Incidence and prevalence of hepatitis C among clients of a Brisbane methadone clinic: factors influencing hepatitis C serostatus

Abstract: The objective of this study was to describe the incidence and prevalence of hepatitis C infection among clients of a methadone program in Queensland. The clinical notes of clients receiving methadone for treatment of opiate dependence who first registered at the clinic after 1989 were perused for information about their serological status for hepatitis C and hepatitis B infections during a six–week period in 1994. We followed hepatitis C negative clients until August–September 1995. At study entry, 69 per cent of the clients were recorded as being hepatitis C positive. Of those who were negative, the seroconversion rate was 11 per 100 person–years. The high incidence and prevalence of hepatitis C among methadone clients emphasises the need for effective early intervention strategies to prevent the transmission of hepatitis C among injecting drug users.     

Mortality in cirrhosis: prevalence,causes, and predictive factors

To determine the global mortality rate during cirrhosis, to point out its principal causes and to look for factors associated with a higher death risk in cirrhotic patients. We carried out a retrospective study on patients hospitalized for cirrhosis during a seven-year period. We indicated the number of deceased patients, as well as the cause and the time interval for death. Age, sex, Child's score, etiology and the state of the cirrhosis were considered in a univariate and a multivariate analysis to look for mortality predictive factors. 109 patients (49 males, 60 females) of average age 57 years (15-87) were studied. The average follow-up interval was 30 months (1-96). The global mortality rate was 24%, with a five-year survival rate of 66%. In univariate analysis, mortality was more frequent in the following cases: presence of an initial complication (p < 0.001), Child C cirrhosis (p = 0.02) and post-hepatitic B cirrhosis (p = 0.004). In multivariate analysis, only B viral etiology (five-year survival rate of 48%, p = 0.002) and the existence of an initial complication (five-year survival rate of 30%, p < 0.001) were independently associated with a higher mortality risk. Our study showed that cirrhosis is associated with an important mortality. Our results confirm the poor prognosis of a cirrhosis revealed by an inaugural complication and suggests that post-hepatitic B cirrhosis is more severe than post-hepatitic C cirrhosis.     

Metabolic syndrome after liver transplantation: prevalence and predictive factors

Objectives

Metabolic syndrome (MetS) is a disorder in which obesity, insulin resistance, high blood pressure and dyslipidemia coexist. This study assessed the prevalence of MetS and its associated factors in patients who underwent orthotopic liver transplantation (OLTx).

Methods

Post-OLTx patients were assessed for the presence of MetS according to the diagnostic criteria proposed by the International Diabetes Federation (IDF) and National Heart, Lung, and Blood Institute/American Heart Association (NHLBI/AHA). Demographic, socioeconomic, lifestyle, clinical, anthropometric, and dietary variables were collected to identify predictors for MetS using logistic regression analysis.

Results

Among the 148 patients assessed, the prevalence of MetS was 50% (IDF criteria) and 38.5% (NHLBI/AHA criteria). For both the IDF and the NHLBI/AHA classifications, the independent factors associated with MetS were older age, shorter time since transplantation, and history of excessive weight prior to OLTx. Other predictors for MetS by IDF criteria were alcohol abuse as the indication for OLTx, physical activity reduction as the cause of weight gain after transplantation, and calcium intake below recommended levels. The presence of MetS (NHLBI/AHA) was also associated with decreased intake of potassium, fiber, and folic acid.

Conclusions

MetS is highly prevalent among post-OLTx patients and it is predicted by older age, shorter time since transplantation, alcohol abuse as the cause of cirrhosis, excessive weight prior to OLTx, and some potentially modifiable factors such as physical activity reduction after OLTx and low intake of calcium, potassium, fiber, and folic acid.     

The prevalence of intrinsic host risk factors associated with progressive disease in patients with chronic hepatitis C viral infections

The prevalences of three risk factors that have been identified as important predictors of more progressive forms of chronic hepatitis C viral (HCV) infections (male gender, transfusion recipients and age greater than 50 years at the onset of infection) were documented by a retrospective chart review of 337 HCV-infected patients attending an urban, hospital-based, viral hepatitis clinic. One hundred and ninety-five patients (58%) were male. One hundred and eighteen (35%) had received blood or blood product transfusions in the past, 33% of whom also gave a history of intravenous drug use. Approximately 5% of patients were over the age of 50 years at the estimated time of infection. Twenty percent of patients had two and 4% had all three risk factors. In conclusion, intrinsic host risk factors associated with progressive HCV infection were common in this patient population. If confirmed in other centres, these results suggest that the medical and financial demand on the health care system is likely to be appreciable unless effective and safe therapies for HCV are identified and implemented in the near future.     

