Hepatitis C Virus Risk Factors Research Articles

Risk Factors of Hepatitis C in the Suez Canal Region, Egypt

Background and study aim: Egypt has very high prevalence of Hepatitis C virus (HCV) infection Aim: To identify possible risk factors of HCV in Suez Canal region of Egypt. Materials and Methods: HCV positive individuals in 5 different hospitals and control blood donors were subjected to anti HCV tests and interview questionnaire to identify risk factors. Results: A total of 1176 subjects were studied for HCV, of which 539 were HCV-positive and637 HCV-negative donors. Subjects who achieved less than university education, unemployed or gaining less than 600 Egyptian pounds monthly had an increased risk of HCV (OR= 4.18, CI3.28-5.34, p 0.000), (OR= 3.26, CI 2.55-4.16, p 0.000), and (OR= 3.32, CI 2.59-4.26, p 0.000). Informal male circumcision doubled the risk of HCV (OR= 2.08, CI 1.53-2.83, p 0.000). Shaving at a barber and sharing razors increased HCV risk 2 times, while sharing tooth brushes increased it 7 times (OR = 7.23, CI 2.74-18.79, p 0.000). HCV risk increased after endoscopy (OR =3.62, CI2.02-6.52, p 0.000), blood transfusion (OR 3.47, CI 2.18-5.54, p 0.000), and injection treatment(OR= 1.41, CI 1.02-1.95, p 0.040). Any delivery and dental care in governmental clinic were independent risk factors (OR 2.57, CI 1.25-5.30, 0.011), (OR 1.46, CI 1.08-1.97, p 0.014). Schistosomiasis parenteral treatment doubled the HCV risk (OR= 2.09, CI 1.35-3.23, p 0.001) and chronic kidney disease patients were more at risk (OR= 2.95, CI 1.40-6.24, p 0.005). Conclusion: Infection control in medical practice and behavioral modifications in this region is essential to prevent HCV transmission.

2203. Risk Factors for Hepatitis C in Western Africa: An Observational Study in a STI Clinic

BackgroundThe pattern of hepatitis C virus (HCV) transmission routes in sub-Saharan Africa (SSA) has not been previously well characterized. A recent meta-analysis reported a general population HCV prevalence of 5.4% and HIV co-infection prevalence of 3.6% in SSA, with considerable regional variation.MethodsA cross-sectional study was performed in Kumasi, Ghana. Subjects were recruited from patients attending an STI clinic at a government-supported health center. Subjects completed a survey emphasizing known risk factors for HCV, including sexual behaviors, to capture potential routes of exposure. Surveys were administered in Twi, the local language, with the assistance of trained interpreters. Blood samples were collected and tested for HCV antibodies using DiaSpot Anti-HCV Rapid Screen Tests (USA). Data were analyzed using univariate analysis and logistic regression using SAS 9.4.ResultsOf the total 312 subjects, 15 were HCV positive (prevalence 4.8%). The HIV-HCV co-infection prevalence was 5.5%. After adjusting for age and sex, statistically significant associated risk factors for HCV infection (P < 0.05) include no/low level of education vs. tertiary (OR 5.0), northern region of birth vs. central region (OR 7.3), and traditional body scarring (OR 4.1). Rough sexual practices, ie dry sex, sores, were also explored and were associated with HCV infection (P = 0.02). Post-hoc stratified analysis of HIV-infected individuals (n = 201) was performed to identify risk factors among those with HCV co-infection. Significant risk factors (P < 0.05) in this sub-population include northern region of origin (OR 12.4) and traditional scars or marks (OR 4.6).ConclusionTwo risk factors for HCV infection, ie region of birth and traditional scarring, were significant in both the total clinic population and HIV co-infected individuals suggesting cultural practices are contributing to an increased risk of infection. Among HCV positive individuals, rough sexual practices were significant risk factors; whereas, IV-drug abuse was not. While HCV treatment exists, it is not currently available in West Africa; therefore, it is critical to identify risk factors to best target education programs and screening of populations to limit disease spread.Disclosures All authors: No reported disclosures.

