCV, HBV, or human immunodeficiency virus had elevated rates of both HCC prevalence and mortality. After adjusting for all study covariates, HCC prevalence, but not mortality, was modestly elevated among inmates with diabetes. Our study showed that the Texas male prison population had a sevenfold higher prevalence of HCC than the general U.S. male population and a fourfold higher death rate from HCC. These findings likely reflect the high concentration of HCC-related risk factors, particularly HCV, among prisoners.

Frequencies of hepatitis B and C infections among haemodialysis and peritoneal dialysis patients in Asia-Pacific countries: analysis of registry data

The impact of dialysis modality on the rates and types of infectious complications has not been well studied. The aim of the present investigation was to evaluate the rates of hepatitis C virus (HCV) and hepatitis B virus (HBV) infections in peritoneal dialysis (PD) and haemodialysis (HD) patients in the Asia-Pacific region. The study included the most recent period-prevalent data recorded in the national or regional dialysis registries of the 10 Asia-Pacific countries/areas (Australia, New Zealand, Japan, China, Taiwan, Korea, Thailand, Hong Kong, Malaysia and India), where such data were available. Longitudinal data were also available for all incident Australian and New Zealand patients commencing dialysis between 1 April 1995 and 31 December 2005. Rates of HCV and HBV infections were compared by chi-square, Poisson regression and Kaplan-Meier survival analyses, as appropriate. Data were obtained on 201,590 patients (HD 173,788; PD 27,802). HCV seroprevalences ranged between 0.7% and 18.1% across different countries and were generally higher in HD versus PD populations (7.9% +/- 5.5% versus 3.0% +/- 2.0%, P = 0.01). Seroconversion rates on dialysis were also significantly higher in HD patients (incidence rate ratio PD versus HD 0.33, 95% CI 0.13-0.75). HCV infection was highly predictive of mortality in Japan (relative risk 1.37, 95% CI 1.15-1.62, P = 0.003) and in Australia and New Zealand (adjusted hazards ratio 1.29, 95% CI 1.05-1.58). HBV infection data were limited, but less clearly influenced by dialysis modality. Dialysis modality selection significantly influences the risk of HCV infection experienced by end-stage renal failure patients in the Asia-Pacific region. No such association could be identified for HBV infection.

Risks for HIV, HBV, and HCV infections among male injection drug users in northern Vietnam: a case–control study

Injection drug use (IDU) and HIV infection are important public health problems in Vietnam. The IDU population increased 70% from 2000 to 2004 and is disproportionately affected by HIV and AIDS – the country's second leading cause of death. Hepatitis B virus (HBV) and hepatitis C virus (HCV) share transmission routes with HIV and cause serious medical consequences. This study aimed to determine risk factors for acquisition of HIV, HBV, and HCV infections among IDUs in a northern province. We conducted a matched case–control study among active IDUs aged 18–45 who participated in a community-based survey (30-minute interview and serologic testing). Each HIV-infected IDU (case) was matched with one HIV-uninfected IDU (control) by age, sex (males only), and study site (128 pairs). Similar procedures were used for HBV infection (50 pairs) and HCV infection (65 pairs). Conditional logistic regression models were fit to identify risk factors for each infection. Among 309 surveyed IDUs, the HIV, HBV, and HCV prevalence was 42.4%, 80.9%, and 74.1%, respectively. Only 11.0% reported having been vaccinated against hepatitis B. While 13.3% of the IDUs reported sharing needles (past six months), 63.8% engaged in indirect sharing practices (past six months), including sharing drug solutions, containers, rinse water, and frontloading drugs. In multivariable models, sharing drugs through frontloading was significantly associated with HIV infection (odds ratio [OR]=2.8), HBV infection (OR=3.8), and HCV infection (OR=4.6). We report an unrecognized association between sharing drugs through frontloading and higher rates of HIV, HBV and HCV infections among male IDUs in Vietnam. This finding may have important implications for bloodborne viral prevention for IDUs in Vietnam.

