天津市慢性丙型肝炎患者感染途径分析

目的 分析天津市133例慢性丙型肝炎(丙肝)患者的感染途径,为丙肝的预防提供依据.方法 2009 ～2012年天津市133例确诊为慢性丙型肝炎患者,通过患者的主诉确定丙肝的感染途径.采用FQ-PCR技术检测血清HCV RNA定量,对于HCV RNA定量＞1 000 IU/mL者参照文献采用基因芯片行HCV RNA基因型检测.应用全自动生化分析仪检测肝功能.结果 133例慢性丙肝患者感染途径有输血及血制品76例,手术10例,牙齿治疗13例,穿耳洞、纹身13例,母婴传播1例,吸毒5例,不明原因15例.38例患者进行病毒基因型检测,1b型患者32例,2a型患者5例,3型患者1例.其中1b型患者输血或血制品感染18例,2a型患者输血或血制品感染4例.2000年之前经输血或血制品感染丙肝的感染率(84.1％)显著高于2000年及之后感染者(23.1％),P＜0.01(x2=30.70),而2000年及之后感染者多数是经纹身、穿耳洞、吸毒等不良生活方式感染.输血及血制品感染者与非输血感染者的年龄分别为(53.84±10.94)、(42.70±12.71)岁,白蛋白(ALB)水平分别为(37.08±6.68)、(41.10 ±5.18) g/L,两者比较,P均＜0.01;病毒载量、丙氨酸氨基转氨酶(ALT)、总胆红素(TBIL)、甲胎蛋白(AFP)三指标在两者之间无统计学差异.不同年龄段慢性丙肝患者血清学指标比较,P均＞0.05.结论 HCV感染者的感染途径包括经输血及血制品途径及经纹身、牙齿治疗、吸毒等非输血途径,病毒基因型多数为1b和2a型,对目前丙肝的主要感染途径进行有效阻断是防止丙肝感染的重要途径.     

广西地区HIV感染人群HCV抗体阳性的流行病学特征分析

目的了解广西地区HIV感染人群HCV抗体阳性率的流行病学现状与特点。方法以2010年-2016年在广西7家医院就诊的HIV抗体阳性的广西籍患者为研究对象,收集患者基本人口学资料及HCV抗体检测结果、HIV/HCV共感染途径等资料。计数资料组间比较采用χ^2检验方法或Fisher’s精确检验,采用Bonferroni法进行多个样本率的多重比较。因变量为二分类变量,采用二分类logistic回归模型进行单因素及多因素分析。结果共选取HIV抗体确证阳性患者6154例,其中HCV抗体阳性409例,阳性率为6.65%[95%可信区间(CI):6.03%~7.27%],其中男性HCV抗体阳性率(7.97%)高于女性(3.57%),差异具有统计学意义(χ^2=29.294,P<0.01);18~44岁年龄段HCV抗体阳性率最高(10.47%),45~59岁年龄段次之(5.44%),均高于其他年龄段,两两分析比较差异均有统计学意义(P值均<0.01);静脉吸毒人群HCV抗体阳性率最高(75.12%),静脉吸毒+性接触次之(70.00%),均高于其他感染途径,差异均有统计学意义(P值均<0.01);HIV抗体和HCV抗体均为阳性的患者中,静脉吸毒所占比例高于其他感染途径,其中男性以静脉吸毒居多(72.30%),女性则以性传播为主(57.58%),2种人群在感染途径分布差异具有统计学意义(P<0.01);18~44岁年龄段患者静脉吸毒比例最高(71.58%),其次为45~59岁年龄段(63.27%),其比例远高于其他年龄段,两两分析比较提示其差异均有统计学意义(P值均<0.01),60~80岁年龄段性接触传播比例高于其他年龄段,两两分析比较提示差异均有统计学意义(P值均<0.01);logistic回归分析表明,HIV感染者中,静脉吸毒者合并HCV感染的危险性是其他途径感染者的60.385倍(95%CI:7.909~461.017),静脉吸毒+性接触者合并HCV感染的危险性是其他途径感染者的46.667倍(95%CI:4.144~525.501)(P值均<0.01)。结论广西地区HIV感染人群HCV抗体阳性率维持在较高的流行病学水平,男性HCV抗体阳性率高于女性,青年人群HCV抗体阳性率高于其他年龄段;男性、中青年人群主要经静脉吸毒途径感染HIV和HCV,而女性、老年人群则主要经性接触途径感染HIV和HCV;静脉吸毒是HIV感染者合并HCV感染的独立危险因素。     

