Risk Factors For HCV Transmission Research Articles

Seroprevalence and Risk Factors for Hepatitis B, Hepatitis C, and HIV in a Substance Abuse Treatment Center.

Alcohol and substance use disorders are important public health problems with an increased risk for bloodborne and sexually transmitted infections. To determine the frequency and risk factors of hepatitis B, hepatitis C and HIV in individuals with drug and alcohol addiction. This prospective study was conducted in the outpatient clinic of Alcohol and Substance Abuse Treatment and Education Center (ASATEC), Izmir, Turkey. Detailed anamneses were taken from alcohol and/or drug addicts who applied to the outpatient clinic; HBV, HCV, HIV serology results in the last 6 months were examined. The study group consisted of 478 persons, including 112 (23.4%) alcohol addicts, 322 (67.4%) substance addicts, and 44 (9.2%) combined alcohol and substance addicts. The mean age of the cases was 32 ± 11 years and 432 (90.4%) were male. Drug injection and needle sharing was recorded in 16.5% and 9.8% of participants, respectively. Hepatitis B surface antigen (HBsAg) positivity was found in 2.7%, anti-HCV positivity in 9.6% and HIV Ag/Ab positivity in 1.9% of the cases. Among patients using intravenous drugs, HBsAg positivity was found in 2%, anti-HCV positivity in 55%, while HIV Ag/Ab positivity was not detected. A history of sexually transmitted disease was a risk factor for HBsAg, HIV Ag/Ab positivity. Intravenous drug use, needle sharing and ecstasy use were determined as risk factors for anti-HCV positivity. Risky behaviors for HBV, HCV and HIV transmission are high in alcohol and substance addicts. The use of ecstasy is a novel risk factor for HCV transmission.

Risk factors associated with HCV co-infection amongst MSM and transgender women living with HIV in Mexico City: a case-control study

Introduction and objectivesHepatitis C virus infection (HCV) is a major cause of co-morbidity in people living with HIV (PLWHIV). The modes of HCV transmission in the local population of PLWHIV are still unclear. We conducted this study to identify risk factors for HCV transmission amongst PLWHIV in central Mexico. Material and methodsWe enrolled HIV/HCV co-infected cases and HIV controls receiving care in two outpatient clinics in Mexico City. Structured questionnaires were applied, covering demographics, history of percutaneous exposures, sexual behaviors, self-reported STD and recreational drug use. The statistical analysis for between-group comparisons were multivariate logistic regression models to assess the risk factors associated with HCV co-infection. We limited the final analysis to men who have sex with men (MSM) to avoid confounders potentially related to HCV acquisition in other populations. ResultsThree hundred and thirty-four MSM with HIV (175 with HCV co-infection and 159 without) were analysed. We did not identify percutaneous exposures as risk factors for HCV. Intravenous drug use (IVDU) occurred in two cases and one control case. Risk factors independently associated with acquiring HCV co-infection were: history of an ulcerative STD (aOR=2.65, 95%CI=1.44-4.88), a HCV positive partner (aOR=5.25, 95%CI=2.78-9.91), having practiced insertive fisting (aOR=2.62, 95%CI=1.01-6.90), and rectal administration of drugs during sex (aOR=2.46, 95%CI=1.25-4.84). ConclusionsRisky sexual behaviors and chemsex seem to be the main drivers of HIV/HCV co-infection amongst PLWHIV in Central Mexico. IVDU and percutaneous exposures have a minor role in the local HCV epidemic. These findings highlight the importance of testing for HCV in sexually active MSMs.

