Untreated HCV Infection Research Articles

Surgical complications in hepatitis C patients undergoing cholecystectomy

BackgroundHepatitis C (HCV) infection affects more than 2.2 million people in the United States and is associated with liver cirrhosis and gallstone formation. However, cholecystectomy outcomes of patients with and without HCV infection are not well studied. This study aimed to examine the differences in cholecystectomy outcomes among patients with untreated, treated, and no HCV infection history. MethodsA retrospective cohort study was conducted at a single institution that included data of more than 12 years. Patients were excluded if they had a previous chronic hepatitis B or HIV diagnosis. Patients without HCV infection were matched to patients with HCV infection based on age, sex (male or female), and race/ethnicity. ResultsThis study identified 66 patients with untreated HCV infection and 33 patients with treated HCV infection. Furthermore, 324 patients without HCV infection were matched to the cohort HCV infection. The overall postoperative complication rate was 10.9%. There was no statistically significant difference in postoperative complication rates between the groups (P = .71). There was no significant difference in the level of intervention required to treat these complications according to the Clavien-Dindo classification (P = .97), postoperative intensive care unit admission (P = .43), or reoperation rate (P = .45). ConclusionDespite having a longer mean length of stay and increased risk of intraoperative blood product transfusion, both patients with untreated HCV infection and those with treated HCV infection had similar rates of postoperative complications and complication severity compared with controls. Our findings suggest that patients with HCV infection tolerate cholecystectomy at a comparable level to patients without HCV infection. The lack of difference in postoperative complication rates between patients with untreated and treated HCV infection indicates that lack of antiviral treatment should not delay cholecystectomy.

Safety and Efficacy of Directly Acting Antivirals (Sofosbuvir & Daclatasvir) in Treatment of Chronic HCV

Abstract Background The introduction of direct-acting antiviral agents, has revolutionized the treatment for chronic HCV with higher cure rates, shorter duration of treatment and more tolerability have been achieved. Aim of the Work The aim of our study is to estimate the efficacy and safety of DAAs in treatment of chronic HCV in patients co-infected with HIV. Patients and Methods This study of previously untreated HCV infection in patients with HCV and HIV co-infection conducted at Abbasia Fever Hospital, from July 2019 to February 2020. Patients included are chronic HCV infection and were receiving antiretroviral therapy for the HIV with a CD4 T-lymphocyte count of 200 cells/mL or greater. Serial measurements of safety parameters, virologic and host immune correlates, and adherence were performed during treatment by combination of daclatasvir 90mg and sofosbuvir 400mg+/- ribavirin 800mg daily for 12 weeks. Results In this study, the rate of a sustained virologic response (SVR) at post-treatment week 12 (SVR 12) were high (29/30, 96.67%). The most common adverse events were fatigue (73.33%), headache (46.67%), and there was a high safety profile on using DAAs. No patient discontinued treatment because of adverse events. No serious adverse events or mortality were reported. In this study, AST & ALT were significantly decreased at end of treatment and 12 weeks after treatment, CD4 count was significantly increased. Otherwise there are no significant changes in both hematological and biochemical laboratory results. Conclusion Combination of daclatasvir and sofosbuvir have showed 96.67% sustained virologic response at 12 weeks after treatment (SVR 12) among HIV/HCV co-infected patients, with a very good safety profile. Moreover, the treated patients showed a significant increase in CD4 count. Accordingly, HIV/HCV co-infected patients should be treated with sofosbuvir and daclatesvir containing regimens.

Concurrence of cat-scratch disease and paradoxical tuberculosis-IRIS lymphadenopathy: a case report