慢性丙型肝炎患者年龄和感染方式对抗病毒治疗应答的影响

目的探讨患者年龄和感染方式与慢性丙型肝炎患者抗病毒疗效的关系。方法应用聚乙二醇干扰素联合利巴韦林治疗113例慢性丙型肝炎患者。采用实时荧光PCR法检测血清HCV RNA定量;采用CE1区测序遗传树比对分析法检测HCV基因型。结果在20例有静脉吸毒史的患者,获得持续病毒学应答率（95.0%）明显高于54例医源性感染患者（75.9%,P〈0.05）和39例既无静脉吸毒史又无明显医源性感染患者（69.2%,P〈0.05）;在年龄≤40岁的患者,获得持续病毒学应答率（82.9%）明显高于年龄〉40岁的患者（65.1%,P〈0.05）;有静脉吸毒史的患者主要感染HCV3型（45%）和6型（50%）,而医源性感染组和其他组感染HCV1b型的比例分别为51.9%和43.6%;在无静脉吸毒史的患者中,年龄≤40岁组患者感染非HCV1型（2型、3型和6型）的比例达64.7%,而年龄〉40岁组患者感染HCV1型的比例达64.3%。结论慢性丙型肝炎患者年龄及感染方式可作为判断感染病毒基因型的参考指标,对抗病毒治疗的疗程确定和疗效预测有一定的意义。     

丙型病毒性肝炎发病机制中自身免疫反应的作用

目的探讨丙型肝炎病毒(HCV)感染的发病机制.方法应用酶联免疫吸附法、间接免疫荧光法、放射免疫法测定了慢性HCV感染者66例,慢性HBV感染者37例和正常对照39例的血清抗GOR抗体(抗GOR)、抗核抗体(ANA)、抗甲状腺球蛋白抗体及抗甲状腺微粒体抗体(TGA/TMA).结果 HCV感染者抗GOR,ANA,TGA/TMA的阳性率较正常对照组均明显增高(53.0% vs 5.1%,χ2=24.649,P＜0.01;42.4% vs 2.6%,χ2=19.490,P＜0.01;13.6% vs 0%,χ2=5.820,P＜0.01);与慢性HBV感染者比较,慢性HCV感染者抗GOR,ANA阳性率显著增高(χ2=20.550,P＜0.01;χ2=4.513,P＜0.05). 慢性HCV感染中,血清谷丙转氨酶(ALT)增高者抗GOR阳性率及ANA阳性率显著高于ALT正常者(65.0% vs 34.6%,χ2=6.110;52.5% vs 26.9%,χ2=5.910,P＜0.05),HCV-RNA阳性者抗GOR阳性率显著高于阴性者(χ2=4.810,P＜0.05).结论上述结果说明HCV感染者存在自身免疫反应,这种自身免疫反应与病毒复制有关,可引起肝功能损害,自身免疫可能是慢性HCV感染的重要发病机制之一.     