Prevalence and Risk Factors for Occult Hepatitis B and HIV Infections Among HCV Infected Intravenous Drug Users, Tehran, Iran

Background: Exposure to hepatitis B virus (HBV) or human immunodeficiency virus (HIV) infection is common among hepatitis C virus (HCV)-infected Intra venous drug users (IVDUs); however there exist only a few data about frequency and risk factors of HCV, occult HBV infection (OBI) and HIV among IVDUs. Objectives: This study aimed to investigate the prevalence and associated risk factors for OBI and HIV infections among Iranian HCV infected IVDUs. Methods: Serum samples were screened for the presence of hepatitis C virus antibody (HCVAb), hepatitis B core antibody (HBcAb), hepatitis B surface antigen (HBsAg), and human immunodeficiency virus antibody/antigen (HIVAb/Ag) using enzyme linked immunosorbent assay (ELISA). For detection of OBI, presence of HBV DNA among HBcAb positive/HBsAg negative subjects was determined using nested polymerase chain reaction (PCR). Results: Among all subjects, 94 cases (53.5%) were positive for HCVAb from which 7% and 23.4% were positive for HCV/OBI and HCV/HIV co-infections, respectively. A significant association existed between HCVAb with type of drug, sharing syringes and needles and a history of imprisonment. In the case of HCV/OBI co-infections, the only significant correlation was between sharing a syringe and occult hepatitis B infection. Also no significant association existed between risk factors and HCV/HIV co-infections. Conclusions: the present data documented an alarming prevalence of HCV and HIV as well as co-infections among IVDUs, which emphasizes the requirement for expansion of public health interventions for this at-risk population. Despite previously high prevalence reported for HCV/HBV/HIV triple infections among IVDUs, low prevalence of triple HCV/OBI/HIV infections was obtained. The reason for this difference may be related to the effect of HCV on HBV expression in case of OBI which had been suggested previously

Screening of hepatitis C virus infection in adult general population in Spain.

The aim was to estimate seroprevalence and prevalence of hepatitis C virus (HCV) infection in a small health area of the Valencian Community, Spain. This is a descriptive cross-sectional study aimed at estimation of HCV infection prevalence in the whole adult population (25-70 years old), that is, a pilot study for an eventual population-based screening program. A total of 5849 participants aged 25-70 years (51% male) were invited to participate by regular mail. Overall, 143 letters were returned owing to errors in the addresses. Of 5706 participants, 2637 (46.2%) participated in the study. Rapid test of anti-HCV antibody detection was positive in 30 cases (HCV seroprevalence 1.14%, 95% confidence intervals: 0.73-1.55%). Of those, seven were not aware of their condition. Participants who had a positive result in the rapid test of anti-HCV detection were given a confirmatory test by enzyme immune assay, and all had a positive result. RNA-HCV determination by quantitative PCR in positive anti-HCV patients showed positive viremia in 13 (43.3%) cases, of which five were not aware of the disease. Of the 17 patients who had negative viremia, two were unaware of their HCV status, one was a carrier of anti-HCV and was already aware of his condition, and 14 had been previously treated with satisfactory results. Regarding fibrosis, of the seven patients who were unaware of HCV infection, none of them had significant fibrosis. Moreover, 26 (86.7%) anti-HCV positive patients were reported to have one or more risk factors for HCV infection. HCV screening strategies applied to the general population are good means to diagnose and treat patients who are not aware of their infection, avoiding new transmissions as well as disease progression.

The burden of hepatitis C virus infection in Punjab, India: A population-based serosurvey.