BackgroundMycobacterial infections can cause significant morbidity when cellular immunity is compromised. Patients with AIDS can be affected directly from infection or through mycobacterial IRIS, especially if they are previously untreated for HIV. Herein a case of tuberculous lymphadenitis is reported, which primarily responded to antimicrobials but complicated by IRIS and cat-scratch disease at a later course.Case presentationA 23-year-old man, intravenous drug user with untreated HIV and HCV infection presented with fever and painful cervical lymphadenopathy. Mycobacterium tuberculosis was isolated from PCR and culture of ultrasound-guided lymph node aspirate and a four-drug anti-TB regimen was subsequently administered, leading to complete resolution of clinical and laboratory abnormalities. Given the patient’s CD4 count (67 cells per mm3), antiretroviral treatment started seven weeks after TB treatment initiation. Within the first month of ART fever recurred along with cervical lymph node inflammation. Paradoxical IRIS was considered as the most probable diagnosis but workup expanded, revealing acute Bartonella infection. A posteriori, the patient remembered being scratched by a stray cat two weeks before his new symptoms started. Doxycycline and corticosteroid monotherapy failed to resolve symptoms, whereas a combination of doxycycline for 3 months and methylprednisolone with long-term tapering led to negative follow-up Bartonella antibodies and complete clinical and biochemical response, without recurrence.ConclusionsCo-infection with TB and Bartonella presenting with lymphadenitis is unusual. Cat-scratch disease can be a rare clinical presentation of Bartonella infection in patients with AIDS, but coexistence of bartonellosis and paradoxical IRIS has never been reported before. However, physicians treating people living with HIV should be aware of this potential concurrence. Early testing for Bartonella infection could be offered in patients with TB and HIV co-infection in case of acute deterioration or partial response to treatment, especially if they have a history of cat exposure, since clinical picture can be indistinguishable.

Use of double filtration plasmapheresis for the treatment of acquired thrombocytopenic thrombotic purpura.

Double filtration plasmapheresis (DFPP) could be an alternative method to simple plasma exchange plasmapheresis in the treatment of acquired thrombotic thrombocytopenic purpura (aTTP). In a retrospective single center case series, we studied clinical presentation, management care, and prognosis of aTTP patients from our academic center treated with DFPP and IV infusion of fresh frozen plasma (FFP) between 2009 and 2018. Nine patients were included for 11 episodes. Median age was 38 years old (IQR 26-53) with 78% women. Six episodes (55%) required admission to the ICU, four of which required mechanical ventilation. Median FFP volume transfused was 35.2 mL/kg/d of session. Response was complete for nine episodes (82%). Four patients presented an early relapse, two a late relapse. Four patients died: one had an active untreated HCV infection, and two were over 80-year-old polymorbid patients. DFPP seems to be an efficient method of therapeutic plasmapheresis in TTP when combined with FFP transfusion and immunosuppressive treatments.

Competing priorities and second chances - A qualitative exploration of prisoners' journeys through the Hepatitis C continuum of care.

High levels of undiagnosed and untreated HCV infection exist in prison populations globally. Prisons are a key location to identify, treat and prevent HCV infection among people who inject drugs (PWID). Understanding prisoners’ lived experiences of the HCV continuum of care informs how HCV care can be effectively delivered to this marginalised and high-risk population. This study aimed to explore Irish prisoners’ experience of prison and community-based HCV care. We conducted one-to-one interviews with 25 male prisoners with chronic HCV infection. Data collection and analysis was informed by grounded theory. The mean age of participants and first incarceration was 39.5 and 18.3 years respectively. The mean number of incarcerations was eight. The following themes were identified: medical and social factors influencing engagement (fear of treatment and lack of knowledge, HCV relevance and competing priorities), adverse impact of HCV on health and wellness, positive experience of prison life and health care and the transformative clinical and non-clinical changes associated with HCV treatment and cure. Findings suggest that prison release was associated with multiple stressors including homelessness and drug dependence which quickly eroded the health benefits gained during incarceration. The study generated a substantive theory of the need to increase the importance of HCV care among the routine competing priorities associated with the lives of PWID. HCV infected prisoners often lead complex lives and understanding their journeys through the HCV continuum can inform the development of meaningful HCV care pathways. Many challenges exist to optimising HCV treatment uptake in this group and incarceration is an opportunity to successfully engage HCV infected prisoners who underutilise and are underserved by community-based medical services. Support and linkage to care on release is essential to optimising HCV management.