皖北地区丙型肝炎流行病学及临床疗效

目的 探讨本地区丙型肝炎的流行特征和基因型分布,探索提高丙型肝炎疗效的方法.方法 调查了解丙型肝炎传播途径,对丙型肝炎病毒(HCV)进行测序分型,根据患者具体情况分别采用普通干扰素(IFN)联合利巴韦林(RBV)和聚乙二醇干扰素(PEG-IFN)联合RBV治疗,根据病毒基因型及应答情况等决定疗程,总疗程24～72周,对治疗过程中出现的不良反应进行适当处理.结果 本地区HCV基因型有1a、1b、2a、3a、3b、6k型.1b型最多,占56.3％,其次为2a型占21.3％,1b和2a混合型占5.3％,3b型占9.6％,3a型占4.3％,1a型占2.1％,6k型占1％.传播途径中通过静脉吸毒感染35.8％(102/285),输血及血制品感染31.2％(89/285).基因1b型和非1b型两组早期病毒学应答(EVR)、治疗结束时病毒学应答(ETVR)、持续病毒学应答(SVR)分别为12(46.1％)、16(61.5％)、15(57.7％)和17(81.0％)、19(90.4％)、19(90.4％),差异均有统计学意义(P＜0.05).采取个体化治疗,能大幅提高丙型肝炎的应答率,减少不良反应,但因各个病例差异较大,无法进行统计学处理.结论 皖北地区丙型肝炎的主要传播方式是静脉吸毒及输血;基因型以1b型为主,占56.3％,其次为2a型,并可见混合型及6k型.治疗上基因1b型疗效远不如非1b型.个体化治疗能明显提高SVR.     

郴州地区门诊美沙酮吸毒人群HCV感染状况及基因型分布特征

目的了解郴州地区美沙酮门诊静脉吸毒人群的HCV感染状况。方法采集2014年8-9月在郴州市美沙酮门诊中具有静脉吸毒史的181例患者血清,通过逆转录聚合酶链反应(RT-PCR)以及ELISA法分别检测HCV核酸和抗体,并通过测序确定HCV基因型。组间比较采用Mann-Whitney U检验。结果 181例患者中HCV核酸或抗体阳性患者160例,阳性率为88.4%(160/181),其中抗体和核酸阳性(Ig G+RNA+)134例(74%),抗体阳性核酸阴性(Ig G+RNA-)19例(10.5%),抗体阴性核酸阳性(Ig G-RNA+)7例(3.9%);HCV和HBV共感染19例(10.5%)。HCV感染患者中Ig G+RNA+组的ALT和AST水平明显高于Ig G-RNA+组和Ig G+RNA-组(P值均0.01);HCV、HBV单感染患者ALT和AST水平与HBV和HCV共感染患者比较,差异无统计学意义(P值均0.05)。在133例HCV核酸阳性样本中,6a型81例(60.9%),3型36例(27.1%)。结论静脉吸毒人群具有高HCV感染率,HCV感染以6a型和3型为主,且HCV和HBV共感染并不加重肝损伤。     

输血及非输血型慢性HCV感染的临床特征分析

目的研究输血及非输血型慢性丙型肝炎病毒(HCV)感染的临床特点。方法根据平行对照试验原则,回顾性分析本院84例HCV感染患者临床资料,其中经输血途径感染者42例,为观察组,另42例为非输血途径HCV感染,为对照组。比较两组基本人口学资料和病理特点相关指标,记录输血与非输血型HCV感染患者临床特点。结果观察组患者年龄显著高于对照组,差异有统计学意义(P0.05)。两组患者性别、体质指数、职业及文化程度无显著性差异(P0.05)。观察组患者病程长于对照组,差异有统计学意义(P0.05),两组HCV基因型分布差异有统计学意义(P0.05)。两组HCV病毒载量无显著性差异(P0.05)。结论不同途径HCV感染患者基因型分布具有显著差异,经输血途径感染者病程较长,年龄较大。     

单采血浆和输血途径感染HIV的患者中HBV和HCV感染状况

目的 了解单采血浆和输血途径感染艾滋病病毒(HIV)的人群中,乙型肝炎(乙肝)病毒(HBV)、丙型肝炎(丙肝)病毒(HCV)的感染状况. 方法 应用酶联免疫吸附试验(ELISA),对825 名HIV阳性的单采血浆献血员和受血者,检测乙肝病毒表面抗原(HBsAg)和丙肝病毒抗体(抗-HCV). 结果 单采血浆和输血途径感染HIV的人群中,HBV、HCV的感染率分别为3.76%、72.24%.其中单采血浆献血员中,HCV感染率(81.85%)高于输血人群(56.03%),而HBV感染率(1.54%)低于输血人群(7.49%)(P均＜0.01). 结论 在单采血浆和输血途径感染HIV的患者中,有很高的HCV感染率,而HBV感染率较低.     