Treatment of chronic hepatitis C in hemodialysis patients

Hepatitis C virus (HCV) infection is especially problematic in patients with end-stage renal disease (ESRD) who are undergoing hemodialysis. Rates of HCV infection are higher among hemodialysis patients than in the general population, and several routes of transmission are thought to stem from the dialysis unit. Management of chronic hepatitis C is also more complicated in hemodialysis patients because of altered pharmacokinetics and a predisposition for drug-related toxicity, particularly ribavirin-induced anemia. Clinical trials of patients with chronic hepatitis C and healthy, functioning kidney grafts are rare because of the inherent dangers of graft rejection. As a result, most studies in patients with ESRD have focused on patients waiting for a kidney transplant. Additionally, because ribavirin is contraindicated in this patient population, many studies have examined monotherapy treatments. According to meta-analyses, conventional interferon alfa treatment yields a sustained virological response (SVR) rate of 37%, whereas studies of pegylated interferon alfa monotherapy have yielded SVR rates between 13% and 75%. Several small studies have also used the monitoring of ribavirin plasma concentrations or hemoglobin levels to facilitate the use of combination therapy. In light of the results from these clinical trials, we herein review treatment guidelines and recommend strategies to help optimize the treatment of patients with ESRD. There remains a lack of clarity surrounding the most effective treatment options for patients with chronic hepatitis C and ESRD. Treatment can be effective with many patients attaining SVR; however, unfavorable tolerability with interferon alfa-based therapy remains a concern and thus close supportive care should be aggressively pursued to help maintain adherence.

Natural Course of Chronic HCV and HBV Infection and Role of Alcohol in the General Population: The Dionysos Study

Population-based studies of the natural course of chronic viral liver disease that consider comorbidity factors are lacking. Using data from the Dionysos Study, we quantified the burden of chronic viral liver disease and the role of alcohol intake to morbidity and mortality in a representative sample of subjects from the general population of two communities of Northern Italy. We followed up 139 subjects with chronic hepatitis C virus (HCV) infection and 61 with chronic hepatitis B virus (HBV) infection for a median (IQR) time of 8.4 (1.0) and 8.3 (0.9) yr, respectively. Ethanol intake was evaluated using a food-frequency questionnaire, fatty liver (FL) was diagnosed by ultrasonography, and liver cirrhosis (LC) and hepatocarcinoma (HCC) were diagnosed by liver biopsy. Exact multivariable Poisson regression was performed to identify predictors of death. The incidence and remission rates of FL were 9.0 and 29.7 in the HCV cohort and 4.0 and 30.4 per 1,000 person-years (PY) in the HBV cohort. Progression to LC and HCC was more common in the HCV than in the HBV cohort (4.5 vs 2.0 and 2.7 vs 2.0 per 1,000 PY, respectively). Ethanol intake was an independent predictor of LC in the HCV cohort [rate ratio (RR) = 4.15 (95% CI 1.02-41.2) for every increase of 30 g/day of ethanol intake at baseline] and of death rate in both cohorts [RR = 8.53 (95% CI 1.40-24.61) and 3.56 (1.34 to 26.50) for every increase of 30 g/day of ethanol intake at baseline]. The morbidity and mortality rate of HBV and HCV infection in the general population is lower than that reported in secondary-care populations, blood donors, or clinical series. Ethanol intake is an independent predictor of LC in subjects with chronic HCV infection and an independent predictor of death in subjects with either HCV or HBV infection.

HCV infection in patients with primary defects of immunoglobulin production.

We tested for infection with hepatitis C virus (HCV) in 58 patients affected by humoral immunodeficiencies: 43 common variable immunodeficiency (CVI), two hyper IgM syndrome (HIM), two IgG subclass deficiency, four ataxia-telangiectasia (AT), and seven X-linked agammaglobulinaemia (XLA). While the assessment of serum specific HCV antibodies in some of these patients was not informative because of the impairment in specific antibody production, the reverse transcriptase polymerase chain reaction (RT-PCR) assay used to detect serum HCV RNA was a useful method for diagnosing infection. We found that 38% of late onset hypogammaglobulinaemic patients (CVI, HIM or IgG subclass deficiency) had evidence of HCV infection. HCV infection was not detectable in patients with XLA or AT. The majority of our patients had persistent viraemia, and those who underwent liver biopsy showed histological findings of chronic hepatitis. Moreover, we could demonstrate in vitro that eight of 18 HCV-infected patients were actively producing anti-HCV antibodies, despite their impaired antibody production. The high rate of HCV infection in hypogammaglobulinaemic patients could be related to several nosocomial routes of transmission, including intravenous immune globulin administration. Despite the persistent viremia only two patients had cirrhosis and none had hepatocarcinoma.