Predictive factors of fibrosis for chronic viral hepatitis C

AIM: To determine the histological aspects and associated factors to significant or severe fibrosis in patients with chronic viral hepatitis C. METHODS: Consecutive patients recruited between 1999 and 2005 were studied. Lecture of hepatic biopsies was performed by the same histopathologist, using the METAVIR grading. RESULTS: We investigated 109 patients (36 men and 73 women, mean age:49.3 years (19 - 65 years). Activity was graded A0, A1, A2 and A3 in respectively 2, 49, 51 and 7 cases. Fibrosis was graded F0, F1, F2, F3 and F4 in 3, 34, 35, 16 and 21 cases. In univariate analysis, associated factors to fibrosis more than F2 were age, diabetes, levels of ASAT, gamma glutamyl transpeptidase, alkaline phosphatase, prothrombin index and APRI score. In multivariate analysis, only age more than 50 years was associated with fibrosis more than F2 (p=0,006 adjusted OR [CI95%]:5,57[1,63 - 18,9]). Associated factors to fibrosis graded F4 were age, levels of ASAT, ALAT, gamma glutamyl transpeptidase, alkaline phosphatase, leucocytes, platelets, prothrombin index, APRI score and hepatic dysmorphy on ultrasound examination. In multivariate analysis, only APRI score more than 1,5 was associated with fibrosis graded F4 (p=0,04 adjusted OR [CI95%] :4,35 [2,25-6,76]). CONCLUSION: Age and APRI score are important prognosis factors in chronic viral hepatitis C.     

Corticosteroid dependence and resistance in Crohn's disease: prevalence and predictive factors]

The aim of our study was to determine the prevalence of corticosensibility, corticodependency, and corticoresistance in patients with Crohn's disease. Ninety four treatments with corticoids were prescribed to the patients during the follow-up. The rates of corticosensibility, corticodependency, and corticoresistance were 66%, 16%, 18%. Corticodependency and corticoresistance are frequent in Crohn's disease. Corticodependency is more frequent in young patients and when corticoids were previously taken. A high CDAI was the only factor associated with a higher risk of corticoresistance.     

Human immunodeficiency virus, hepatitis B, C and D in Bangladesh's trucking industry: prevalence and risk factors

BACKGROUND: Human immunodeficiency virus (HIV) and hepatitis B and C, viral infections with shared percutaneous, mucosal and perinatal routes of transmission, are responsible for serious morbidity and mortality globally. In Bangladesh there is a dearth of research on prevalence and risk factors for these diseases. This study examines the prevalence of HIV and hepatitis (B, C, D) and risk factors associated with infection in men in Bangladesh's trucking industry (drivers and helpers on trucks), a population at risk for sexually transmitted infections. METHODS: The study population comprised 388 men (245 drivers, 143 helpers) working out of Tejgaon truck stand in Dhaka, Bangladesh. Subjects were selected through a two-tiered sampling strategy. Of 185 trucking agencies 38 were randomly selected and a of 10 subjects was recruited from each agency. Subjects were interviewed, underwent a comprehensive physical examination and had blood samples taken. Gold standard laboratory tests were conducted to detect HIV, hepatitis B, C, and D infections. To assess risk factors associated with current hepatitis B infections or being a carrier (HBsAg) and lifetime exposure to hepatitis B infection (anti-HBc), simple and multiple logistic regression analyses were performed. RESULTS: The prevalence of diseases were: HIV 0%, hepatitis C <1%, hepatitis B surface antigen 5.9%, antibody to hepatitis B core antigen 48.1% (with 5 of the 23 HBsAg positive cases testing positive for HBeAg and 18 for anti-HBe), and hepatitis D 0%. Having ever received a therapeutic injection and having had relations with a commercial sex worker (CSW) in the past year were both significantly associated with lifetime exposure to hepatitis B (anti-HBc); having received a therapeutic injection in the past year was associated with being either currently infected with hepatitis B or a carrier (HBsAg). CONCLUSIONS: The results of the study illustrate the importance of educating health care practitioners about the dangers of unsterile injections, and of educating men in the trucking industry as well as their partners (CSW in particular) about the importance of condom use, especially in high-risk sexual contacts.     