Hepatitis C virus infection in Irish drug users and prisoners \u2013 a scoping review

BackgroundHepatitis C infection is a major public health concern globally. In Ireland, like other European countries, people who use drugs (PWUD) and prisoners carry a larger HCV disease burden than the general population. Recent advances in HCV management have made HCV elimination across Europe a realistic goal. Engaging these two marginalised and underserved populations remains a challenge. The aim of this review was to map key findings and identify gaps in the literature (published and unpublished) on HCV infection in Irish PWUD and prisoners.MethodsA scoping review guided by the methodological framework set out by Levac and colleagues (based on previous work by Arksey & O’Malley).ResultsA total of 58 studies were identified and divided into the following categories; Epidemiology, Guidelines and Policy, Treatment Outcomes, HCV-related Health Issues and qualitative research reporting on Patients’ and Health Providers’ Experiences. This review identified significantly higher rates of HCV infection among Irish prisoners and PWUD than the general population. There are high levels of undiagnosed and untreated HCV infection in both groups. There is poor engagement by Irish PWUD with HCV services and barriers have been identified. Prison hepatology nurse services have a positive impact on treatment uptake and outcomes. Identified gaps in the literature include; lack of accurate epidemiological data on incident infection, untreated chronic HCV infection particularly in PWUD living outside Dublin and those not engaged with OST.ConclusionIreland like other European countries has high levels of undiagnosed and untreated HCV infection. Collecting, synthesising and identifying gaps in the available literature is timely and will inform national HCV screening, treatment and prevention strategies.

Evaluating peer-supported screening as a hepatitis C case-finding model in prisoners

BackgroundHepatitis C Virus (HCV) infection is endemic in prison populations, and HCV management in prisons is suboptimal. Incarceration is a public health opportunity to target this cohort. Community peer support increases HCV screening and treatment uptake. Prison peer workers have the potential to support the engagement of prisoners with health services and reduce stigma. This study’s primary aim is to evaluate peer-supported screening as a model of active HCV case finding with a secondary aim to describe the HCV cascade among those infected including linkage to care and treatment outcomes.MethodsAn observational study was conducted in a medium-security Irish male prison housing 538 inmates, using a risk-based questionnaire, medical records, peer-supported screening, laboratory-based HCV serology tests and mobile elastography.ResultsA prison peer-supported screening initiative engaged large numbers of prisoners in HCV screening (n = 419). The mean age of participants was 32.8 years, 92% were Irish and 33% had a history of injecting drug use. Multiple risk factors for HCV acquisition were identified including needle sharing (16%). On serological testing, 87 (21%) were HCV Ab +ve and 50 (12%) were HCV RNA +ve of whom 80% were fibroscaned (25% showing evidence of liver disease). Eighty-six percent of those with active infection were linked with HCV care, with 33% undergoing or completing treatment. There was a high concordance with HCV disclosure at committal and serological testing (96% for HCV Ab +ve and 89% for HCV Ab −ve).ConclusionPeer-supported screening is an effective active HCV case-finding model to find and link prisoners with untreated active HCV infection to HCV care.

Hepatitis C Virus Infection, but Not Hepatic Iron Overload Is the Dominant Risk Factor for the Manifestation of Hepatocellular Carcinoma Among Greek Thalassemic Patients

