scholarly journals THE COURSE OF HEPATITIS C INFECTION AND RESPONSE TO ANTI-VIRAL THERAPY IN PATIENTS WITH THALASSEMIA MAJOR AND HEPATITIS C INFECTION: A LONGITUDINAL, PROSPECTIVE STUDY.

2019 ◽  
Vol 11 (1) ◽  
pp. e2019060 ◽  
Author(s):  
Sanaa Kamal ◽  
Sara Abdelhakam ◽  
Dahlia Ghoraba ◽  
Mohamad Amer Mohsen ◽  
Ahmed Abdelsalam ◽  
...  
Keyword(s):  
Hepatitis C ◽  
Liver Fibrosis ◽  
Thalassemia Major ◽  
Hcv Infection ◽  
Progression Rate ◽  
Hepatitis C Infection ◽  
Fibrosis Progression ◽  
Acute Hcv ◽  
Chronic Hcv ◽  
Prospective Longitudinal

Background/Aims: The course of hepatitis C infection (HCV) in patients with thalassemia has not been adequately studied and management has not been optimized. The current prospective longitudinal study assessed the clinical course, outcome, progression and management of recently acquired HCV in patients with transfusion dependent thalassemia major versus acute HCV without thalassemia. Methods: A well-characterized cohort of patients with thalassemia and recent HCV infection or recent HCV without thalassemia were enrolled and prospectively followed. The blood transfusion needs and chelating agents were determined. Liver functions tests, HCV-RNA, iron and ferritin levels were measured. Patients with chronic HCV evolution received treatment for HCV. The fibrosis progression rate was determined in chronic HCV patients with or without thalassemia by paired liver biopsies or serial transient elastography (TE), or serum markers of liver fibrosis. Liver iron content (LIC) was assessed by R2 MRI.   Results: Self-limited acute HCV was observed in 17% of patients with acute HCV and thalassemia versus 35% of patients without thalassemia (P=0.031). The fibrosis progression rates were significantly higher in patients with chronic HCV and thalassemia compared to those with chronic HCV alone (1.14±0.48) and (0.35±0.14) (P < 0.0001) respectively. A direct linear correlation was observed between the fibrosis progression rate and each of LIC (R=+0.67; P=0.01) and ferritin (R=0.77; P<0.01). In patients with chronic HCV and thalassemia, the sustained virologic response (SVR) to pegylated interferon based therapy and direct antiviral agents (DAAS) were 33% and 82% respectively (P=), while in chronic HCV patients without thalassemia, the SVR rates to PEG-IFN/RBV and DAAs were 51% and 92% respectively. Five patients with concomitant HCV and thalassemia died during the study due to cardiac causes (n=3) and liver cancer (n=2). Conclusions: Patients with acute HCV and thalassemia have low rates of spontaneous resolution of HCV infection and the majority develop chronic HCV.  Direct acting antiviral combinations are associated with high SVR rates and low adverse event in treatment naïve and experienced patients with chronic HCV and thalassemia. Liver fibrosis is accelerated in thalassemia patients with chronic HCV, therefore, early diagnosis, treatment with DAAs, adequate iron chelation and non-invasive monitoring liver status are recommended to prevent cirrhosis and hepatocellular carcinoma.

scholarly journals Factors predicting staging and treatment initiation for patients with chronic hepatitis C infection: insurance a key predictor

2021 ◽  
Author(s):  
Janet Lin ◽  
Cammeo Mauntel-Medici ◽  
Anjana Bairavi Maheswaran ◽  
Sara Baghikar ◽  
Oksana Pugach ◽  
...  
Keyword(s):  
Chronic Hepatitis ◽  
Hepatitis C ◽  
Liver Fibrosis ◽  
Chronic Hepatitis C ◽  
Treatment Initiation ◽  
Cox Regression ◽  
Hcv Infection ◽  
Inpatient Setting ◽  
Hepatitis C Infection ◽  
Chronic Hcv

