Hepatitis C in veterans

Hepatitis C virus (HCV) infection is the most common chronic bloodborne infection in the United States and has recently been identified as the single most important emerging pathogen in the Department of Veterans Affairs (VA) health care system. The Third National Health and Nutrition Examination Survey estimated that 3.9 million Americans (1.8%) are infected with HCV. In contrast, the prevalence is much higher (6.6% to 51.0%) among veterans receiving care at VA facilities. The prevalence of HCV is highest among Vietnam veterans, and injection drug use is the most common mode of transmission. A significant proportion of veterans are not candidates for treatment with currently available antiviral medications due to comorbid psychiatric and substance abuse disorders. Furthermore, the limited data available on the treatment of HCV in veterans suggest that the sustained virologic response to current antiviral therapies is lower than in nonveterans. Treatment and management of HCV will be a challenge for the VA health care system, and additional studies to evaluate the epidemiology, treatment, and outcomes of veterans with HCV are warranted.     

Arthritis prevalence and symptoms among US non-veterans, veterans, and veterans receiving Department of Veterans Affairs Healthcare

OBJECTIVE:. Studies suggest arthritis and rheumatic diseases are common among military veterans, but prior research has not directly compared arthritis between veterans and the general population. This study compared arthritis prevalence and symptoms between veterans of the US Armed Forces and non-veterans, and between veterans who are US Department of Veterans Affairs (VA) healthcare users and veteran nonusers. METHODS: Study participants were 123,395 respondents from 36 states that completed the 2000 Behavioral Risk Factor Surveillance System arthritis module. Analyses compared self-reports of doctor-diagnosed arthritis, chronic joint symptoms, and activity limitation according to veteran status. Analyses also compared relationships of demographic characteristics to arthritis according to veteran status. RESULTS: US veterans were more likely to report doctor-diagnosed arthritis than non-veterans (32% vs 22%; p < 0.001), and VA healthcare users were more likely to report doctor-diagnosed arthritis than veteran nonusers (43% vs 30%; p < 0.001). Differences remained in analyses controlling for demographic characteristics. Among respondents with arthritis, veterans were more likely to report chronic joint symptoms and activity limitation than non-veterans, and VA healthcare users were more likely to report chronic symptoms and activity limitation than veteran nonusers. Demographic factors predicting doctor-diagnosed arthritis were similar among the 3 groups. CONCLUSION: This study shows a significant burden of arthritis among US veterans, particularly VA healthcare users. Increased prevention of orthopedic injuries in the military may reduce the risk of arthritis in veterans. Within the VA healthcare system, self-management interventions may help to improve outcomes among the many patients with arthritis.     

Prevalence of hepatitis C virus seropositivity among hospitalized US veterans

BACKGROUND: Hepatitis C virus (HCV) is a major cause of acute and chronic hepatitis in the United States and abroad. HCV antibody prevalences ranging from 10 to 90% have been reported in intravenous drug abusers, hemodialysis patients, and persons suffering from other liver diseases, whereas HCV seropositivity rates for volunteer-blood donor populations are generally under 1%. However no information has been available concerning the prevalence of HCV in general hospital populations in the United States. METHODS: We examined the rate of HCV seropositivity in 530 patients admitted to the Atlanta VA Medical Center between November 1993 and November 1994. The test population consisted of 400 random hospital admissions, 100 successive admissions to the surgical service, and 30 random admissions to the gastrointestinal service. Serum samples were assayed for HCV antibodies by a second generation EIA, and all repeat reactives were re-examined using a supplemental research assay to confirm the presence of HCV antibodies. Complete chart reviews were carried out on all HCV seropositive patients and on 100 HCV seronegative patients. RESULTS: Sixty-two of the 530 patients tested (11.7%) were repeatedly positive for HCV antibodies. Of these 62 repeat reactives, 56 (90.3%) were positive and 3 others (4.8%) indeterminate by the supplemental assay. The HCV seropositivity rate after supplemental testing was 11.8% for random admissions, 5.0% for surgical admissions, and 13.3% for patients admitted to the gastroenterology service. HCV-associated risk factors in HCV seropositive patients included a history of intravenous drug abuse, current or previous alcohol abuse, previous or concurrent liver disease, previous blood transfusions, hemodialysis, and multiple sex partners or unsafe sex. CONCLUSIONS: HCV infection may be more prevalent among hospitalized VA patients (and among other US hospital populations) than previously expected.     