慢性丙型肝炎患者胰岛素抵抗相关因子分析

目的 探讨慢性丙型肝炎患者体内TNF-α、视黄醇结合蛋白4(RBP-14)、脂联素(ADP)与稳态模型法胰岛素抵抗指数(HOMA-IR)之间的关系,为进一步研究慢性丙型肝炎患者胰岛素抵抗的机制提供理论依据.方法 选择69例慢性丙型肝炎患者和50名体检正常者,测定各组空腹血糖、空腹胰岛素、血清TNF-α、RBP-4、AD...     

慢性丙型肝炎患者糖代谢异常及其相关因素研究

目的 丙型肝炎病毒（hepatitis C virus,HCV）患者常常伴随胰岛素抵抗以及糖尿病发生。本研究旨在探究慢性丙型肝炎（chronic hepatitis C,CHC）患者发生血糖异常的相关因素。方法 本研究共纳入1 039名未经治疗的CHC患者。研究对象人口学资料、生化检查指标及其肝脏功能和HCV病毒载量等资料均来源于句容市人民医院传染科。结果 有140名（13.5%）CHC患者被诊断为糖代谢异常。身体质量指数（χ²=9.231,P=0.010）、腰围（χ²=7.984,P=0.018）、收缩压（χ²=16.366,P<0.001）、舒张压（χ²=13.970,P=0.001）、丙氨酸转氨酶（alanine aminotransferase,ALT）（χ²=4.809,P=0.028）以及HCV-RNA载量（t=-3.818,P<0.001）等在CHC患者糖代谢正常与异常组间的分布差异具有统计学意义。多元回归分析发现,ALT（OR=2.986,95%CI：1.171~7.615）、HCV-RNA载量（OR=2.061,95%CI：1.165~3.644）为CHC患者合并糖代谢异常的危险因素。结论 ALT、HCV-RNA载量可作为CHC患者糖代谢异常的提示因子,仍需对更多临床资料以及相关基因作进一步研究以发现CHC患者发生糖代谢异常新的危险因素。     

慢性丙型肝炎患者抑郁焦虑状况及影响因素分析

目的 探究昆明市慢性丙型肝炎患者抑郁、焦虑状况及影响因素。方法 随机选取2013年1月至2018年12月昆明市传染病监测系统报告的慢性丙型肝炎患者480例作为研究对象,采用焦虑自评量表（SAS）与抑郁自评量表（SDS）评估慢性丙型肝炎患者抑郁、焦虑程度,通过单因素分析与Logistic回归分析筛选影响患者抑郁、焦虑的相关因素。结果 480例慢性丙型肝炎患者中男/女为320/160,平均年龄（45.40±3.72）岁,病程0.5~12.0年,平均（7.63±2.45）年。患者SDS评分为（47.81±9.69）分、SAS评分为（42.62±9.53）分,其中SDS≥53分的有124例（25.83%）,SAS≥50分的有110例（22.92%）。Logistic回归分析显示：初中及以下文化程度（OR=2.986）、中间型性格（OR=1.895）、内向型性格（OR=1.869）、人均月收入<1 000元（OR=3.735）、感到被歧视（OR=1.447）是影响患者抑郁的独立危险因素,知晓预防措施（OR=0.326）为保护因素;中间型性格（OR=1.957）、内向型性格（OR=2.043）及感到被歧视（OR=1.862）是影响患者焦虑的危险因素,知晓预防措施（OR=0.387）为保护因素。结论 昆明市慢性丙型肝炎患者抑郁、焦虑评分处于较高水平,文化程度低、性格内向、收入低、感到被歧视是影响抑郁、焦虑的危险因素,知晓预防措施为保护性因素。     

Estimating the prevalence of chronic hepatitis C virus infection in New York City, 2015