Abstract Background Chronic hepatitis C (HCV) infection affects over 2.4 million Americans and accounts for 18 000 deaths per year. Treatment initiation in this population continues to be low even after introduction of highly effective and shorter duration direct-acting antivirals. This study assesses factors that influence key milestones in the HCV care continuum. Methods Retrospective time-to-event analyses were performed to assess factors influencing liver fibrosis staging and treatment initiation among individuals confirmed with chronic HCV infection at University of Illinois Hospital and Health Sciences System between 1 August 2015 and 24 October 2016 and followed through 28 January 2018. Cox regression models were utilized for multivariable analyses. Results Individuals tested at the liver clinic (hazard ratio [HR] = 2.03; 95% confidence interval [CI]: 1.19–3.46) and at the federally qualified health center (HR = 3.51; 95% CI: 2.19–5.64) had higher instantaneous probability of being staged compared with individuals tested at the emergency department (ED) or inpatient setting. And probability of treatment initiation increased with advancing liver fibrosis especially for Medicaid beneficiaries (HR = 1.64; 95% CI: 1.35–1.99). Conclusions The study demonstrates a need for improving access for patients with early stages of the disease in order to reduce HCV-related morbidity and mortality, especially those tested at nontraditional care locations such as the ED or the inpatient setting.

S1273 The Natural History of Liver Fibrosis Progression Rate in Hepatitis C Infection

2010 ◽  
Vol 138 (5) ◽  
pp. S-218
Author(s):  
David Yamini ◽  
Benjamin Basseri ◽  
Anush Arakelyan ◽  
Pedram Enayati ◽  
Tram T. Tran ◽  
...  
Keyword(s):  
Hepatitis C ◽  
Liver Fibrosis ◽  
Natural History ◽  
Progression Rate ◽  
Hepatitis C Infection ◽  
Fibrosis Progression ◽  
History Of

Treatment of acute hepatitis C infection with interferon-alfa 2b monotherapy prevents development of chronic HCV infection

2001 ◽  
Vol 120 (5) ◽  
pp. A567-A567 ◽  
Author(s):  
E JAECKEL ◽  
M CORNBERG ◽  
T SANTANTONIO ◽  
J MAYER ◽  
H WEDEMEYER ◽  
...  
Keyword(s):  
Hepatitis C ◽  
Acute Hepatitis ◽  
Interferon Alfa ◽  
Hcv Infection ◽  
Acute Hepatitis C ◽  
Hepatitis C Infection ◽  
Chronic Hcv Infection ◽  
Chronic Hcv

scholarly journals 293. Hepatitis C is now a Millennial Disease in Response to the Opioid Crisis: A Demographic Shift in Hepatitis C Infection

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S159-S159
Author(s):  
Michelle Rose ◽  
John Allen Myers ◽  
Nicholas Ryan ◽  
Alissa Prince ◽  
Morgan Talbot ◽  
...  
Keyword(s):  
Hepatitis C ◽  
Baby Boomers ◽  
Infected Individual ◽  
The United States ◽  
Hcv Infection ◽  
Demographic Shift ◽  
Hepatitis C Infection ◽  
Opioid Crisis ◽  
Chronic Hcv ◽  
Over Time

Abstract Background Previous research has shown millennials represent the fastest growing generation for those infected with the hepatitis C virus (HCV). Millennials are also a key driver in the opioid crisis, particularly in states of the Appalachian region including Kentucky. Despite research demonstrating a change in prevalence from baby boomers (born 1945–1965) to millennials (born 1980–1995), large representative studies providing evidence of the magnitude of this demographic shift are lacking in the United States. Our objective was to assess trends of HCV infection since 2016 in a large healthcare system located in an area of high prevalence of opioid use and HCV infection. Methods All individuals were screened for HCV infection in 2016, 2017, and 2018 within Norton Healthcare per standard risk-based criteria (e.g., injection drug users, baby boomers, etc.) as recommended by CDC, except for pregnant women who were universally screened since 2016. We tested for demographic shifts over time using longitudinal and time series analyses techniques Results A total of 86,243 individuals were screened for HCV infection from 2016 to 2018. Of those, 2,615 (3.0%) individuals screened positive for chronic HCV. The average age of those infected significantly decreased by an average of 3.7 years annually (from 47.3 years in 2016 to 39.9 years in 2018, P < 0.001). We forecast a plateau near the age of 28 years will be observed in just over 7 years. In addition, the proportion of millennials increased over time (33.6% in 2016, 42.4% in 2017 and 51.4% in 2018, P < 0.001), while baby boomers significantly decreased over time (44.0% in 2016, 38.8% in 2017, and 29.3% in 2018, P < 0.001). Lastly, over time, those with chronic HCV were more likely to be male (increasing from 49.6% to 54.4%, P = 0.008) and Hispanic (increasing from 1.6% to 17.7%, P < 0.001) Conclusion Our results suggest that HCV infection has become a predominately millennial disease, skipping a generation. These results correlate with trends seen with the opioid epidemic, which is driven by millennials. We conclude that the opioid crisis has led to a drastic demographic shift, and currently the typical HCV-infected individual is a younger male. Without interventions, this trend will continue for over seven years, plateauing near the demarcation of millennials and generation Z Disclosures All authors: No reported disclosures.