IntroductionHepatitis C virus (HCV) infection prevalence is believed to be elevated in Punjab, India; however, state-wide prevalence data are not available. An understanding of HCV prevalence, risk factors and genotype distribution can be used to plan control measures in Punjab.MethodsA cross-sectional, state-wide, population-based serosurvey using a multi-stage stratified cluster sampling design was conducted October 2013 to April 2014. Children aged ≥5 years and adults were eligible to participate. Demographic and risk behavior data were collected, and serologic specimens were obtained and tested for anti-HCV antibody, HCV Ribonucleic acid (RNA) on anti-HCV positive samples, and HCV genotype. Prevalence estimates and adjusted odds ratios for risk factors were calculated from weighted data and stratified by urban/rural residence.Results5,543 individuals participated in the study with an overall weighted anti-HCV prevalence of 3.6% (95% Confidence Interval [CI]: 3.0%–4.2%) and chronic infection (HCV Ribonucleic acid test positive) of 2.6% (95% CI: 2.0%–3.1%). Anti-HCV was associated with being male (adjusted odds ratio 1.52; 95% CI: 1.08–2.14), living in a rural area (adjusted odds ratio 2.53; 95% CI: 1.62–3.95) and was most strongly associated with those aged 40–49 (adjusted odds ratio 40–49 vs. 19–29-year-olds 3.41; 95% CI: 1.90–6.11). Anti-HCV prevalence increased with each blood transfusion received (adjusted odds ratio 1.36; 95% CI: 1.10–1.68) and decreased with increasing education, (adjusted odds ratio 0.37 for graduate-level vs. primary school/no education; 95% CI: 0.16–0.82). Genotype 3 (58%) was most common among infected individuals.DiscussionThe study findings, including the overall prevalence of chronic HCV infection, associated risk factors and demographic characteristics, and genotype distribution can guide prevention and control efforts, including treatment provision. In addition to high-risk populations, efforts targeting rural areas and adults aged ≥40 would be the most effective for identifying infected individuals.

Knowledge of Hepatitis C Risk Factors is Lower in High Incidence Regions.

Despite ambitious goals to eliminate hepatitis C virus (HCV) in the United States by 2030, the majority of those infected are not aware of their diagnosis, and only a small minority have been cured. A lack of knowledge regarding risk factors and treatment may contribute to low cure rates. We aimed to evaluate HCV knowledge and the association of risk factor knowledge with HCV incidence. In fall 2017, a survey regarding HCV knowledge was disseminated through social media, web link, and in person throughout the state of Virginia. The survey was completed by 613 individuals. Residents of high-incidence counties identified fewer risk factors (5.6 vs 6.1 of 9, p = 0.04), a difference that remained significant when controlling for education and age (p = 0.03). Fewer participants in the high-incidence group recognized snorting drugs to be a risk factor (25% vs 36%, p = 0.01). Only 38% of all respondents correctly identified HCV to be curable. Knowledge of HCV risk factors is lower in high incidence regions. These results identify a critical knowledge gap in the general population at a time of ongoing HCV transmission. Public health interventions must target these gaps in high-incidence regions as part of comprehensive disease prevention programs.

High Seroprevalence of Hepatitis C Virus Among Australian Psychiatric Inpatients: A Multicentre Study of Seroprevalence, Risk Factors and Treatment Experience

Background and aims: Treatment of hepatitis C virus (HCV) in patients with mental illness was previously hampered by the adverse neuropsychiatric effects of interferon therapy. The new era of directly acting antiviral (DAA) therapy has renewed interest in HCV treatment in this population due to its improved safety profile. The aims of this study were therefore to assess HCV prevalence and risk factors in psychiatric inpatients and to explore treatment models of care. Methods: This prospective study involved patients admitted to four inpatient psychiatric units, from December 2016 to December 2017. After consent HCV testing was performed, and information about HCV risk factors was obtained. Results: Two hundred and sixty patients (70% male), median age 44 years (IQR 24) participated in the study. The period prevalence of HCV antibody was 10·8% (95% CI 7-15). 80% of the study cohort had at least one risk factor for HCV. Independent predictors of HCV positive status were injection drug use (p<0·001, OR 44·05, 95% CI 7·9-245·5), exposure to custodial stay (p=0·011, OR 7·34, 95%CI 1·6-33·9), and age (p=0·011, OR 1·09, 95%CI 1·02-1·16). Of the 28 seropositive patients, 16 were HCV RNA positive. Eight of them were initiated on DAAs. Hepatitis nurses liaised with community mental health teams for treatment initiation. Six patients achieved sustained viral response, one achieved end of treatment response, and results are awaited in one. The remaining eight patients have proven difficult to engage with. Conclusion: HCV prevalence was high in this multicentric study cohort of psychiatric inpatients. Although treatment uptake was achieved only in 50% patients, it was successful in the majority. The findings highlight the urgent need to educate the mental health sector about the necessity to embed HCV screening practices and to build effective linkages for their patients to HCV treatment in the current DAA era. Funding: Unrestricted educational grant was received from Merck Sharp & Dohme (Australia) Pty Ltd (MSD), 2017 for this study. The funding agency had no role in the study design, execution or write- up. Conflict of interest: None Ethics approval: The project was approved by the Southern Adelaide Clinical Human Research Ethics committee (OFR #291.16 – HREC/16/SAC/232)