老年冠心病患者介入治疗术后的预后因素分析

目的 探讨影响老年冠心病患者介入治疗后的预后因素. 方法 1981例经皮介入治疗后的冠心病患者被分为老年组(≥65岁)801例和对照组(非老年组,＜65岁)1180例.术后随访12～84个月(平均36个月). 结果 老年组全因死亡率明显高于对照组(5.4％和2.3％,P＜0.01);老年组的主要心血管不良事件(MACE)明显高于对照组(18.9％和3.7％,P＜0.01).影响介入治疗后死亡的因素为年龄65岁(OR=1.05,95％ CI=1.02～1.10,P=0.014),左主干病变(OR=4.78,95％ CI=2.36～17.22,P=0.027),冠状动脉3支病变(OR=5.68,95％ CI=3.17～15.32,P=0.018),合并糖尿病(OR=6.24,95％CI=2.11～16.36,P=0.001);影响介入治疗后主要心血管不良事件的因素为年龄65岁(OR=2.06,95％CI=2.23～4.32,P=0.007),左主干病变(OR=3.64,95％CI=1.86～15.34,P=0.001),冠状动脉3支病变(OR=4.35,95％CI=2.54～13.82,P=0.017),合并糖尿病(OR=5.35,95％ CI=1.77～14.51,P=0.001).性别和高血压不是影响总死亡率和主要心血管不良事件的因素. 结论 年龄、糖尿病、左主干病变、冠状动脉3支病变是影响老年冠心病患者介入治疗预后的主要因素,而性别和高血压对预后影响不明显.     

白细胞介素-28B基因多态性与丙型肝炎病毒感染自然清除的相关性

目的 探讨IL-28B基因多态性与HCV感染自然清除的相关性.方法 HCV感染者280例,其中慢性丙型肝炎患者200例,HCV感染后复查自发清除者80例,检测IL-28B基因rs8099917位点基因型,并分析IL-28B基因型与HCV感染自然清除的关系.统计学处理采用x2检验.结果 慢性丙型肝炎组与自发清除组IL-28B rs8099917位点TT、非TT(TG和GG)基因型的频率差异有统计学意义(x2=15.874,P＜0.01).TT型在自发清除组中的频率为86.2％,高于慢性丙型肝炎组的62.0％.慢性丙型肝炎患者、自发清除者IL-28B rs8099917 T和G等位基因频率分别为78.0％、22.0％和92.5％、7.5％.自发清除人群中以T等位基因频率为主(92.5％),两组等位基因的差异有统计学意义(P＜0.01).TT型HCV感染者自发清除HCV的可能性是非TT型感染者的2.84倍,而非TT型(TG+GG)HCV感染者慢性化的危险性是TT型的1.36倍.结论 宿主IL-28B rs8099917位点TT基因型与HCV感染自发清除相关,可作为HCV感染自发清除的一个重要预测因素.     