Chronic hepatitis C virus (HCV) infection is the most common blood-borne infection in the USA. Estimating prevalence is critical for monitoring diagnosis, treatment, and cure and for allocating resources. Surveillance data reported to the New York City (NYC) Health Department, 2000–2015, were used to estimate HCV prevalence in NYC in 2015. The numbers who died, out-migrated or whose last RNA test was negative were removed from the count of people reported with HCV. A simulation model was used to remove estimates of people whose infection spontaneously cleared or was cured and to add an estimate of people unaware of infection. The surveillance-based HCV prevalence in NYC in 2015 overall was 1.4% (95% certainty level (CL) 1.2–1.6%; n ≈ 116 000, 95% CL ≈99 000–135 000) and among adults aged ⩾20 years was 1.8% (95% CL 1.5–2.0%, n ≈ 115 000, 95% CL ≈99 000–134 000), lower than the 2010 estimate among adults aged ⩾20 years of 2.4% (n ≈ 147 000). Contributors to the decrease in HCV prevalence from 2010 to 2015 include both the availability of highly effective treatment and also deaths among an ageing population. The 2015 estimate can be used to set NYC-specific HCV screening and treatment targets and monitor progress towards HCV elimination.Key words: Estimating, hepatitis C, prevalence of disease, surveillance     

慢性丙型肝炎患者血清视黄醇结合蛋白4水平及相关影响因素的研究

目的 探讨慢性丙型肝炎患者血清视黄醇结合蛋白4(RBP4)的水平及相关影响因素.方法 选择56例慢性丙型肝炎患者(观察组)及35例健康体检者(对照组),采用ELISA法测定空腹血清RBP4水平,并测定空腹血糖(FBG)、三酰甘油(TG)、总胆固醇(TC)、丙氨酸氨基转移酶(ALT)、γ谷氨酰转移酶(γ-GT),PCR法测定丙型肝炎病毒(HCV)-RNA水平.结果 两组FBG、TC、TG、γ-GT水平比较差异无统计学意义(P＞0.05),观察组血清RBP4水平为(33.38±6.43)mg/L,明显高于对照组的(26.11±3.35)mg/L(P＜0.01).ALT正常的观察组26例患者血清RBP4水平为(38.96±4.09)mg/L,明显高于ALT异常的观察组30例患者的(28.53±3.43)mg/L(P＜0.01).观察组患者的ALT水平与RBP4水平呈负相关(r=-0.6368,P＜0.05).结论 血清RBP4水平与慢性丙型肝炎有显著相关性,且与ALT呈负相关,与FBG、TC、TG、γ-GT及HCV-RNA无关.     

宿主因素对慢性丙型肝炎抗病毒治疗的疗效影响

慢性HCV感染已成为世界范围内重要的公共卫生问题,目前慢性丙型肝炎的治疗主要是IFN-α联合利巴韦林,然而许多患者不理想的治疗效果已成为临床和试验肝脏病学面临的一个主要挑战.IFN抗病毒治疗失败的分子机制并不清楚,可能与病毒和宿主因素有关.病毒因素的作用已被广泛研究和概述,此文就宿主因素对慢性丙型肝炎抗病毒治疗疗效的影响进行综述.     

Treatment of chronic hepatitis C

Since last 5 years there have been several important advances that significantly impact therapy. The most notable advances have been the availability of sensitive, specific, and standardized tests for identifying hepatitis C virus (HCV) RNA in the serum, the addition of ribavirin to alpha interferon, the pegylation of alpha interferon, and the demonstration that sustained virological response (SR) is the optimal surrogate endpoint of treatment. The combination of high-dose peginterferon and ribavirin is more efficacious than standard interferon and ribavirin in persons infected with HCV genotype 1 (Genotype HCV1 patients may show SR of about 40%.) Compensated HCV cirrhosis patients may also be treated with PEG-IF and ribavirin combination. Decompensated cirrhosis needs liver transplantation. Strategies to enhance response to current therapies include the development of novel interferons, nucleoside analogues, inosine 5' monophosphate dehydrogenase inhibitors, and other immunomodulators that are being evaluated as adjunctive therapy to interferon-based regimens.     

Search for hepatitis delta virus (HDV) infection in hepatitis C patients in north-eastern Poland. Comparison with anti-HDV prevalence in chronic hepatitis B

Hepatitis C virus and hepatitis D virus have been shown to suppress HBsAg synthesis. Thus it is possible that HDV infection occurs despite the lack of detectable HBsAg. The aim of our study was to (a) determine the prevalence of HDV infection in patients with chronic hepatitis C (b) compare it with the prevalence of HDV infection in HBsAg positive patients with hepatitis B. The study group consisted of 51 chronic hepatitis C patients, 30 HIV infected drug addicts (27 of them were also positive for anti-HCV) and 102 hepatitis B patients. The participants were tested for anti-HDV, anti-HCV and HBsAg. All anti-HCV positive patients were negative for anti-HDV. Four individuals with anti-HDV belonged to hepatitis B group and constituted 3.9% of all HBsAg positive subjects. We conclude that (a) there is currently no evidence of HDV infection among HCV infected patients in our region (b) hepatitis delta infection is rare in north-eastern Poland.     