Epidemiology of hepatitis C virus infection among injection drug users in China: Systematic review and meta-analysis

Injection drug use (IDU) is the predominant mode of hepatitis C virus (HCV) transmission in China. This paper aims to provide a comprehensive and reliable tabulation of available data on the epidemiological characteristics and risk factors for HCV infection in injection drug users (IDUs) in China to help inform prevention programmes and guide future research. Data from articles and reports according to pre-defined criteria on HCV infection rates among IDUs of different regions, genders, ethnic backgrounds and risk factors (injecting practice, needle sharing, long duration, sex behaviour and co-infection status) were abstracted and pooled by meta-analysis. A systematic review was constructed based on both pooled data and representative viewpoints. Ninety-five percent confidence intervals (CI) of infection rates were calculated using the approximate normal distribution model. Odds ratios and 95% CI were calculated by fixed or random effects models. Publication bias was examined using Begg's test and Egger's test. Data manipulation and statistical analyses were undertaken using STATA 7.0 and RevMan 4.2. Epi Info 3.4.3 was used for map construction. The pooled prevalence of HCV infection among IDUs in China was 61.4% (95% CI 55.7-67.2%), and the epidemic was most severe in Hubei, Yunnan, Guangxi, Hunan and Xinjiang. No significant difference was found in HCV infection rates between male and female IDUs. A significant association was found between HCV infection and ethnic-minority status. IDUs were 9.24 times more likely to be infected with HCV than non-IDUs, while non-IDUs were more likely to be infected with HCV than members of the general population and other risk populations. There was no significant difference in the risk of HCV infection for needle-sharing IDUs and non-needle-sharing IDUs. A longer duration of IDU was associated with increased HCV prevalence. High-risk sexual practices were strongly associated with drug injection behaviours. Co-infection with human immunodeficiency virus (HIV) greatly increased the probability of HCV infection among IDUs, while the probability of hepatitis B virus infection remained similar for HCV-positive and HCV-negative IDUs in China. IDU continues to fuel the HCV/HIV epidemics spreading throughout China. Many pragmatic strategies are being implemented but need further evaluation.

Incidence Rates of Hepatitis B and C Virus Infections among Blood Donors in Hiroshima, Japan, during 10 Years from 1994 to 2004

Objective: Although prevalence rates of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections have kept decreasing in blood donors, there is little information on incidence rates of these hepatitis viruses in Japan. Methods: During 10 years from June 1994 through April 2004, 418,269 inhabitants of Hiroshima, Japan, donated blood (1,409,465 units in total). They were screened for serum markers of HBV and HCV infections, and individuals who developed de novo infections were identified. Results: Infection with HBV occurred at a rate of 2.78 per 100,000 person-years (95% confidence interval: 1.78–4.14/100,000 person-years) and that with HCV at a rate of 1.86 per 100,000 person-years (95% confidence interval: 1.06–3.01/100,000 person-years). Residual risks of transmission by transfusions, based on the relationship risk [window period (estimated at 0.15 and 0.03 years in chimpanzees inoculated with minimum infectious doses for HBV and HCV, respectively) × incidence], were 1/243,000 for HBV and 1/1,960,000 for HCV infections. Conclusion: At present, incidence rates of HBV and HCV infections are extremely low in Japan.

Infection with Hepatitis C Virus among HIV-Infected Pregnant Women in Thailand

Objective. The purpose of this study was to describe the epidemiology of coinfection with hepatitis C virus (HCV) and HIV among a cohort of pregnant Thai women. Methods. Samples from 1771 pregnant women enrolled in three vertical transmission of HIV studies in Bangkok, Thailand, were tested for HCV. Results. Among HIV-infected pregnant women, HCV seroprevelance was 3.8% and the active HCV infection rate was 3.0%. Among HIV-uninfected pregnant women, 0.3% were HCV-infected. Intravenous drug use by the woman was the factor most strongly associated with HCV seropositivity. Among 48 infants tested for HCV who were born to HIV/HCV coinfected women, two infants were HCV infected for an HCV transmission rate of 4.2% (95% 0.51–14.25%). Conclusions. HCV seroprevalence and perinatal transmission rates were low among this Thai cohort of HIV-infected pregnant women.

Liver disease in adolescents: A cohort study of high-risk individuals

Little is known about the health and behavior of adolescent offenders as they relate to abnormalities of liver biochemistry and hepatitis C virus (HCV) infection. A large study of male juvenile offenders was undertaken that allowed a re-evaluation of the normal limits of alanine aminotransferase (ALT), associations with elevated ALT, and HCV antibody positivity. Young offenders (age 12-19 years) serving community orders participated in a wide-ranging health survey and laboratory assessment between October 2003 and December 2005. Normal ranges for liver biochemistry were calculated from the 95th percentile of males at the lowest risk for liver disease. The final sample comprised 682 males, of whom 439 (64%) gave blood. The calculated upper limit of normal for ALT was 28 IU/L. Seventeen percent of adolescents had an elevated ALT. Strong associations with elevated ALT included HCV antibody positivity [odds ratio (OR) 14.6], overweight and obesity (OR 6.9), and elevated total cholesterol (OR 3.6). More than 90% of adolescents with elevated ALT levels had 1 or more features of the metabolic syndrome. HCV antibody was positive in approximately 3% of the cohort, with the most significant risk factor being injecting drug use (OR 7.8; P < 0.01). The new infection rate was 3.7% per year. New upper limits for ALT provide greater sensitivity for the early diagnosis of liver disease in adolescents. High rates of HCV infection and obesity-related liver disease exist in this group, and targeted interventions are needed to reduce future health-related morbidity.