Prevalence and clinical significance of GB virus type C/hepatitis G virus coinfection in patients with chronic hepatitis C undergoing antiviral therapy

Summary. Coinfection with GBV‐C/HGV in patients with chronic hepatitis C (CHC) may influence clinical course and response rates of antiviral therapy. Aim of the study was to investigate the prevalence of GBV‐C/HGV/HCV coinfection and its influence on outcome of interferon/ribavirin combination therapy. Three hundred and four patients with CHC [m/f = 211/93, age: 42 (18–65)] were investigated. HGV RNA detection was performed by polymerase chain reaction prior to and 6 months after the end of antiviral therapy. HGV/HCV coinfection could be identified in 37/304 (12.2%) patients with intravenous drug abuse as the most common source of infection (N = 21, (56.8%)). The predominant HCV genotype in coinfected individuals was HCV‐3a (HCV‐3a: 51.4%, HCV‐1: 37.8%, HCV‐4: 10.8%). HGV coinfection was more prevalent in patients infected with HCV‐3 compared to HCV‐1 or HCV‐4 [19/45 (42.2%) vs 14/185 (7.6%) vs 4/52 (7.7%), P < 0.01]. Patients with HGV/HCV coinfection were younger [35 (18–56) vs 43 (19–65), years; P < 0.01], and advanced fibrosis (F3‐F4) was less frequent (22.2%vs 42.9%, P < 0.05). A sustained virological response was achieved more frequently in HGV/HCV coinfected patients [26/37 (70.3%)] than in monoinfected patients [120/267 (44.9%), P < 0.01]. HGV RNA was undetectable in 65.7% of the coinfected patients at the end of follow‐up. Intravenous drug abuse seems to be a major risk factor for HGV coinfection in patients with chronic hepatitis C. Coinfection with HGV does not worsen the clinical course of chronic hepatitis C or diminish response of HCV to antiviral therapy. Interferon/ribavirin combination therapy also clears HGV infection in a high proportion of cases.     

Epidemiology of hepatitis C virus infection in American veterans

OBJECTIVE: This study reports the findings of hepatitis C virus (HCV) infection in a large Department of Veterans Affairs Health Care System in suburban Northern California. METHODS: All veterans who had anti-HCV (EIA II) tested during a 6-yr period (7/92 to 6/98) were included in this study. To estimate the seroprevalence of anti-HCV among our population, 126 consecutive bloodborne pathogen exposure accidents were studied. RESULTS: Of 8558 veterans tested for anti-HCV (EIA II), 2985 (35%) veterans were positive with a mean age of 48.4 yr (range, 28-89 yr). Sixty percent were between the age of 41 and 50 yr. Risk factors for HCV infection identified in 409 consecutive veterans were intravenous drug abuse (81%), unknown (11%), blood transfusion (3%), sexual/household contact (2%), transfusion and intravenous drug use (2%), and tattoo (1%). Of 215 consecutive anti-HCV-positive veterans whose sera were tested by polymerase chain reaction, 96% were viremic. The most common HCV genotypes were 1a (50.5%), 1b (22.8%), 3a (12.1%), 2b (9.7%), 2a (1.9%), undetermined (1.9%), and mixed infection (1%). Veterans infected with genotype 1b were significantly older. Among 126 consecutive bloodborne pathogen exposure accidents, hepatitis C serology was available for 72 index veterans involved in the accidents and 18% were positive. CONCLUSIONS: We found the epidemiology of hepatitis C infection was different in the veteran population when compared to other published data on nonveterans. Hepatitis C infection was much more common among veteran, within a very narrow age distribution and intravenous drug use was the major risk factor.     