▪Background: Effective iron chelation and other supportive treatment have a substantial impact on survival prolongation of thalassemic patients, who may reach late adulthood, and therefore, may manifest various neoplastic disorders. However, no systemic analysis of the prevalence of neoplastic disorders in this patient population has been performed.Aims: We systematically analyzed all cases of malignant neoplastic disorders, occurred in a large cohort of Greek thalassemic patients and investigated for possible underlying predisposing factors.Patients and methods: Data of 3652 patients with hemoglobinopathies (Group I: beta-thalassemia homozygous N=1981, Group II: thalassemia Intermedia N=746, Group III: sickle-cell disease +/- beta-Thalassemia n=751, Group IV: hemoglobinopathy-H N=174) were retrieved, followed up at 24 specific Hospital Units, between 1985 and 2018. Totally, 165 cases of a malignant disorder were identified (overall prevalence 4.52%). The significance of the following predisposing factors was investigated: familial history of neoplasia, occupational exposure to known mutagens, previous autoimmunity, previous splenectomy, tobacco smoking, alcohol use, HBV, HCV or HIV infection, iron overload, hydroxyurea treatment, previous irradiation for extramedullary hematopoietic tumors and systemic use of androgens/estrogens.Results: Patients were 84 males and 81 females with a median age at diagnosis of the neoplastic disorder of 45 years (range 9-73 years). Higher prevalence of neoplasia was noted among patients of Groups I and II (4.99% vs 3.03% among patients of Groups III and IV, p<0.05). Table 1 shows histological diagnosis of the 165 neoplastic disorders, of which 139 (84.2%) were solid tumors and 26 (15.8%) hematological malignancies. The dominant malignancy was hepatocellular carcinoma, diagnosed in 63 patients, followed by thyroid cancer (17 cases), non-Hodgkin's lymphoma (13 cases), and renal cell carcinoma (10 cases). There was a strong positive association between hepatitis C virus infection and hepatocellular carcinoma, and a negative one between HCV infection and thyroid and renal cancer. Active HCV infection was found in 81 patients (49.1%) compared to an estimated prevalence of about 25% among the whole thalassemic patient population. Hepatocellular carcinoma was more frequently diagnosed in men (M/F ratio 1.86) of the fourth and fifth decade (median age 45 years) with thalassemia homozygous or intermedia (89% of the cases), with long-standing, untreated HCV infection (76%), irrespective of the burden of hepatic iron load, estimated with MRI T2*. Indeed, no difference in the occurrence of hepatocellular carcinoma, as well as of any other type of cancer was found, in relation to Liver Iron Concentration (LIC). Moreover, no preponderance of any HCV genotype was identified, but interestingly, all 1b HCV genotype-associated neoplasms were hepatocellular carcinoma (7 cases). Finally, no association between any of the remaining potential risk factors with the manifestation of any specific neoplastic disorder was observed.Discussion: In our large thalassemic patient cohort, representative of the whole country of Greece, we have identified increased prevalence of four types of cancer. Besides hepatocellular carcinoma, we have unexpectedly encountered high prevalence of thyroid and renal cancer, as well as of all types of lymphomas. These primary findings deserve further investigation, since, excluding hepatocellular carcinoma, no prominent or speculative causality can be currently attributed for the remaining malignancies. [Display omitted] DisclosuresKattamis:Vifor Pharma: Consultancy; ApoPharma: Honoraria; CELGENE: Consultancy, Honoraria; Novartis: Consultancy, Honoraria.

IN1 - Impact of Sofosbuvir-Based Regimens for Chronic Hepatitis C Infection: A Work Productivity Model from Mainland China

Chronic Hepatitis C (CHC) imposes a considerable disease burden in China. There are approximately 10 million Chinese CHC patients, the majority of which are genotype 1 (GT1). Untreated infections are associated with a poor clinical prognosis and impairment in work productivity (WP), which has not been comprehensively evaluated in mainland China. This study models the impact of CHC infection on WP in China and estimates potential WP gains associated with ledipasvir/sofosbuvir (LDV/SOF) and sofosbuvir/velpatasvir (SOF/VEL) treatments, which are currently under review by China FDA. An economic model was developed to assess the impact of treatment with LDV/SOF on WP over a one-year period, with patients entering the model post-treatment, having achieved sustained virological response at 12 weeks (SVR12), or not. Absenteeism (absence from work) and presenteeism (reduced productivity at work) rates were extracted from the Phase III ION and ASTRAL trials as measured by the Work Productivity and Activity Index-Specific Health Problem questionnaire (WPAI-SHP); rates were assumed to be unchanged from baseline for patients not achieving SVR12. These rates were converted into hours of lost productivity, multiplied by the average working wage, total employment rate, and adult GT1 population in mainland China. We assumed universal treatment with either LDV/SOF or SOF/VEL in the model and contrasted the results relative to no treatment. Total annual work productivity loss due to not treating GT1 CHC patients was estimated to be around ¥18.11 billion. Treatment with sofobusvir-based regimens resulted in estimated productivity gains of ¥6.85 billion, primarily due to reduced presenteeism. Productivity losses due to untreated HCV infection represent a substantial indirect economic burden in China. Treatment with sofobusvir-based regimens is likely to result in substantial economic savings for society versus no treatment, which should be considered when assessing the value of CHC treatment.