Hepatitis C comorbidities affecting the course and response to therapy

Several studies have demonstrated that the outcome of chronic hepatitis C (CHC) infection is profoundly influenced by a variety of comorbidities. Many of these comorbidities have a significant influence on the response to antiviral therapy. These comorbidities negatively affect the course and outcome of liver disease, often reducing the chance of achieving a sustained virological response with PEGylated interferon and ribavirin treatments. Comorbidities affecting response to antiviral therapy reduce compliance and adherence to inadequate doses of therapy. The most important comorbidities affecting the course of CHC include hepatitis B virus coinfection, metabolic syndrome, and intestinal bacterial overgrowth.Comorbidities affecting the course and response to therapy include schistosomiasis, iron overload, alcohol abuse, and excessive smoking. Comorbidities affecting response to antiviral therapy include depression,anemia, cardiovascular disease, and renal failure.     

Hepatitis C comorbidities affecting the course and response to therapy

Several studies have demonstrated that the outcome of chronic hepatitis C (CHC) infection is profoundly influenced by a variety of comorbidities. Many of these comorbidities have a significant influence on the response to antiviral therapy. These comorbidities negatively affect the course and outcome of liver disease, often reducing the chance of achieving a sustained virological response with PEGylated interferon and ribavirin treatments. Comorbidities affecting response to antiviral therapy reduce compliance and adherence to inadequate doses of therapy. The most important comorbidities affecting the course of CHC include hepatitis B virus coinfection, metabolic syndrome, and intestinal bacterial overgrowth.Comorbidities affecting the course and response to therapy include schistosomiasis, iron overload, alcohol abuse, and excessive smoking. Comorbidities affecting response to antiviral therapy include depression,anemia, cardiovascular disease, and renal failure.     

Decline in rheumatoid vasculitis prevalence among US veterans: A retrospective cross‐sectional study

Objective

To examine trends in the prevalence of rheumatoid vasculitis in a national US population comprising both hospitalized and ambulatory patients with rheumatoid arthritis (RA).

Methods

In this serial cross‐sectional study, we analyzed data on hospitalized and ambulatory patients spanning 22 years (1985–2006) and 10 years (1997–2006), respectively, to determine the prevalence of rheumatoid vasculitis, as defined by the International Classification of Diseases, Ninth Revision. Our search encompassed data collected on a predominantly male study population during 10 million hospitalizations and outpatient visits, and included annual data on >37,000 RA patients. To test for a decrease in rheumatoid vasculitis prevalence, breakpoint analysis was performed using stepwise Chow and Durbin‐Watson tests.

Results

There was a clear decline in the prevalence of rheumatoid vasculitis, and this decline remained evident even after accounting for a decreased number of hospitalizations among RA patients. Peak prevalence occurred among hospitalized patients in the 1980s, and prevalence gradually declined throughout the 1990s. Furthermore, simultaneous breakpoints representing a significant drop in rheumatoid vasculitis prevalence between the years 2000 and 2001 were demonstrated for both inpatients (P < 0.000) and outpatients (P < 0.003). The prevalence of vasculitis dropped 53% among inpatients and 31% among outpatients between 2000 and 2001.

Conclusion

Our results demonstrate a significant decline in rheumatoid vasculitis prevalence after 2000 in this nationwide sample of hospitalized and ambulatory patients. The clear, consistent drop in prevalence provides an opportunity for the formulation of causal hypotheses, including consideration of the impact of biologic agents used to treat RA, on rheumatoid vasculitis.

     

Hepatitis C prevalence among the migrant population in Spain: A systematic review and meta-analysis

Introduction

Spain, which has one of the largest migrant populations in Europe, has committed to eliminating the hepatitis C virus (HCV). The aim of this study was to estimate the prevalence of HCV among migrant groups in Spain, a country of 46 million people, with an estimated HCV-antibody prevalence of 1.7%.

Hepatitis C prevalence among men who have sex with men in Central Brazil

To assess the prevalence of hepatitis C virus infection among men who have sex with men (MSM) in Central Brazil, a cross-sectional study was conducted in the City of Goiânia, Central Brazil, using Respondent-Driven Sampling (RDS). All serum samples were tested for anti-HCV and also for alanine aminotransferase (ALT). Anti-HCV positive samples and/or those with elevated ALT were tested for HCV RNA and genotyped. Of the 522 participants, four were found to be anti-HCV positive, and one was also HCV RNA positive (active HCV infection). Elevated ALT was found in 14 individuals. Of these, one showed evidence of acute HCV infection (HCV RNA positive and anti-HCV negative). Therefore, five MSM were positive for either anti-HCV and/or HCV RNA, giving a crude overall HCV prevalence of 1.0%; 1.3% (95% CI: 0.3–5.5) after being weighted by RDSAT. All five individuals reported high-risk sexual behaviors, including two who showed evidence of active HCV infection (genotype 1, subtypes 1a and 1b). Although the study population reported high-risk sexual practices, HCV infection was not more frequent in MSM than in the general Brazilian population.     