Viral Hepatitis C (HCV) in Hemodialysis

The aim of the study is to show the prevalence and risk factors of HCV at our hemodialysis (HD) center , in a study carried out on chronic hemodialysis patients during the year 2019, we identified eight cases out of 87 patients infected with HCV, or 9%. The average age in this population is 48 years, dialysed for an average of 15 years. Viral infection was discovered on average 12.5 years after the start of hemodialysis, during a routine screening examination. In this series, the genotype 1b was found in 2 cases (25%). Seven patients were treated out of the eight HCV hemodialysis patients, received dual therapy with sofosbuvir 400mg and daclar 60 mg for three months, with an early virologic response. A study done during a previous period, between 2015 and 2018, in the same center, looking at the risk factors for HCV transmission: 11 cases out of 134 hemodialysis patients infected with HCV. Among these cases, we noted the following factors; Blood transfusion: 3 cases (27.2%), surgery: 4 cases (45.4%), dental care: 2 cases (18%), no obvious cause: 2 cases (9%). Serologically ; HCV antibodies positive: 11/134, i.e. an 8.2% seroprevalence, PCR-viral RNA was positive in 10 out of 11 patients, i.e. a prevalence of 7.4% by PCR, number of copies: Above 1.03x 1, 000,000 (100%), number of Logs: Sup to 3.32 (100%), negative PCR: 01 patient.

Highlights for Dental Care as a Hepatitis C Risk Factor: A Review of Literature.

Hepatitis C (HCV) is a viral infection that affects an estimated 71 million people worldwide, with over 1 million new infections yearly. While medical treatments exist, HCV continues to be a significant public health concern. Primary prevention and transmission risk factor identification remain key in helping decrease disease prevalence. While intravenous drug use, healthcare exposure (i.e. blood transfusions and surgical care), and body modification (i.e. tattooing and piercings) are well accepted risk factors for HCV transmission, others remain controversial. Because dental practice is often associated with procedures and bleeding, the possibility of HCV transmission seemed reasonable to investigate. Here, we review the evidence for dental care as a potential risk factor for HCV transmission. We identified a total of 1,180 manuscripts related to HCV and dental care, of which 26 manuscripts were included in the study after exclusionary criteria were applied. As per our review of the available literature, in the developing world, the improper use of sterile technique and lack of provider education likely increases the risk of HCV transmission during dental care. In developed nations, on the other hand, general dental care does not appear to be a significant risk factor for HCV transmission in non-intravenous drug user patients; although, the improper use and reuse of anesthetics during procedures poses a rare potential risk for viral transmission.

Prevalence of Hepatitis C Virus and Associated Risk Factors among Inmates at New Bell Prison, Douala, Cameroon

Although a high prevalence of HCV infection in correctional facilities has been well reported in several countries around the world, there has been no such data from Cameroon. The aim of this study was to determine the prevalence and factors associated with viral hepatitis C seropositivity among prisoners incarcerated at the New Bell Central Prison in Douala. From the 2nd to the 27th of July 2018, 940 inmates selected using a systematic random sampling method were interviewed to collect data on sociodemographic status, duration of incarceration, number of incarcerations and risk factors for HCV transmission. Blood samples were collected for screening of anti-HCV antibodies via HEPA-SCAN HCV CARD Test. Positive samples had a confirmatory ELISA test. Data were analysed using EPI DATA 4.4.0.0 software. Statistical significance was set at a p < 0.05. Of the 940 prisoners selected, 94.1% (884) were males. The mean age of the study population was 33.81 ± 10.35 years (extremes: 14 and 74 years). HCV prevalence was 4.4% (40). The use of non-injectable illicit drugs (OR 2.87 95% CI 1.44 - 5.73) (p = 0.002) but not injectable illicit drugs (OR 1.91 95% CI 0.43 - 8.41) (p = 0.42), male homosexuality (OR 17.45 95% CI 7.58 - 40.13) (p < 0.001), sharing of needles (OR 3.45 95% CI 1.59 - 7.83) (p = 0.001), past history of tattooing or piercing (OR 5.94 95% CI 2.80 - 12.16) (p < 0.001) and age ≥ 50 (OR 4.069; 95% CI 1.9 - 8.68) (p = 0.003) were significantly associated with HCV antibodies positivity. Inmates in New Bell Central Prison accumulate risk factors for viral hepatitis C, thus contributing to the high prevalence in this setting. Control strategies and programs that reach this particular population should urgently be implemented.