Clinicopathological and prognostic features of primary clear cell carcinoma of the liver

Primary clear cell carcinoma of the liver (PCCCL) is a subgroup of primary hepatocellular carcinoma (HCC), pathologically characterized by diffuse clear cells of the tumor, showing a clear cytoplasm that does not stain with hematoxylin-eosin. At present, its clinicopathological and prognostic features are not fully clarified. This study aims to clarify the clinicopathological and prognostic features of PCCCL. The clinicopathological data of 43 patients with PCCCL treated with hepatectomy in our hospital from January 1999 to December 2003 were retrospectively analyzed. The chi(2)-test showed a positive rate of hepatitis C virus (HCV) infection and capsule formation in the PCCCL group, which was markedly higher than in the common type HCC (CHCC) group (P = 0.000 and P = 0.005). Meanwhile, the vascular invasion rate was notably lower in the PCCCL group, but there were no significant differences between the twogroups (P = 0.129). The Kaplan-Meier method showed that the 1-, 3-, and 5-year survival rates were significantly higher in the PCCCL group than in the CHCC group (P = 0.021). The prognosis of patients in the PCCCL group was related to capsule formation, vascular invasion, liver cirrhosis, and clear cell ratio. The 1-, 3-, and 5-year survival rates were markedly higher in the group with a higher clear cell ratio than in the group with a lower clear cell ratio (P = 0.011). The notable clinicopathological features of the patients in the PCCCL group included a higher rate of HCV infection, capsule formation, and a lower rate of vascular invasion. The prognosis was better than that of the patients in the CHCC group and related to the ratio of clear cells.

Modelling the hepatitis C virus epidemic in Australia

Background Hepatitis C virus (HCV) infection in Australia is predominantly transmitted through injecting drug use. A reduction in the heroin supply in Australia in late 2000 and early 2001 may have impacted the number of injecting drug users (IDUs) and consequently the number of new hepatitis C infections in Australia. This paper updates estimates of HCV incidence and prevalence between 1960 and 2005. Methods Simple mathematical models were used to estimate HCV incidence among IDUs, migrants to Australia from high HCV-prevalence countries, and other HCV exposure groups. Recent trends in numbers of IDUs were based on indicators of injecting drug use. A natural history of HCV model was applied to estimate the prevalence of HCV in the population. Results The modelled best estimate of past HCV incidence showed a consistent increasing rate of HCV infections to a peak of 14,000 new seroconversions in 1999, followed by a decline in 2001–2002 coincident with the decline in heroin availability. HCV incidence was estimated to be 9700 (lower and upper limits of 6600 and 13,200) in 2005. Of these, 88.7% were estimated to be through injecting drug use, 7.2% among migrants and 4.1% through other transmission routes. An estimated 264,000 (lower and upper limits of 206,000 and 318,000) people were HCV antibody positive in 2005. Conclusions Mathematical models suggest that HCV incidence in Australia decreased from a peak of 14,000 new infections in 1999 to 9700 new infections in 2005, largely attributable to a reduction in injecting drug use. The numbers of people living with HCV in Australia is, however, estimated to continue to increase.

New hepatitis C guidelines for the Asia–Pacific region: APASL consensus statements on the diagnosis, management and treatment of hepatitis C virus infection

New hepatitis C guidelines for the Asia–Pacific region: APASL consensus statements on the diagnosis, management and treatment of hepatitis C virus infection