323例慢性丙型肝炎患者流行病学及临床特点分析

目的 了解慢性丙型肝炎患者的流行病学及临床特点.方法 对323例确诊为慢性丙型肝炎患者的临床资料进行系统分析,研究该组人群感染HCV的传播途径,临床表现及病毒学特征,并分析39例行肝组织活检患者的肝脏组织学改变.两组之间比较采用t检验.结果 323例慢性丙型肝炎患者经输血或使用血制品感染者135例,占41.8%;有手术等有创操作史者67例,占20.7%,其中接受过针灸治疗者19例,占5.9%,有血液透析史者18例,占5.6%;母婴传播2例,占0.6%;有静脉注射毒品史者21例,占6.5%;性传播者2例,占0.6%;其他不明原因者78例,占24.1%;合并HBV感染者14例,占4.3%.222例患者中,HCV基因型1b型和2a型分别为145例和21例,分别占65.3%和9.5%,283例患者血清HCV RNA病毒载量为1×105和1×106IU/mL者分别为74例和103例,分别占26.1%和36.4%.临床表现有明显肝炎症状和体征者23例,占7.1%.行肝组织活检的39例慢性丙型肝炎患者中,肝脏炎症活动指数(HAI)≥4有14例,占35.9%;纤维化评分(F)≥3的患者6例,占15.4%;HAI≥4同时 F≥3的患者4例,占10.3%.结论 我国慢性丙型肝炎患者感染途径多为输血或使用血制品,经手术等有创操作感染也不容忽视,而除输血外,静脉注射毒品、血液透析及针灸疗法等感染途径亦增加.感染HCV常见的病毒基因型为1b和2a型,病毒复制水平较高,大多数患者发病隐匿,无明显肝炎症状和体征,但肝组织活检显示多数患者肝脏有组织学改变.     

Epidemiology and risk factors for hepatitis C in Alaska Natives

Large cohorts of persons infected with hepatitis C virus (HCV) that include patients with multiple risk exposures and behaviors have been rarely reported. We herein describe a population-based cohort of 759 Alaska Natives (AN) with HCV who were recruited into a long-term follow-up study. History of injection drug use (IDU) was reported by 60.1% and blood transfusion by 14.0%. The most common genotype was 1a (42.0%), followed by 1b (20.3%), 2b (14.7%), 3a (14.3%), and 2a (7.8%). By multivariable analysis, risk exposures (blood transfusion vs. other; P < 0.01; odds ratio [OR], 2.87; 95% confidence interval [CI], 1.51-5.45) and year of infection (P < 0.01; OR, 3.47; 95% CI, 1.34-8.96) were significantly associated with HCV RNA-positivity. Having an RNA concentration >/=2 million copies/mL was associated with male gender (OR, 1.94) and genotype (P < 0.01 overall; 1a vs. 3a: OR, 1.92; 2b vs. 3a: OR, 3.17) by multivariable analysis. In conclusion, the two principal risk exposures for AN infected with HCV (IDU and blood transfusion) are the same as the overall U.S. population. Persons with a history of blood transfusion were more likely to be HCV RNA positive than those without such history. Higher RNA levels found in males may explain the more severe disease previously reported in this group.     

Epidemiology of chronic hepatitis C in Germany--an analysis of 10,326 patients in hepatitis centres and outpatient units

Little is known about the epidemiology of chronic hepatitis C (CHC) in Germany and especially about the importance of transmission, duration of infection, genotypes, symptoms and quality of life of the patients. The current study prospectively evaluates epidemiological and clinical data of patients infected with the hepatitis C virus (HCV). Using online data entry, various characteristics of 10,326 untreated patients with CHC were documented from March 2003 until May 2006 in 352 centres all over Germany. Mean age of patients was 43.4 years. Patients infected by i.v. drug abuse were considerably younger (36.5 years) than the remaining patients (49.2 years). As indicated by their native language, 64.4% of the patients came from Germany and 19.2% from Russia. 61.7% were infected with genotype 1 and 34.9% with genotype 2 or 3. 45.5% of the patients had been infected by i.v. drug abuse. In at least 5.4% of the patients liver cirrhosis had been proved by biopsy. 63.5% of the patients felt an impairment of quality of life caused by CHC. In many patients infected with hepatitis C socio-economic issues are existent. This is reflected, i.e., in very high rates of unemployment in special subpopulations. Coinfections with hepatitis B and HIV occurred in 1.5% and 4.7%, respectively. Nearly 80% of patients were managed near their homes. The data of the 10 326 patients represent about 2% of all German patients with CHC. This database is up to now the largest of its kind and gives a representative insight into the epidemiological situation of CHC in Germany.     