Hepatitis C Infection Screening and Management in Opioid Use Epidemic in the United States

Introduction: The prevalence of injection drug use (IDU) of opioids has significantly increased among young adults in the U.S. IDU of opioids is the primary risk factor for HCV transmission. According to CDC reports, among people aged 18-29, HCV infection increased by 400% in response to a 6-fold rise in injection opioid-associated hospitalization from 2004 to 2014. Although Direct-Acting Antiviral (DAA) therapy is curative, HCV-associated disease burden still remains substantial nationwide. The inequality in access to DAA remains a major concern, particularly in young and low socioeconomic populations. However, recent policies such as Medicaid expansion under the Affordable Care Act which was implemented in Nevada in 2014 have shown promises in reducing this disparity. Empirical evaluations are warranted to further explore the epidemiology of opioid-related consequences in Nevada.2883 Figure 1. Annual rate of opioid-associated emergency department visits per 100,000 emergency department discharges by age groups and primary payerMethods: We performed a cross-sectional data analysis using the Nationwide Emergency Department Sample (NEDS) in the state of Nevada from 2009 to 2017. We captured ED visits with opioid-use as either principal or secondary diagnosis. Our outcome of interest is the annual rate of opioid-associated ED visits per 100,000 ED discharges. We specified annual rates by age groups (age 1-24, 25-44, 45-65, 65 or older) and proportion of primary payer (uninsured and Medicaid). Results: As presented in Figure, the annual rate of opioid-associated ED visits per 100,000 ED discharges showed similar trends of monotonic increase among all age groups. Both prevalence and annual rate of increase was the highest among age group 25-44 and the second highest among age 45-64. We found remarkable crossover in primary payer after 2014: an increased proportion in Medicaid in response to decrease in uninsured. Conclusion: Nevada opioid epidemic follows similar patterns as national trends. Approach to co-occuring HCV requires further discussion in this state specific setting. For example, it is plausible that a “screen all” strategy for HCV could provide more cost savings as compared to currently accepted “age-based” or “risk-based” screening strategies. The accessibility of DAA therapy maintains at risk in lieu of the American Health Care Act that may lead to the loss of insurance coverage for many Nevadans. Overall, little attention has been given to the unintended impacts of current opioid crisis and further decision analytic methods should be tested within each state to guide future practice management.

Recent trends in molecular epidemiology of Hepatitis C virus in Mardan, KPK Pakistan

To determine the genotypic distribution of HCV, frequency of risk factors involved in its transmission, and correlation of genotype with viral load in Mardan population which is the second largest city of Khyber Pakhtunkhwa (KPK), Pakistan. Blood samples of 1140 were collected from different regions of Mardan and major proportion of recruited patients were internally displaced people (IDPs), refugees, and slum dwellers. Complete patient's history was analyzed to assess the possible risks involved in HCV transmission. Viral genotype was determined by PCR (polymerase chain reaction) whereas, HCV RNA was measured by qRT-PCR. Data was analyzed using SPSS statistical software. Our results indicate 3a as the most abundant subtype in Mardan population followed by 3b, 2a, 2b, 4a, untypeable, mixed, 1a, and 1b. In contrast to previous findings, genotype 1 was the least prevalent genotype and the overall prevalence of HCV in Mardan population was significantly higher in females (n = 687, 60.2%) than males (n = 453, 39.7%). Significant difference between-genotypes and gender was observed in genotype 1 (p < .034) and genotype 3 (p < .004). The mean age was 44 (SD ± 9.51). The most frequently found mixed genotype was 3a + 1b and mixed genotype was more prevalent in males. The proportion of middle-aged people (41–49 years) was higher whereas, older and younger people were least infected with HCV. This is the first study that showed substantial correlation of genotype 3 with low and intermediate viral load in Mardan population. Moreover, high and extremely high viral load was associated with other genotypes. Our findings showed that most of the patients who experienced high and extremely high viremia in their blood were males and belonged to Takhat Bhai and Mardaan regions. There were significant difference in the prevalence of HCV genotype 3a (p = .001) and genotype 3b (p = .005) in different regions of Mardan. Pre-treatment viral load is significantly high (p 0.001) in tehsil Mardan patients infected with HCV genotype 3 as compared to other genotypes. Unsafe medical practices such as medical and dental surgeries, intravenous drug use, and blood transfusions were the main risk factors for HCV transmission in Mardan, KPK Pakistan. This study gives clear insights into the epidemiological status of HCV in Mardan population. Genotype 3 is correlated with low and intermediate viral load whereas high viral loads were revealed among patients infected with genotypes other than genotype 3. In the absence of better data and robust epidemiological information, this detailed analysis of HCV genotypes with special reference to risk factors, pretreatment viral load, gender, and age will provide the baseline data for development of optimal HCV eradication and preventive strategies.