Hepatitis c virus infection risk tool for patients with cancer.

e18694 Background: Hepatitis C virus (HCV) infection can cause adverse hepatic and oncologic outcomes in cancer patients. In the general population, HCV screening is recommended using risk-factor-based and 1945-1965 birth-cohort-based strategies; however, in cancer patients the optimal screening strategies have yet to be established. Methods: We prospectively enrolled 2122 patients at MD Anderson Cancer Center prior to first anticancer therapy during 7/2013-12/2014 and surveyed HCV risk factors, including birth year, injection drug use, blood transfusion or organ transplant before 1992, clotting factor concentrate before 1987, chronic liver disease, and HIV. We estimated HCV prevalence by positive HCV antibody (anti-HCV) and examined associations of demographic, clinical, and behavioral factors with HCV status using Fisher’s exact test or Student’s t-test. False negative rates (FNR) are given for 3 screening strategies: risk-based cohort (positive for ≥1 risk factor), birth-year risk cohort, or both cohorts combined. Results: Prevalence of anti-HCV was 1.93% (41 patients; 95% CI 1.39-2.61%) and highest among blacks (5.0%; 95% CI 2.2-9.6%), followed by whites (1.9%; 95% CI 1.3-2.6%). Participant race/ethnicity was white (76%), Hispanic (11%), black (8%), or Asian (4%). Median age was 59 years (range 18-91), and 54% were female. Primary cancer diagnosis was non-hepatocellular carcinoma (HCC) solid cancers (79%), hematologic cancers (20%), or HCC (1%). Education less than a bachelor’s degree, birth-year cohort, injection drug use, blood transfusion or organ transplant, and chronic liver disease were each significantly associated with detectable anti-HCV. Sixty-two percent (n = 1,315) of participants, including 39 of 41 with anti-HCV, reported ≥1 risk factor. FNR for the 3 screening strategies was 32% (95% CI 18−48%) for the risk-based cohort, 20% (95% CI 9−35%) for birth-year cohort, and 5% (95% CI 1−17%) for the combined strategy. Conclusions: Combined birth-year and risk-based screening was superior to either screening strategy alone; however, this approach increases the burden placed upon the medical teams and yet still miss 5% of infected patients. Thus, universal HCV testing may be more efficient in patients with cancer.

Epidemiology of Hepatitis C in Pregnancy in North Central Florida: A Reassessment of Risks [10I

INTRODUCTION: Hepatitis C virus (HCV) affects 1% - 2.5% of pregnancies. Universal screening is not recommended aside from those with risk factors including among others: intravenous or intranasal drug use, incarceration or those having a sexually transmitted infection. Our purpose was to assess the epidemiology of HCV in North Central Florida. METHODS: IRB approval was obtained for this retrospective descriptive study. Patients were identified through ICD-9 Diagnosis codes for HCV and pregnancy from 2009-2014. Data abstracted from medical records included demographic information, concomitant sexually transmitted infections, tobacco or substance abuse, transfusion history and tattoos. RESULTS: Of 17,081 patients, 275 patients were identified with HCV (prevalence 1.6%). Mean age of those infected was 27.3 years old (range 16 to 49) with 89.1% Caucasian and 7.3% African American. Concomitant infections with Hepatitis B, HIV, chlamydia and herpes simplex occurred in 9%, 0.7%, 16% and 12% of patients, respectively. Most HCV patients smoked tobacco (89%); one third smoked cannabis (34%). A history of intravenous drug use was present in 75% and cocaine use in 37.5%. Although not a classical risk factor for HCV, prescription narcotic use was reported among 2/3 patients whereas 44% took non-prescribed narcotics. A minority of women had exposure to either tattoos 28.5% or blood transfusion 15%. CONCLUSION: We identified prescribed and self-administered oral narcotic medication and tobacco use as additional risks for HCV. We suspect adhering to the current screening recommendations permits cases of HCV to be missed and that more widespread if not universal screening should be considered.