Myasthenia gravis and hepatitis C virus infection

SUMMARY. Chronic hepatitis C virus (HCV) infections are often associated with extrahepatic immunological manifestations, including various autoimmune disorders. The aims of this study were to determine the prevalence of HCV markers in patients with myasthenia gravis (MG) and to determine any relationship with HCV infection. Eighty-three patients with MG, 40 men aged 20–93 years and 43 women aged 13–87 years (mean age 54 years) were studied. The MG patients were positive for antibody to acetylcholine receptor, in addition, their sera was analysed for antibody to HCV (HCVAb) and HCV RNA. HCVAb was detected in two of the 83 patients (2.4%). Four patients were repeatedly HCV RNA positive. They were infected by HCV genotype 1 (one patient), HCV genotype 2a (two patients) and an undetermined HCV genotype in one patient. They received plasmapheresis or intravenous immunoglobulin treatment. Among the four patients, one was infected after the onset of MG without receiving a blood transfusion or using intravenous drugs. The other three had chronic hepatitis C which was discovered at the same time as MG and only one patient had been exposed to blood products. The prevalence of HCV markers in patients with MG (4.8%) was higher than that reported for the general French population, about 1%. This prevalence is similar to that occurring in patients exposed to plasmapheresis or intravenous immunoglobulin. In conclusion, HCV appears to play little, if any, role in causing MG. The higher prevalence of infection among MG patients may be related to transmission in the course of therapy.     

Seroepidemiology of hepatitis C and its risk factors in Khuzestan Province, South-West of Iran: A case-control study

AIM: To evaluate possible risk factors for the spread of hepatitis C infection and to analyze the characteristics of the epidemiological and clinical patterns among the patients with hepatitis C infection. METHODS: During a five-year period a cross-sectional study was conducted among HCV positive individuals referred to the Ahwaz JundiShapour University Hospitals (AJSUH) and Hepatitis Clinic from 1 Sept 1999 to 1 Sept 2003. The control group consisted of first time blood donors referred to the Regional Blood Transfusion organization. Enzyme-linked immunosorbent assay and recombinant immunoblot assay anti-hepatitis C virus (HCV) tests were performed for two groups. Positive serum specimens were retested using polymerase chain reaction (PCR) for HCV RNA. Risk factors were evaluated using a questionnaire. Reported risk factors among infected subjects ("HCV-positive") were compared to those of subjects never exposed ("HCV-negative") to HCV.RESULTS: A total of 514 subjects were studied for HCV, of which 254 were HCV-positive and 260 HCVnegative donors comprised the control group. Mean age of the patients was 28.4 (Std 15.22) years. HCV-positive subjects were more likely to be of male gender (63% versus 37%). Transfusion 132 (52%), non-intravenous (n-iv) drug abuse and iv drug abuse 37 (14.5%),haemodialysis 25 (10%), receiving wounds at war and extramarital sexual activities (2.4%), tattooing (3.6%) were found to be independent risk factors of being HCV positive. No apparent risk factors could be demonstrated in 29 (11.2%) of the positive cases. CONCLUSION: Our data indicate that a history of transfusion and iv drug abuse and haemodialysis are important risk factors for HCV infection in our area and that more careful pretransfusion screening of blood for anti HCV must be introduced in our blood banks. Improvements in certain lifestyle patterns, and customs in this area may be essential to prevent transmission of the infection.     