Acute hepatitis C: clinical and laboratory diagnosis, course of the disease, treatment

Acute hepatitis C (AHC) is asymptomatic in about 70-80 % of cases and, therefore, is usually undiagnosed. Although the clinical course is typically mild, AHC has a high rate of transition to chronicity. We evaluated the literature data concerning risk factors for HCV transmission, diagnosis, natural history, and antiviral treatment of AHC. Although new methods have been developed, anti-HCV seroconversion remains the gold standard for the diagnosis of AHC. This phenomenon, however, is identifiable in less than half of cases in the everyday clinical practice, since most AHC patients do not know their previous anti-HCV/HCV-RNA status. An early short-term interferon treatment in AHC patients prevents progression to chronicity in most of treated patients. The literature data give evidence of the clinical relevance of an early diagnosis of AHC for an early short-term interferon treatment. There is also the suggestion to use newly developed laboratory methods to distinguish AHC from an acute exacerbation of a chronic HCV infection.

Protection Against Hepatitis C and Other Enveloped Viruses? Another Reason Why "Breast Is Best"

Protection Against Hepatitis C and Other Enveloped Viruses? Another Reason Why "Breast Is Best"

Evidence of association between hepatitis C virus genotype 2b and nosocomial transmissions in hemodialysis centers from southern Brazil

BackgroundHepatitis C virus infection is a serious public health problem. Hemodialysis is considered one of the main risk factors of HCV infection, due to several invasive medical procedures and potential nosocomial transmission that patients with chronic renal failure (CRF) are continuously submitted. The aims of this study were to determine the prevalence of HCV and its genotypes in patients with CRF in hemodialysis units in southern Brazil.MethodsDemographic data and risk factors for HCV transmission were collected and analyzed. These data were obtained from patients undergoing hemodialysis treatment from January 2009 to August 2010, on two dialysis units of Rio Grande, southern Brazil. Genotyping was carried out by sequencing analysis of HCV NS5b, core-E1 junction and 5′UTR genomic regions.ResultsOne hundred fifty-nine patients under regular hemodialysis treatment were studied. HCV prevalence was 23.3%. HCV-infected patients had been on dialysis treatment for 91.9 months, a more prolonged period compared to HCV-negative patients (p = 0.001). While HCV genotypes 1b and 3a were identified as the most frequent strains, a surprisingly high proportion of genotype 2b was observed among patients in one of the dialysis centers compared to the general HCV-infected population of the same area. Hemodialysis treatment exposure time and healthcare working were associated with HCV infection.ConclusionsBesides the efforts to minimize nosocomial transmission of HCV, some events of transmission are still evidenced in dialysis units.

Persisting role of healthcare settings in hepatitis C transmission in Pakistan: cause for concern

Transmission of hepatitis C (HCV) in Pakistan is a continuing public health problem; 15 years ago it was linked to the practice of reusing therapeutic instruments in healthcare settings. We sought to examine current risk factors for HCV transmission in a hospital population in Karachi, Pakistan. We enrolled 300 laboratory-confirmed HCV-positive participants and 300 laboratory confirmed HCV-negative participants from clinics at Indus Hospital. Independent and significant risk factors for both men and women were: receiving o12 injections in the past year, blood transfusions, having had dental work performed, and delivery in hospital or transfusion for women. Interestingly, being of Mohajir origin or born in Sindh province were protective.Encouragingly, a strong protective effect was observed for those that reported bringing their own needle for injections (59%). The widespread reuse of therapeutic needles in healthcare settings in Karachi remains a major driver of the HCV epidemic.