Determinants of survival following hepatocellular carcinoma in Egyptian patients with untreated chronic HCV infection in the pre-DAA era

Background and Study AimsIn this study we assessed rates and determinants of survival in people with untreated chronic HCV infection and hepatocellular carcinoma (HCC) in an Egyptian liver clinic setting. Patients and MethodsThis is a prospective cohort study of patients diagnosed with HCV-related HCC and undergoing HCC management at a national liver centre in Egypt in 2013–2014 and with a follow-up through 2016. ResultsA total of 345 patients diagnosed with HCV-related liver cirrhosis complicated by HCC were included. Median age at diagnosis was 57 years (IQR = 52, 62), the majority were male (78%) and Child-Turcotte-Pugh (CTP) class A (64%). At diagnosis Barcelona Clinic Liver Cancer staging (BCLC) was 0 (8%), A (48%), B (20%), C (17%), and D (7%). Most common HCC management modalities were transarterial chemoembolization (TACE) (42%), and radiofrequency ablation (RFA) (21%). Median survival following HCC was 22.8 months. Factors associated with poorer survival in adjusted analyses were INR (HR = 1.81, p = 0.01), alpha-foeto protein (AFP) ≥200 (HR = 1.41, p = 0.02), higher CTP score (HR = 2.48, p < 0.01), and advanced BCLC stage (HR = 1.85, p < 0.01). One year survival in patients with CTP A, B, and C was 85%, 71% and 32%, respectively. One year survival following RFA, TACE, combination RFA/TACE, and sorafenib was 93%, 79%, 80% and 60%, respectively. ConclusionSurvival following HCV-HCC in Egyptian patients undergoing HCC management in a specialised clinic setting is poor, although similar to high income country settings. CTP score is a key determinant of survival, even following adjustment for BCLC stage and HCC management.

Pelvic Congestion Syndrome: A Rare Presentation of Chronic Hepatitis C Infection

Introduction: Hepatitis C is a viral infection of the liver caused by hepatitis C virus, which is primarily a blood-borne pathogen. The virus can cause both acute and chronic infection. Unfortunately, most people with acute hepatitis C do not have any symptom and upwards of 85% of them will become chronic carriers. Untreated HCV infection can have considerable morbidity and mortality if undiagnosed. Clinicians should have a low threshold for HCV testing since there is an effective treatment. We describe an unusual presentation of chronic HCV infection. Case Description: A 46 year-old woman without significant medical history presented with progressively worsening left lower quadrant abdominopelvic and left lower extremity pain with associated paresthesia for a few months. She further endorsed intermittent chills and night sweats. Physical exam was notable for exquisite tenderness in the left lower quadrant with diminished sensation in the left lower extremity. Serologic workup was significant for platelet count of 82 x109(ref range 150-450x109) and a mildly elevated alkaline phosphatase at 125 U/L (ref range 39-100 U/L). Abdominal CT showed mild splenomegaly with prominence of the inferior mesenteric vein and varicosities in the left lower pelvis. Ultrasound of the liver showed a non-occlusive thrombus in the main portal vein with coarse echotexture of the hepatic parenchyma suggestive of chronic liver disease. HCV ribonucleic acid (RNA) quantification returned at 21.2 million IU/mL. She received anticoagulation treatment for portal vein thrombus and was scheduled for an outpatient appointment for HCV treatment. Discussion: In this case, the patient presented to the emergency department as undifferentiated left lower abdominal pain without traditional risk factors for HCV. Suspicion for underlying liver disease stemmed from the dilated inferior mesenteric vein on CT abdomen and the associated thrombocytopenia on serologic testing. Although patients with chronic HCV infection can have elevated liver enzymes and reduced liver function tests, often these laboratory values can be normal. Any signs of hepatic congestion on imaging with thrombocytopenia should raise suspicion for liver disease. With the ability to cure HCV at high rates, clinicians should have low threshold for HCV testing.Figure: Coronal view of the CT pelvis with dilated inferior mesenteric vein sitting adjacent to the sigmoid colon.Figure: Coronal view of the CT abdomen showing more proximal dilatation of the inferior mesenteric vein.