Hepatitis C virus knowledge improves hepatitis C virus screening practices among primary care physicians.

AIMTo understand the role of knowledge as a promoter of hepatitis C virus (HCV) screening among primary care physicians (PCP).METHODSA 45-item online questionnaire assessing knowledge of HCV natural history, risk factors, and treatment was distributed to 163 PCP. Logistic regression, adjusted for survey responses, assessed associations between PCP knowledge of HCV natural history and treatment and birth cohort (i.e., birth between 1945 and 1965) screening. Response stratification and weighting were used to account for nonresponse and to permit extension of responses to the entire survey population. Associations between various predictors including demographic characteristics, level of training, and HCV treatment experience and HCV knowledge were assessed.RESULTSNinety-one individuals (55.8%) responded. Abnormal liver enzymes (49.4%), assessment of HCV-related risk factors (30.6%), and birth cohort membership (20%) were the leading HCV screening indications. Most PCP (64.7%) felt that the combination of risk-factor and birth cohort screening utilizing a self-administered survey while awaiting the physician (55.3%) were the most efficient screening practices. Implementation of birth cohort screening was associated with awareness of the recommendations (P-value = 0.01), knowledge of HCV natural history (P-value < 0.01), and prior management of HCV patients (P-value < 0.01). PCP with knowledge of HCV treatment was also knowledgeable about HCV natural history (P-value < 0.01). Similarly, awareness of age-based screening recommendations was associated with HCV treatment knowledge (P-value = 0.03).CONCLUSIONComprehensive knowledge of HCV is critical to motivate HCV screening. PCP-targeted educational interventions are required to expand the HCV workforce and linkage-to-care opportunities as we seek global HCV eradication.

Declining prevalence and increasing awareness of HCV infection in Italy: A population-based survey in five metropolitan areas

BackgroundData on the prevalence of hepatitis C virus (HCV) infection in Italy are outdated and usually derived from studying residents in small towns. MethodsTo assess prevalence of and risk factors for HCV infection among Italian residents in 5 metropolitan areas, subjects ≥20 years of age were randomly selected from the list of the general practitioners' registers in 2015. Anti-HCV was tested by a salivary test; HCV-RNA, HCV genotypes, and ALT were determined in positive individuals. Logistic regression analysis evaluated independent risk factors for HCV. ResultsOf the 4907 enrolled subjects, 112 (2.3%) tested anti-HCV positive. The prevalence of HCV increased with age, from 0.2% in subjects born after the year 1984, to 4.2% in those born before the year 1935 (P < 0.01). The birth-cohort prevalence peaked (7.0%) in elderly. Serum HCV-RNA was detected in 1.7% of the whole population. Nearly 80% of anti-HCV subjects were aware of their status. Age > 70 years, low education level, past use of glass syringes, blood transfusion, intravenous drug use, and cohabitation with an anti-HCV positive subject predicted the HCV positivity. InterpretationIn metropolitan areas in Italy, HCV is prevalent in elderly, reflecting a cohort effect determined by modalities of viral transmission no longer operative. The impact of the infection will further diminish in the years to come due to the natural depletion of the reservoir of the virus. This age pattern and the high proportion of subjects aware of their status do not warrant a policy of screening.