Occupational transmission of hepatitis C in healthcare workers and factors associated with seroconversion: UK surveillance data

The study aims were to describe a case series of occupationally acquired hepatitis C (HCV) infections in UK healthcare workers and examine factors associated with transmission using exposure data reported to the Health Protection Agency between July 1997 and December 2007. Fifteen reported cases of documented HCV seroconversion occurred after percutaneous exposure, the majority from hollow-bore needles used in the source patient's vein or artery and contaminated with blood or blood-stained fluid. The seroconversion rate was 2.2% (14/626). In multivariable analysis of healthcare workers with percutaneous exposure to blood or blood-stained fluid, we demonstrate that blood sampling procedures (odds ratio [OR], 5.75; 95% CI, 1.33-24.91; P = 0.01) and depth of injury (OR for deep vs superficial injury, 21.99; 95% CI, 2.02-239.61; P = 0.02) are independently associated with a greater risk of HCV seroconversion. This is the first UK study of occupationally acquired HCV in healthcare workers. It has reinforced our knowledge of risk factors for HCV transmission. Most of these exposures and transmissions were preventable. Healthcare employers should provide regular education on the risks of occupational exposure and prevention through standard infection control procedures. They should ensure the availability of effective prevention measures and facilitate prompt reporting and adequate follow-up of exposures.

PP-127 Transmission of hepatitis C between spouses an epidemiological study at National Liver Institute hospital

Background/Aims: In Egypt, relatively higher rates of sexual transmission have been reported and reflect the higher background prevalence in this country. In rural Egypt, sexual transmission between monogamous spouses ranged between 3 and 34%. Methods: This is a cross sectional hospital based study evaluated the non-sexual and sexual risk factors of HCV infection transmission from male and female index cases to their spouses. This study documented previously uncertained lifestyle risk factors for HCV transmission between spouses, confirmed the high prevalence of HCV infection (17% to 26%) in Egypt which is higher than other parts of the world, and provided evidence of sexual transmission of HCV (30). Results: HCV transmission from wife to husband including sexual relationship occurred in 46% of cases while from husband to wife was 25% and 35.5% overall HCV transmission between spouses. Sexual intercourse of positive HCV female more than 4 times per month is 66 times risky to transmit HCV infection to her husband. Conclusion: This study emphasize that transmission between spouses significantly occur due to sexual contact but we can’t ignore the significant role of non sexual risk factors of HCV transmission among married couples.

Prevalence of hepatitis C virus among users attending a voluntary testing centre in Rio Grande, southern Brazil: predictive factors and hepatitis C virus genotypes

We estimated the prevalence of hepatitis C (HCV) infection and associated risk factors in 750 individuals attending the Voluntary Counseling and Testing Center of Rio Grande (VCT/RG), in Southern Brazil, and identified viral genotypes. Demographic data and risk factors for HCV transmission were also collected and analysed. Anti-HCV antibody-positive individuals were tested for HCV-RNA and genotyped by sequencing the 5' untranslated region of the viral genome. Prevalence estimates of anti-HCV and HCV-RNA were 6% and 5.5%, respectively. We identified genotypes 1 (67%), 2 (2%) and 3 (31%); the latter was more prevalent than in other regions of Brazil. Anti-HCV prevalence in VCT/RG users was similar to previous reports. Age, previous blood transfusion, sexual orientation and injecting drug use were independent predictors of HCV infection. The presence of multiple risk factors was also associated with a higher risk for HCV infection. HCV genotype was not associated with any variable analysed in this study.

Hidden hazards of HCV transmission

Hepatitis C virus infection is a global health problem that has important epidemiological and clinical consequences. It has been well established that exposure to infected blood is the main risk factor for HCV transmission. However, in 20% of cases the agent transmission occurs by unknown route or in the presence of an unidentified source of infection. Understanding of the epidemiology of HCV is needed to help us define future control and preventive strategies. Herein, we discuss about diagnosis of HCV infection and hepatitis C surveillance in the context of its transmission.