Impact of Hepatitis C Screening in Outpatient Population

Introduction: For patients born between 1945 and 1965 with no identifiable risk factors, one-time Hepatitis C (HCV) screening test was recommended by CDC and USPSTF in 2012 and 2013 respectively. In January 2014, the state of New York mandated the offer of HCV screening for this cohort. We performed a retrospective study investigating the benefits of cohort-based HCV screening in terms of identification of asymptomatic HCV infection and its treatment in a city hospital ambulatory care setting. Methods: Patients born between 1945 and 1965, screened for HCV in primary care clinic were divided into 2 groups. The first group consisted of patients screened between 7/1/2012-12/31/2013 and the second between 1/1/2014-7/1/2015 after the NY law was passed. Patients with high risk factors including deranged LFT were excluded. Results: Since 1/1/2014, 3206 patients were screened and 1.06% (n=34) tested positive for HCV antibody test. Among these, 7 had detectable viral load on HCV PCR testing, and 6 were treated and cured with sustained virologic response. 16 had undetectable viral load, and 11 were lost to follow up after initial antibody testing. At our setting HCV antibody test costs $74, and $237,244 was spent in diagnosing 6 patients who underwent curative treatment. Thus, at least $39,541 was spent per diagnosis, which along with the average treatment cost, is much lower than the average cost of a untreated HCV infection with chronic liver disease and related complications. Among the 34 patients with positive HCV antibody, 61.76% were women, 47% were Asians, with Black (41%) as the next majority. 26% patients were from US and Guyana each. Only 244 patients were screened during the 18 months prior to the law, resulting in 1 positive HCV antibody test with undetectable viral load. Conclusion: According to the CDC, approximately 3.5 million people in US have chronic HCV infection and approximately 3/4th of this population is accounted by baby boomers born between 1945 - 1965. Many of these people are unaware about being infected with HCV. HCV reached the highest recorded number of 19,649 fatalities in 2014 in US, which surpasses the total combined fatalities linked to 60 other infectious diseases. Barriers to HCV screening and treatment include lack of awareness, insurance, homelessness, incarceration, provider failure to test and refer, and fear of side effects. Our study demonstrates the cost effectiveness of cohort based HCV screening in a city hospital setting, in accordance to the US national data.

Current and Emerging Therapeutic Regimens for Patients with Chronic Hepatitis C Infection

With 5.2 million people living with Hepatitis C, it is the most common blood-borne infection in the United States. Untreated chronic HCV infection may result in adverse consequences such as cirrhosis, portal hypertension, hepatic failure and hepatocellular carcinoma. Previously approved treatments include Pegylated-interferon alpha-2a/2b plus ribavirin, Boceprevir and Telaprevir. Recently approved medications include Sofosbuvir (SOF), Simeprevir (SMV), Ledispavir-Sofosbuvir (Harvoni®) and Ombitasvir-paritaprevir-ritonavir with dasabuvir tablets (Viekira Pak). Here we review the literature describing the current and emerging therapies for chronic hepatitis C.

P754 INCREASING RATE OF UNTREATED HCV INFECTION IN HIV–HCV COINFECTED PATIENTS

P754 INCREASING RATE OF UNTREATED HCV INFECTION IN HIV–HCV COINFECTED PATIENTS

Premature senescence of circulating T cells in HCV-chronically infected patients (105.41)

Abstract Persistent HCV infection is characterized by chronic immune system activation and inflammatory cytokine production. Thus, HCV infection may result in features characteristic of premature aging of immune cells (immune senescence), driven by chronic antigen exposure and immune system activation. To determine if untreated HCV infection is associated with premature aging of naïve and memory CD4+ and CD8+ T cells, peripheral blood mononuclear cells (PBMCs) from 24 individuals chronically infected with HCV and 13 healthy blood donors were stained with fluorochrome-conjugated antibodies, and then subjected to multiple-color flow cytometric analysis. We found that chronic HCV infection was associated with a decreased CD28 median florescence intensity on both CD4+ (CD3+/CD4+/CD45RA+CD27+CD28+) and CD8+ (CD3+/CD8+/CD45RA+CD27+CD28+) T cells. An increased proportion of intermediate- and late-differentiated CD4+ and CD8+ T cells was also observed in PBMCs from HCV chronically-infected individuals. In addition, higher levels of activated monocytes (CD14+/CD16+ or CD14+/CD69+) were detected in HCV chronically-infected individuals than that in healthy blood donors. Conclusions: The overall change during chronic HCV infection is associated with a shift in the T-cell population toward an aged confirmation. Our data suggest that HCV-infected individuals experience similar immunologic changes as the individuals infected with HIV-1.