36 Institutional Adherence to CDC Guidelines for Hepatitis C Virus Screening Reveals Added Utility of Confirmatory Molecular Testing

Current Centers for Disease Control and Prevention (CDC) recommendations for hepatitis C virus (HCV) screening include confirmation of reactive HCV antibody (HCVAB) results for all patients and confirmation of nonreactive results for patients who may have been exposed within the past six months. Our aim was to assess adherence to these recommendations at a 1,250-bed tertiary care hospital in the Midwestern United States. In cases for which confirmatory testing was performed, our secondary aim was to determine the accuracy of the HCVAB screen for the assessment of active HCV infection. We retrospectively identified consecutive HCVAB samples tested by the ADVIA Centaur Immunoassay System over a period of seven years (January 2010 to December 2016) and by the COBAS AmpliPrep/COBAS TaqMan HCV RNA viral load assay (HCVRNA) over the same time period. The HCVAB test results were recorded as well as the percentage of reactive and nonreactive results that received confirmatory testing within 30 days. When both tests were performed, we calculated the concordance rates. Using the HCVRNA as the gold standard, we calculated the positive predictive values (PPVs) and negative predictive values (NPVs) of the HCVAB for the detection of active HCV disease within the patient population receiving both tests within 30 days of each other and within the patient population receiving both tests within one day of each other. Over the seven-year period, 66,066 samples were tested for HCVAB; 61,976 (93.8%) were negative, and 4,090 (6.2%) were positive. Of the 4090 HCVAB samples with positive results, 3,607 HCVAB samples underwent HCVRNA testing within 30 days, suggesting 88.2% adherence to CDC guidance for confirmation of positive HCVAB results. Of the 61,976 negative HCVAB results, 1,888 (3.0%) received confirmatory HCVRNA testing within 30 days. Among the 5,495 HCVAB samples followed up by HCVRNA testing within 30 days, there were 892 false-positive (HCVAB-positive, HCVRNA-negative) and 171 false-negative (HCVAB-negative, HCVRNA-positive) results, leading to a HCVAB PPV/NPV of 75.3%/90.6%. When the analysis was limited to HCVAB/HCVRNA test pairs that were taken within 1 day of each other (n = 1,790), the PPV/NPV improved to 78.6%/96.0%. The adherence to CDC confirmatory recommendations for patients with positive HCVAB results is high (88.2%), and a large proportion of patients with negative HCVAB results do not receive additional testing (97.0%). A small but significant proportion of patients with negative HCVAB tests will have a positive viral load within 30 days and even within one day. Although repeat testing in our study was likely to occur primarily among high-risk patients, creating the potential for bias, these findings suggest that patients with ongoing risk factors for HCV should receive follow-up testing with HCVRNA quantification.

Assessment of hepatitis C risk factors in center of Iran: A case-control study.

Background:Hepatitis C virus (HCV) infections remain as one of the major public health problems worldwide. The current study aimed at investigating the potential risk factors of HCV+ in a sample of Iranian patients.Materials and Methods:In a case–control study, 436 HCV-infected patients and 531 age-matched HCV antibody negative controls were recruited in a central region of Iran. Sociodemographic characteristics, blood and therapeutic factors, underlying diseases, and behavioral risk factors were evaluated through a standard checklist and compared between two study groups.Results:Although among studied potential risk factors, many of them were significantly associated with infected with HCV; however, in multivariable logistic regression model in the presence of other variables being male gender (odds ratio [OR]: 4.1; 95% confidence interval [CI]: 2.2–7.8), illiterate or less educated (OR: 62.64; 95% CI: 5.94–660.35), having history of intravenous (IV) drug addiction (OR: 33.0; 95% CI: 5.43–250.0), and tattooing (OR: 14.29; 95% CI: 1.82–90.91) increased risk of infection with HCV.Conclusion:In total, the current case–control study documented that socioecomical factors including economical state, marital status, education, and ethnicity and also other expected factors such as hospitalization, imprisonment, dialysis, tattooing, needle sharing, IV drug abuse, and extramarital sexual relationship represent an important source of HCV infection among adults in a central region of Iran. Thus, we suggest further considerations for prevention of HCV infection as most of related factors are preventable by close considerations.