The Diagnosis and Management of Hepatitis C: The Role of the Physician Assistant

Hepatitis C will pose a serious challenge to the health care system during the next 2 decades. Physician assistants can play an important role in the screening, diagnosis, and management of hepatitis C infection, and in educating patients about this disease. Screening for risk factors for hepatitis C virus (HCV) can be used to identify most infected individuals, who can then be tested for the presence of anti-HCV antibodies and HCV RNA. Hepatitis C can be treated with a combination of pegylated interferon plus ribavirin, and the virus can be cleared in a significant percentage of infected individuals. HEPATITIS C: SCOPE OF THE PROBLEM The United States faces a major public health challenge over the next 2 decades from the largely silent but widespread infection of adults by HCV. This is now the most common blood-borne infection in the United States. 1 About 2% of adults in this country are infected, but only a small fraction of these individuals have been identified and are aware of their positive viral status. 123 The Centers for Disease Control and Prevention (CDC) estimated that there were approximately 30,000 new cases of HCV infection in 2003. 4 These estimates are probably conservative, because the National Health and Nutrition Examination Survey (NHANES) data on which they were based excluded people who were incarcerated or homeless, individuals known to have high rates of HCV infection. 3,4 Chronic HCV infection is defined as the persistence of HCV RNA in the blood for at least 6 months. 2 Chronic HCV is frequently asymptomatic in its early stages, and years or decades may pass before affected individuals seek treatment. 5 Even symptomatic individuals may complain of only vague feelings of tiredness or malaise, leading to delays in diagnosis if HCV is not suspected. 5 HCV-infected patients may progress to very grave illnesses, chief among them being the occurrence of silent but progressive fibrotic liver disease. 6 The rate of progression to cirrhosis varies widely in infected patients, but it is currently estimated that up to 20% of patients infected with HCV will develop cirrhosis over a 20to 25-year period. 7 Many of these patients may progress to end-stage liver disease and death unless a transplant is performed, and HCV infection has now become the most common reason for liver transplantation in the US. 7,8 Once an HCV-infected individual develops cirrhosis, the risk of hepatocellular carcinoma is also present, contributing to mortality rates. 7 Because HCV is a systemic disease, infected patients can also develop serious extrahepatic complications of immunologic origin, including rheumatoid symptoms, kidney disease, and skin disorders. 2 If HCV-infected individuals are not identified and treated, deaths due to HCV infection are expected to increase 2to 3fold by 2010 to 2020, and annual deaths from HCV infection will exceed deaths from HIV/AIDS. 9 Physician assistants (PAs) can play important roles in identifying these individuals and helping to manage their disease, with the goal of lessening the overall health care burden and reducing the risks of mortality and morbidity from this deadly but still largely silent outbreak. HEPATITIS C: A TREATABLE DISEASE The current standard of care for HCV infection is combination therapy with pegylated interferon (IFN) alfa and ribavirin. 10 Interferons are naturally occurring proteins that have antiviral, immunomodulatory, and antiinflammatory properties. 11 Interferon alfa-2a and interferon alfa-2b have been shown to inhibit HCV replication and strengthen the host immune response to the virus. 11 Pegylated interferons are interferons that have been conjugated to inert polyethylene glycol (PEG) moieties. 11 The Diagnosis and Management of Hepatitis C: The Role of the Physician Assistant 2 of 10 Interferon alfa-2b is conjugated 1:1 to an unbranched, 12kilodalton (kd) PEG moiety to form peginterferon alfa-2b, whereas interferon alfa-2a is conjugated 1:1 to a branched, 40-kd PEG moiety to form peginterferon alfa-2a. 12 Pegylation protects the molecules from enzymatic degradation and reduces their rate of renal elimination, thereby creating more desirable, longer-acting agents. 11 The combination of pegylated interferon plus ribavirin has been shown to be more effective than either pegylated interferon monotherapy or combination therapy with standard interferon plus ribavirin in inducing a sustained virologic response (SVR), defined as the complete absence of detectable HCV RNA in serum 6 months after the end of

Prevalence and Correlates of Hepatitis C Virus Infection among Street-Recruited Injection Drug Users in San Juan, Puerto Rico

Throughout the world, injection drug users (IDUs) are the group at highest risk for hepatitis C virus (HCV) infection. IDUs residing in the island of Puerto Rico and Puerto Rican IDUs residing in the U.S. mainland have been shown to be at very high risk of infection with HIV. However, the extent to which HCV infection has spread among IDUs in Puerto Rico is not yet known. The aims of this study were to estimate seroprevalence of HCV and to identify the correlates associated with HCV transmission. The sample was drawn through street outreach strategies and was comprised of 400 injection drug users not in treatment, living in the San Juan metropolitan area. HCV and HIV infection were detected by enzyme-linked immunosorbent assay and the results were confirmed by Western blot. Information on sociodemographics, drug use patterns, and risk behaviors was obtained through structured interviews. Bivariate analyses and multivariate logistic regression were used to assess covariates of infection with HCV. The prevalence of HCV infection was 89%. After controlling for sociodemographic characteristics, HCV infection was positively associated with increasing years of injection, injecting in a shooting gallery, tattooing in prison, and self-reported STD infection. Notably, IDUs who had initiated drug injection within the year prior to the study interview had an HCV infection rate of 57%. This study indicates that more aggressive educational programs are urgently needed to reduce the spread of HCV infection among IDUs in Puerto Rico.