Hepatitis C virus infection among healthy Egyptian children: prevalence and risk factors

Summary. The aim of this study was to estimate the prevalence and identify the risk factors of hepatitis C virus (HCV) infection among healthy Egyptian children. A representative random sample of 500 children, age between 6 and 15 years, was selected from 10 schools in Alexandria, Egypt. A questionnaire was used to collect demographic data and potential risk factors, while blood samples were collected and analyzed for antibodies to HCV (anti‐HCV). Positive sera were further confirmed by HCV‐RNA. HCV seroprevalence of 5.8% was found, with HCV viraemia in 75% of the studied children. The prevalence of anti‐HCV increased with age from 0% in children aged 6–7 years to 16% in those of 15 years old. It was also shown that history of previous blood transfusion (odds ratio[OR] = 34.8, 95% CI = 4.39–272.95), intravenous injections (OR = 4.68, 1.89–11.59), surgical intervention (OR = 5.64, 2.55–12.52), dental treatment (OR = 6.81, 2.64–17.39), injection (OR = 2.29, 1.08–4.89) and circumcision for boys by informal health care providers (OR = 2.6, 1.0–6.73), age above 10 years (OR = 6.83, 2.44–19.07), very low socioeconomic class (OR = 5.92, 1.3–25.2) and rural area residence (OR = 2.49,1.61–5.29) are the most significant risk factors for HCV infection. Adjusting for all other risk factors by multivariate logistic regression analysis, it has been shown that blood transfusion, surgical procedures, dental treatment, and age above 10 years are still significant risk factors associated with anti‐HCV (P < 0.05). The current study reveals the extremely high HCV seroprevalence among Egyptian children. This mandates immediate preventive strategies to limit further HCV spread.     

Hepatitis C virus prevalence and genetic diversity among pregnant women in Gabon,central Africa

Background  

Hepatitis C virus (HCV) infection is a major global public health problem in both developed and developing countries. The prevalence and genetic diversity of HCV in pregnant women in Gabon, central Africa, is not known. We therefore evaluated the prevalence and the circulating genotypes of HCV in a large population cohort of pregnant women.     

Hepatitis C virus among childbearing women in Scotland: prevalence, deprivation, and diagnosis

OBJECTIVES: (A) To examine the prevalence and demographic characteristics of hepatitis C virus (HCV) infection among childbearing women in Scotland; and (B) to determine the extent of maternal HCV infection diagnosed prior to birth. METHODS: (A) Residual dried blood spot samples from routine neonatal screening, collected throughout Scotland during March-October 2000, were unlinked from identifiers and tested anonymously for HCV antibodies; and (B) electronic record linkage of Scotland's databases of births and diagnosed HCV infections was performed. RESULTS: (A) Of 30,259 samples, 121 were enzyme linked immunosorbent assay repeat reactive and 88 of these were confirmed as anti-HCV positive in the recombinant immunoblot assay, representing a seroprevalence of 0.29-0.40%. HCV seroprevalence was high among 25-29 year olds (0.4-0.57%), in high deprivation areas (0.92-1.07%), and in Greater Glasgow (0.83-0.96%) and Grampian (0.38-0.62%). Adjusted relative risk for HCV infection was highest among residents in high deprivation areas of Glasgow (7.2 (95% confidence interval 2.0-25.5)). (B) Of 121 HCV infections found among women at delivery, 24% and 46% were estimated to have been diagnosed prior to pregnancy and birth, respectively. CONCLUSIONS: HCV prevalence among Scottish childbearing women is consistent with that expected from injecting drug use. Based on reported rates of mother to child transmission, 8-11 paediatric infections are expected per annum. Diagnosis in only 24% of infected women prior to pregnancy indicates the extent to which HCV goes unrecognised in the injecting community. The current HCV screening approach-to test only those with a history of injecting drug use (or other risk factors for infection)-identifies approximately a quarter of previously undetected infections among pregnant women.     

Hepatitis C: prevalence and common genotypes among ethnic groups in Jeddah, Saudi Arabia

The presence of antibodies to hepatitis C virus (HCV) was examined using a third-generation ELISA in 3,350 serum samples obtained from patients visiting different outpatient clinics, preoperative patients, and women visiting for ante-natal care at the Dr. Fakeeh hospital in Jeddah, Saudi Arabia from January to September 1998. The population included mainly Saudis, Egyptians, and Yemenis, and patients from other Middle East and Asian countries. The prevalence of HCV infection was 5.87% among Saudis, 22.54% among Egyptians, and 2.12% among Yemenis. The prevalence among patients from other Middle East and Asian countries were 3.38% and 4.98%, respectively. The overall prevalence among the studied group was 6.75%. Genotyping of isolates from Saudi Arabia showed that the prevalences of types 4, la, 1b, and 2 were 45.9%, 40.6%, 10.85%, and 2.7%, respectively. Genotyping of isolates from Egypt showed that type 4 was the major type among Egyptians (91.6%), while types 1a and 1b each had prevalences of 4.2%.