The acceptability and effectiveness of a questionnaire for the identification of risk factors for HIV and hepatitis B and C: An observational study in general practice

Background: Many people in Europe remain undiagnosed for human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV).Objectives: To evaluate acceptability and effectiveness of a questionnaire designed to facilitate identification of risk factors for these viruses.Methods: We performed an observational study, in a prospectively enrolled cohort of patients in Paris (France) seen in 2014. Eighteen GPs administered a questionnaire to the first 50 patients, collecting information about risk factors. GPs were randomized into two groups: A (self-administered questionnaire) and B (GP-administered questionnaire). We used the overall response rate to assess the acceptability of the questionnaire. We used the rate of newly identified risk factors and compared the number of tests performed one year before and immediately after the intervention to assess the effectiveness of the questionnaire.Results: 842 patients were randomized: 349 (41.5%) in group A and 493 (58.5%) in group B. Acceptability was 88.5% (95%CI: 86.3–90.6); 93.1% (95%CI: 90.5–95.8) in-group A and 85.2% (95%CI: 82.1–88.3) in group B (P = 0.0004). Prevalence of risk factors was 51.8% (95%CI: 48.2–54.4) and 58.3% were newly identified (95%CI: 52.9–63.7). The number of HIV tests performed during the four weeks after intervention increased by 27% compared to the same period one year before (P = 0.22). It increased by 113% (P = 0.005) and 135% (P = 0.005) for HBV and HCV, respectively.Conclusion: The questionnaire proved acceptable and effective in identifying risk factors for HIV, HBV and HCV in general practice.

Hepatitis C virus risk factors in blood donors from Sohag governorate, Egypt

Egypt has the highest prevalence of hepatitis C virus (HCV) worldwide. Most of data came from lower Egypt regions (Cairo and northern to it). So, we decided to study risk factors and prevalence of HCV transmission in our governorate. In this cross sectional study, we recruited 631 blood donors from April, 2011 to March 2012 who were tested for anti-HCV, HBs Ag, anti- HBc and anti-HIV. Fifty seven donors were excluded as they are HBs Ag and anti-HBc positive. We found 138 (24%) HCV seropositive participants. Logistic regression final model demonstrated that endoscopy, hospital admission, socioeconomic status, IV drug use and age made a significant contribution to prediction (P=0.0001). The level of education also made significant contribution to prediction (P=0.014). In conclusion, it is wise to determine high HCV prevalence areas and risk factors for its seropositivity then build up a governorate suitable infection control program concentrating upon prevention more than treatment of HCV patients. Also, the introduction of pre-test and post-test counseling in blood banks will help in better donor selection and early detection of patients.

P109 Routine hepatitis C antibody testing in MSM – are we overtesting?

IntroductionThe hepatitis C virus (HCV) is rarely transmitted sexually. MSM with HIV are at increased transmission risk. Debate exists regarding sexual transmissibility of HCV in those without HIV or additional risk factors beyond receptive anal intercourse. Following outbreaks of HCV in Europe and London in MSM, Oxfordshire Sexual Health Services introduced annual unselected HCV antibody testing as a screening minimum for all MSM. Evidence now suggests this may not be necessary. We set out to audit our HCV testing to assess this and identify potential policy modification.MethodsWe reviewed all HCV antibody tests undertaken in a 12 month period. We identified all HCV positive patients to determine risk factors for infection in order to establish whether these patients were identified through annual screening or would have been identified using a selective basic risk analysis.ResultsWe found 13 positive results out of 1351 tests. 6 had previously known HCV, 4 were co-infected with HIV. 2 were heterosexual men with additional risk factors, one was an MSM with additional risk factors. No HIV negative MSM with HCV infection were identified through annual screening alone. Approximately 3.5% of tests undertaken were based on recognised risk factors for HCV, 96.5% were undertaken as part of annual screening. This equated to £1486 per new diagnosis, excluding service costs.DiscussionRoutine annual screening of HIV negative MSM in this study did not pick up any new HCV diagnoses. Cost per diagnosis may be reduced with targeted testing. The annual screening policy needs modification.

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.

Incidence of Hepatitis C Virus Infection in the Human Immunodeficiency Virus Outpatient Study Cohort, 2000-2013.