Progressive chronic kidney disease in primary care: Modifiable risk factors and predictive model

Objective

To determine the incidence and prevalence of CKD and of progressive GFR decline, to identify modifiable risk factors of and to develop a predictive risk model for progressive GFR decline in high risk primary care patients.

Methods

Retrospective observational study of 803 patients with or at high risk of CKD exclusively managed in primary care. Baseline data was collected in 2003, follow-up data in 2006. High risk was defined as inadequately controlled hypertension or diabetes, and GFR < 60, progressive GFR decline as annual GFR decline > 2.5 ml min^− 1 1.73 m^− 2.

Results

CKD was present in 25.4% at baseline and developed in further 13.7% during follow-up, 42.5% demonstrated progressive GFR decline. Obesity, proteinuria, heart failure, inadequate hypertension and diabetes control, lacking angiotensin-converting-enzyme-inhibitors or angiotensin-receptor-blockers, radio contrast, and dual renin–angiotensin-aldosterone-system blockade were identified as modifiable, independent risk factors of progressive GFR decline. The risk model, containing 7 readily obtainable variables, showed good discriminative ability.

Conclusions

High risk primary care patients demonstrated high CKD prevalence and incidence, and rate of progressive GFR decline. Identified risk factors can be modified in primary care. Our risk model may aid primary care physicians to predict patients at high risk of progressive GFR decline.     

Global prevalence of occult hepatitis C virus: A systematic review and meta-analysis

BACKGROUNDOccult hepatitis C infection (OCI) is characterized by the presence of hepatitis C virus (HCV) RNA in the liver, peripheral blood mononuclear cells (PBMC) and/or ultracentrifuged serum in the absence of detectable HCV-RNA in serum. OCI has been described in several categories of populations including hemodialysis patients, patients with a sustained virological response, immunocompromised individuals, patients with abnormal hepatic function, and apparently healthy subjects.AIMTo highlight the global prevalence of OCI.METHODSWe performed a systematic and comprehensive literature search in the following 4 electronic databases PubMed, EMBASE, Global Index Medicus, and Web of Science up to 6th May 2021 to retrieve relevant studies published in the field. Included studies were unrestricted population categories with known RNA status in serum, PBMC, liver tissue and/or ultracentrifuged serum. Data were extracted independently by each author and the Hoy et al tool was used to assess the quality of the included studies. We used the random-effect meta-analysis model to estimate the proportions of OCI and their 95% confidence intervals (95%CI). The Cochran''s Q-test and the I² test statistics were used to assess heterogeneity between studies. Funnel plot and Egger test were used to examine publication bias. R software version 4.1.0 was used for all analyses.RESULTSThe electronic search resulted in 3950 articles. We obtained 102 prevalence data from 85 included studies. The pooled prevalence of seronegative OCI was estimated to be 9.61% (95%CI: 6.84-12.73) with substantial heterogeneity [I² = 94.7% (95%CI: 93.8%-95.4%), P < 0.0001]. Seropositive OCI prevalence was estimated to be 13.39% (95%CI: 7.85-19.99) with substantial heterogeneity [I² = 93.0% (90.8%-94.7%)]. Higher seronegative OCI prevalence was found in Southern Europe and Northern Africa, and in patients with abnormal liver function, hematological disorders, and kidney diseases. Higher seropositive OCI prevalence was found in Southern Europe, Northern America, and Northern Africa.CONCLUSIONIn conclusion, in the present study, it appears that the burden of OCI is high and variable across the different regions and population categories. Further studies on OCI are needed to assess the transmissibility, clinical significance, long-term outcome, and need for treatment.     

Systemic manifestations of chronic hepatitis C

It's well known that hepatitis C virus (HCV) related chronic liver disease may be associated with various extra hepatic disorders. These manifestations can revealed the hepatic disease. We review the available data on the conditions and asses their clinical implications: vascular, cutaneous, articular, neurological or renal disorders. There is no correlation between these extra hepatic manifestations and the severity of liver disease. Several recent studies have established a strong link between HCV infection and essential mixed cryoglobulinemia but some other extra hepatic associations are just fortuitous. Others datas are necessary to better analyze these extra hepatic disorders and to offer the beneficial treatment of patients with chronic hepatitis C.