Approach to the patient with chronic hepatitis C virus infection

Chronic hepatitis C virus (HCV) infection is common and often asymptomatic. Antibodies against HCV are a highly sensitive marker of infection. Molecular testing for HCV is used to confirm a positive result on antibody testing and to provide prognostic information for treatment; however, quantitative HCV RNA does not correlate with disease severity or risk for progression. Chronic HCV infection is most frequently associated with remote or current intravenous drug use and blood transfusion before 1992, although as many as 20% of infected patients have no identifiable risk factor. In an estimated 15% to 20% of persons infected with HCV, the infection progresses to cirrhosis; alcohol intake is an important cofactor in this progression. Most specialists prefer to include an examination of liver histology in the management of patients with chronic HCV infection to aid prognostic and treatment decisions. The current standard of pharmacologic treatment of chronic HCV is weekly subcutaneous peginterferon in combination with daily oral ribavirin, which results in sustained virologic response in approximately 55% of chronically infected patients. Side effects of interferon therapy include myalgias, fever, nausea, irritability, and depression. The cost-effectiveness of interferon therapy is similar to that of many commonly accepted medical interventions. The primary care physician serves a vital role in identifying patients with chronic HCV infection, educating patients about risk factors for transmission, advising patients about the avoidance of alcohol, and aiding patients in making treatment decisions.     

The prevalence of hepatitis B and C in HIV-positive Greek patients: relationship to survival of deceased AIDS patients

OBJECTIVES: To determine the prevalence of hepatitis viruses B (HBV) and C (HCV) co-infections in HIV-infected patients and the overall impact of these co-infections on deceased AIDS patients survival. METHODS: One hundred and eighty-one patients (159 males, 22 females) infected with HIV, attending an academic AIDS unit in Athens, Greece, constituted the study population. The study population consisted of 124 homo/bisexual men, 34 heterosexuals, 12 intravenous drug users (IDU) and 11 blood transfusion recipients. Virological markers tested for HBV infection included HBsAg, anti-HBs and total anti-HBc by enzyme-linked immunoassays. Detection of HCV antibodies was carried out by third generation enzyme-linked immunoassay, and repeatedly positive samples were further tested by a supplemental enzyme-linked immunoassay; only sera reactive by both methods were considered to be HCV-positive. RESULTS: The prevalence of HBV markers was 67.4%: 71.8% in homo/bisexuals, 35.3% in heterosexuals, 91.7% in IDUs and 90.9% in blood transfusion recipients (P = 0.00004). The prevalence of HCV antibodies was 13.8%: 8.1% in homo/bisexuals, 8.8% in heterosexuals, 58.3% in IDU and 45.5% in blood transfusion recipients (P<0.000001). The prevalence of HCV antibodies was not significantly higher in homo/bisexuals than in heterosexuals (P= 0.8). Coinfection with HBV or HCV, or both, did not influence the survival of deceased AIDS patients (n = 73). CONCLUSIONS: HBV infection was equally prevalent among homo/bisexuals and IDU with HIV infection, whereas HCV infection was more prevalent in IDU than in homo/bisexuals with HIV infection. The prevalence of HCV infection was equal among heterosexuals and homo/bisexuals, indicating that if sexual transmission of HCV occurs, homo/bisexuals are not at greater risk than heterosexuals. Finally, the survival of deceased AIDS patients was not affected by the presence of HBV and HCV co-infections.     

Current status and clinical course of hepatitis C virus in Korea

The mortality due to chronic liver disease, including liver cirrhosis and hepatocellular carcinoma (HCC), ranks as one of the highest in Korea. The prevalence rates of hepatitis C virus (HCV) and hepatitis B virus (HBV) infections in the general Korean population are approximately 1 and 5%, respectively. Blood transfusion was the strongest risk factor for the transmission of HCV infection. Therefore, the evaluation of risk factors for HCV infection including blood transfusion, intravenous drug user, hemophilia, and hemodialysis, is important. The most prevalent HCV genotype is 1b followed by 2a. The annual incidence of HCC among HCV-related liver cirrhosis has been estimated at 5%, and approximately 12% of HCC is attributable to HCV and 68% to HBV in Korea. HCV infection is more closely associated with HCC in elderly patients than HBV-related HCC. Even though the prevalence of anti-HCV in Korea has been reduced and the risk of HCV transmission through blood transfusion has markedly decreased, public-health programs to prevent de novo infections should be developed. This review describes the HCV prevalence and risk factors among the general population, and the distribution of HCV genotypes as well as the clinical course of HCV in Korea.