OC-031 Outreach community testing for hepatitis C in an ethnic population

Introduction Hepatitis C (HCV) is a leading cause of liver disease worldwide The World Health Organisation (WHO) estimates a worldwide prevalence of 170 million or 2.2%, although there is considerable geographical variation, Scotland, due to intravenous drug misuse, has higher prevalence of HCV infection compared with other European countries, estimated at 1% of the population. There is considerable ethnic diversity in Scotland, with a large Pakistani subpopulation. In Pakistan the prevalence of HCV is between 6 and 10%.1 Methods We arranged a series of HCV awareness meetings in Mosques and Pakistani Women9s Associations in Dundee. Thereafter we set up a series of sessions in the same venues offering HCV testing. Venous blood samples were taken for testing of HCV IgG and HBsAg, using the Abbott Architect system. Relevant past medical, family and travel history was also recorded as well as history of risk factors for HCV. Results 170 people were tested, representing 10% of the Dundee Pakistani population of which 145 were male. The mean age±SD was 45.11 (16.7) years. Seven patients (4.1%) of the cohort were Anti HCV positive and five (2.9%) were PCR positive. Only two people had previous testing for HCV, although 86.5% of the cohort had attended their GP within the past 2 years. 76.5% of the cohort had resided in the UK for at least 5 years. Less than 7% of the cohort was born in the UK. Risk factors for HCV transmission were only noted in a minority of patients who were HCV positive. One of seven had a family history and two of seven had a previous injection (IM or IV) in Pakistan. None had a history of drug misuse or transfusion. Of the entire group 33.5% reported previous therapeutic injections and 10% had a previous surgical procedure carried out in Pakistan. 3.5% of the cohort had a blood transfusion. 15.2% reported a family history of HCV infection. Conclusion This pilot project confirms that the Hepatitis C incidence in the healthy Pakistani migrant is higher than the native population. At-risk groups for HCV can be targeted for testing and treatment with outreach clinics. Using Scottish Intercollegiate Guidelines Network (SIGN) recommendations for assessing risk factors we would not have tested majority of those infected.2 Awareness needs to be raised among physicians regarding screening of ethnic populations for HCV.

Most common genotypes and risk factors for HCV in Gaza strip: a cross sectional study.

BackgroundThe present work aims at determining HCV genotypes in patients with chronic HCV infection, in Gaza strip, Palestine. The most common risk factors for HCV transmission were also evaluated in conjunction with the genotyping data.ResultsThe study shows that there are only two major genotypes of HCV in Gaza Strip: Genotype 1 (subtypes 1a and 1b) collectively contribute to 28.3% of the cases, and genotype 4 (subtypes 4a and 4c/d) collectively contribute to 64.1% of the cases. Mixed infection with the two genotypes was also present among 7.6% of the cases. In this study a statistically significant relationship was established between the distribution of these genotypes and the patients' living place, traveling history, history of blood transfusion and history of surgical operations.ConclusionThe present study is the first to link HCV genotyping in Gaza strip with its possible roots of transmission. Traveling to endemic countries, especially Egypt; blood transfusion and surgical operations are major roots of HCV infection in Gaza strip. The results indicate that iatrogenic and nosocomial procedures may be responsible for the majority of HCV infections in Gaza strip.

Prévalence des anticorps anti-VHC et incidence de séroconversion dans cinq centres d’hémodialyse au Maroc

Dialysis patients are among groups at risk for development of hepatitis C infection (HCV). The aim of the study was to evaluate the prevalence and the incidence of seroconversion for HCV in five haemodialysis units in Morocco. The study was conducted during the period from September 2003 to September 2004. We studied 303 patients (148 females), mean age 49+/-16 years; dialysis duration was higher than five years in 64% of the cases. The prevalence of HCV infection was evaluated by using a fourth generation enzyme immunoassays. In the seronegative patients, we performed anti-HCV tests at three and six months intervals and monthly testing of alanine aminotransferase (ALT) activity and assessment of anti-HCV tests if the ALT activity was elevated. Moreover, risk factors, such as blood transfusion, surgery and other invasive procedures were recorded. Seroprevalence of HCV was 68.3%. Among 85 patients who were tested negative for anti-HCV at the entry of the study, four (4.60%) seroconverted in six month (estimated incidence: 9.41 new cases per year). HCV seropositivity was associated with longer duration of dialysis (p=0.000), and previous blood transfusions (p=0.047). The follow-up of the ALT in the seronegative patients did not show any significant variation. In conclusion, the prevalence and incidence of HCV infection in haemodialysis units in Morocco are dramatically elevated. High incidence seropositivity suggested nosocomial transmission of HCV; the dialysis processes itself, and blood transfusions are important risk factors for HCV transmission in these patients.