Natural course of treated and untreated chronic HCV infection: results of the nationwide Hepnet.Greece cohort study

Interferon (IFN-alpha)-based regimens have been used with varying success in the treatment of chronic hepatitis C (CHC) for over two decades. The effect of such treatments on the natural course of CHC has been evaluated in small clinical trials with conflicting results. To investigate the natural course of IFNalpha-based-treated and untreated patients with CHC by analysing data from the HEPNET.GREECE study. We retrospectively analysed 1738 patients from 25 Greek Centres (median age 40.1; males 57.6%; cirrhosis 9.2%), 734 untreated and 993 treated with IFNalpha-based regimens [44.7% sustained viral response (SVR)], followed-up for median 25.2 and 46.8 months, respectively. During follow-up, 48 patients developed liver decompensation and 24 HCC. Older age was significantly related to disease progression (HR = 2.6 per 10 years of increasing age). Stratified by baseline cirrhosis, Cox analysis showed that patients with SVR, but not without SVR, had significantly lower hazard for events compared with nontreated patients (HR = 0.16; P < 0.001), whereas the detrimental effect of older age remained highly significant. Separate group analysis demonstrated that in cirrhosis, the beneficial effect of treatment was evident even without SVR. Treatment effect interacted significantly with age, indicating that older patients, mainly noncirrhotic, gained the most benefit. IFNalpha-based treatment does alter the natural course of CHC. A protective effect is mostly present in patients with SVR, but older patients, at higher risk of events, gain the greatest benefit. In established cirrhosis, treatment carries a protective effect even among those without SVR.

Health-related quality of life in methadone maintenance patients with untreated hepatitis C virus infection

Objective To assess health-related quality of life (HRQOL) in methadone maintenance treatment (MMT) patients with untreated chronic HCV infection and to determine the clinical factors that predict HRQOL. Method HRQOL was measured in 100 MMT patients entering an HCV treatment trial. Subjects were mostly male (61%) and white (81%) with a mean age of 43 (±10). 57% had a current non-substance use psychiatric disorder. 55% had a current (past 12 months) substance use disorder, including 44% with current opioid or cocaine abuse/dependence. HRQOL in our sample was compared to published reports for the general population as well as for non-MMT HCV patients. To assess predictors of SF-36 HRQOL, hierarchical multiple regression techniques were used to assess model improvement with four blocks of baseline predictors: Demographics, Medical Severity, Addiction Severity, and Depression Severity. Results HRQOL scores were significantly lower than scores for the general population and were also lower than scores reported for untreated HCV patients not in MMT. Regression analysis demonstrated a consistent pattern whereby Depression Severity increased predictive accuracy for HRQOL measures over simpler models. Beck Depression Inventory scores significantly predicted quality of life across both the mental and physical composite scores and all eight sub-scales of the SF-36. Conclusions Untreated HCV patients in MMT had lower HRQOL than HCV patients not in MMT. Depression Severity was associated with significantly lower quality of life measures, suggesting that psychiatric evaluation and intervention prior to the start of HCV treatment may improve overall quality of life and could influence HCV treatment outcomes in MMT patients.

Outcomes and Treatment of Acute Hepatitis C Virus Infection in a United States Population

Acute hepatitis C infection progresses to chronic infection in up to 80% of infected persons. Reports from Europe indicate that early treatment of acute hepatitis C infection produces sustained virologic response rates as high as 80%-98%. However, the outcome of acute hepatitis C infection in United States cohorts is not well-characterized. We describe the clinical course of 28 episodes of acute hepatitis C infection in 24 persons at our institution. Of the 28 infections, 7 episodes resolved spontaneously. Of the remaining 21 episodes, 16 were treated, and 5 did not receive treatment. Of the 16 treated episodes, 4 received interferon and ribavirin, 11 received pegylated interferon and ribavirin, and 1 was treated initially with interferon monotherapy followed by pegylated interferon monotherapy. Among those episodes treated with interferon, 3 of 4 experienced sustained virologic response. Among those episodes treated with pegylated interferon, all 12 achieved SVR. In total, 15 of 16 treated patients (94%) experienced SVR. In all, 18 of the 24 patients (75%) experienced spontaneous or treatment-induced sustained virologic clearance. Our experience with treated and untreated acute HCV infection is comparable to that observed in Europe. Patients treated with antiviral therapy had an excellent response. Randomized trials to investigate immediate versus delayed treatment of acute hepatitis C infection are warranted. In view of these strongly positive outcomes, increased vigilance for acute hepatitis C becomes essential.

594 Natural course of treated and untreated chronic HCV infection: Results of the nationwide HEPNET. Greece cohort study

594 Natural course of treated and untreated chronic HCV infection: Results of the nationwide HEPNET. Greece cohort study