There are few recent studies of incident hepatitis C virus (HCV) infection among human immunodeficiency virus (HIV)-infected patients in the United States. We studied HIV Outpatient Study (HOPS) participants seen in 9 HIV-specialty clinics who had ≥1 clinical encounter during 2000-2013 and ≥2 HCV-related tests, the first of which was a negative HCV antibody test (Ab). Hepatitis C virus incident cases were identified by first positive HCV Ab, viral load, or genotype. We assessed rates of incident HCV overall, by calendar intervals, and by demographic and HIV risk strata, and we explored risk factors for incident HCV using Cox proportional hazards models. The 1941 eligible patients (median age 40 years, 23% female, 61% men who had sex with men [MSM], and 3% persons who injected drugs [PWID]) experienced 102 (5.3%) incident HCV infections for an overall incidence of 1.07 (95% confidence interval [CI], 0.87-1.30) per 100 person-years (py). Hepatitis C virus incidence decreased from 1.83 in 2000-2003 to 0.88 in 2011-2013 (P = .024), with decreases observed (P < .05) among PWID and heterosexuals, but not among MSM. Overall, MSM comprised 59% of incident cases, and PWID were at most risk for incident HCV infection (adjusted hazard ratio [aHR] for PWID = 4.62 and 95% CI = 2.11-10.13; for MSM, aHR = 1.48 and 95% CI = 0.86-2.55 compared with heterosexuals). Among HIV-infected patients in care during 2000-2013, incidence of HCV infection exceeded 1 case per 100 py. Our findings support recommendations for annual HCV screenings for HIV-infected persons, including persons with only MSM risk, to enable HCV diagnosis and treatment for coinfected individuals.

Prevalence of hepatitis B, hepatitis C and human immunodeficiency viruses, and evaluation of risk factors for transmission: Report of a population screening in Nigeria.

Hepatitis B virus (HBV), hepatitis C virus (HCV) and HIV are common blood-borne infections unevenly distributed across regions in Nigeria. Few population-based prevalence studies have been done in Nigeria. To determine the prevalence of HBV, HCV and HIV and risk factors for infection with these viruses in a Nigerian population. Hepatitis B surface antigen, anti-HCV and HIV were assayed in 1 498 healthy adult participants. A structured questionnaire was used to assess risk factors for viral acquisition. Bivariate analysis was used to compare differences in sociodemographic characteristics. Significant risk factors were identified by stepwise logistic regression. A p-value &lt;0.05 was considered significant. The prevalences of HBV, HCV and HIV were 8.8%, 10.0% and 12.9%, respectively, with urban/rural disparity. HBV/HCV positivity was higher among males than females. The reverse was true for HIV. Age was significantly associated with being HBV-, HCV- or HIV-positive. Communal use of a toothbrush was significantly associated with HBV positivity in the final model (odds ratio 2.46, 95% confidence interval 1.45 - 4.18). The prevalence of HBV, HCV and HIV infection is high in Nigeria, with urban/rural disparity. HCV may be more of a public health concern than HBV in some communities. Population-based studies are required to provide vital data to inform optimal national control strategies.

Hepatitis C virus transmission in a skilled nursing facility, North Dakota, 2013.

From March-May 2013, 3 cases of acute hepatitis C virus (HCV) infection were diagnosed among elderly patients residing at the same skilled nursing facility (facility A) and who received health care at hospital X during their likely exposure period. We performed HCV testing of at-risk populations; quasispecies analysis was performed to determine relatedness of HCV in persons with current infection. Infection control practice assessments were conducted at facility A and hospital X. Persons residing in facility A on September 9, 2013, were enrolled in a case-control study to identify risk factors for HCV infection. Forty-five outbreak-associated infections were identified. Thirty cases and 62 controls were enrolled in the case-control study. Only podiatry (odds ratio, 11.6; 95% confidence interval, 2.4-57.2) and international normalized ratio monitoring by phlebotomy (odds ratio, 6.7; 95% confidence interval, 1.7-26.6) at facility A were significantly associated with case status. Infection control lapses during podiatry and point-of-care testing procedures at facility A were identified. HCV transmission was confirmed among residents of facility A. The exact mode of transmission was not able to be identified, but infection control lapses were likely responsible. This outbreak highlights the importance of prompt reporting and investigation of incident HCV infection and the need for adherence to basic infection control procedures by health care personnel.