Changing pattern of hepatocellular carcinoma (HCC) and its risk factors in Egypt: Possibilities for prevention

The burden of hepatocellular carcinoma (HCC) has been increasing in Egypt with a doubling in the incidence rate in the past 10 years. This has been attributed to several biological (e.g. hepatitis B and C virus infection) and environmental factors (e.g. aflatoxin, AF). Other factors such as cigarette smoking, occupational exposure to chemicals such as pesticides, and endemic infections in the community, such as schistosomiasis, may have additional roles in the etiology or progression of the disease. Estimates of the burden of cancer caused by these factors provide an opportunity for prevention. Previously, there was strong evidence that hepatitis B virus (HBV) was the major cause of HCC in Egypt, but more recently HCV has become the predominant factor associated with the more recent epidemic of HCC. It has been well documented that Egypt has one of the highest prevalence rates of HCV infection in the world. The natural history of HCV infection and disease progression, however, are influenced by additional factors such as duration of infection, age at infection, sex, co-infection with HBV, the level of HCV viraemia and its genotype. The role of exposure to aflatoxins and development of HCC in Egypt was historically less clear. Nevertheless, recent food sampling surveys and population-based studies indicated that exposure to aflatoxins in Egypt may have been underestimated in the past. Recent results indicated that both local and imported samples were positive for aflatoxin B1 (AFB1, 17.5% and 20%, respectively), with concentrations ranging from 3 to 25 microg/kg. The level of AFB1 was dependent on the area of collection as well as the season of the year. In a population-based study, the level and frequency of aflatoxin M1 (AFM1, a major metabolite of aflatoxin B1 excreted in breast milk) was assessed as a biomarker of maternal exposure. The samples were collected from a selected group of 388 Egyptian lactating mothers during May-September 2003. Non-working status, obesity, high corn oil consumption, and the number of offspring contributed to the variability in occurrence of AFM1 in breast milk. Prevention and intervention approaches directed to risk factors of HCC can play a critical role in its prevention. In the case of HCV infection a prevention programme can be achieved by changing personal behaviors and/or cultural habits which are risk factors for HCV transmission, such as injection with contaminated syringes, blood transfusion, surgical operations, venous catheterization, use of common syringes, dental treatment and circumcision at home. Prevention of exposure to aflatoxins can be achieved either at community (via good agriculture practices) or individual levels (treatment or dietary interventions). In conclusion, due to the alarming increase in the incidence of HCC in Egypt, there is a need to further investigate the contribution of these emerging risk factors to the development of HCC in Egypt. This may enable us to determine the susceptibility to HCC among high-risk groups and to provide these individuals with effective measures for early prevention or intervention.

Hepatitis C virus antibodies and other markers ofblood-transfusion-transmitted infection in multi-transfused Cuban patients

Background: HCV was initially identified in 1989 when it was found to be the primary causative agent of non-A, non-B hepatitis,a condition associated with high rates of progressive and end-stage liver disease, cirrhosis, and hepatocellular carcinoma. Since then, appreciation of the significant worldwide health impact of HCV infection has grown. HCV infection was identified as a public health problem in Cuba in the 1990s. Despite universal blood donor screening, which was achieved in 1995 using the Cuban immunoassay system UMELISA HCV, the infection is still found in multi-transfused patients. Objectives: To determine the magnitude of HCV, HBV and HIV-1&2 infections among Cuban blood recipients and to assess the role of potential risk factors. Study design: Cross-sectionalstudy of 318 patients from Havana City, Pinar del Río and Villa Clara, who had been previously treated with 10 or more units of allogenic blood or blood components in at least two different occasions. The patients were evaluated for HCV Ab, HBsAg, anti-HBc Ab, and HIV-1&2 Ab. Data management and statistical analysis were performed using EpiInfo and SSPS software. Results: Prevalence rates were 51.6% for HCV Ab; 5.3% for HBsAg; 45.0% for anti-HBc and 0% for HIV-1&2 Ab. Ten (3.1%) patients were co-infected with HCV and HBV Blood transfusion was not identified as the main risk factor for HCV transmission. The number of blood units received by the patients was not statistically associated with the HCV Ab prevalence. Conclusions: Infection with HCV was identified more frequently than HBV and HIV among our study population. Patients undergoing hemodialysis were at the highest risk of becoming infected. Medical procedures including surgery, transplantation, invasive odontology, and sharing or reuse of needles and syringes, are associated with higher HCV Ab seroprevalences compared with blood transfusion alone.