scholarly journals Body mass index (BMI) and alpha-fetoprotein (AFP) level correlate with the severity of HCV-induced fibrosis in a cohort of Egyptian patients with chronic HCV

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Amal Ahmed Mohamed ◽  
Amr Ali Hemeda ◽  
Ramy Karam Aziz ◽  
Mohamed Salaheldin Abdel-Hakeem ◽  
Marwa Ali-Tammam
Keyword(s):  
Body Mass Index ◽  
Hepatitis C ◽  
Liver Fibrosis ◽  
Body Mass ◽  
Alpha Fetoprotein ◽  
Hcv Infection ◽  
Hcv Genotype ◽  
Egyptian Patients ◽  
Chronic Hcv ◽  
Severe Fibrosis

Abstract Background Viral hepatitis is the seventh leading cause of mortality globally, and half of this mortality is attributed to hepatitis C virus (HCV). Egypt has the highest HCV prevalence worldwide, with an estimated 14.7% of the population being HCV-positive. HCV infection is the primary cause of liver fibrosis, cirrhosis, and hepatocellular carcinoma. Liver fibrosis varies in severity during chronic HCV infection, and 10–20% of chronic hepatitis C (CHC) patients with severe fibrosis develop cirrhosis. The goal of this work was to assess the clinico-demographic predictors of severity of HCV-induced fibrosis in a cohort of Egyptian patients. Results A cohort of Egyptian patients with chronic HCV genotype 4a infection showed significant association between severe fibrosis stages and obesity, represented by a higher body mass index (BMI), low albumin level, high alpha-fetoprotein (AFP) level, low thyroid-stimulating hormone (TSH) level, and high alkaline phosphatase (ALP) level. Multivariate analysis delineated BMI, TSH, and ALP as independent significant variables that could predict the risk of fibrosis severity in HCV infections. Conclusion This study argues in favor of using the biomarker profile of CHC patients infected with HCV genotype 4a to identify patients at higher risk of developing severe fibrosis, which is a necessary first step towards precision medicine via patient stratification.

Prospective Risk Analysis of Hepatocellular Carcinoma in Patients with Chronic Hepatitis C by Ultrasound Strain Elastography

2016 ◽  
Vol 34 (6) ◽  
pp. 650-653 ◽  
Author(s):  
Norihisa Yada ◽  
Toshiharu Sakurai ◽  
Tomohiro Minami ◽  
Tadaaki Arizumi ◽  
Masahiro Takita ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Chronic Hepatitis ◽  
Hepatitis C ◽  
Liver Fibrosis ◽  
Liver Cancer ◽  
Chronic Hepatitis C ◽  
Hcv Infection ◽  
Rank Test ◽  
Entire Cohort ◽  
Chronic Hcv

Objective: We have reported about real-time tissue elastography (RTE), which displays relative strain by measuring the relative distortion of the tissue, and found this information to be useful for diagnosing liver fibrosis. However, its use in predicting hepatocellular carcinoma has not been reported as yet. Here, we investigated RTE to predict liver carcinogenesis in patients with chronic hepatitis C virus (HCV) infection. Methods: We enrolled 160 patients with chronic HCV, who were followed up for 39.9 ± 22.9 weeks (median). They underwent RTE and then ultrasounds every 3-6 months. Results: Respective cumulative liver cancer incidences for years 1, 2, 3, 4, and 5 were, for the entire cohort: 2.0, 5.6, 8.8, 13.1, and 23.9%; for those whose liver fibrosis index (LFI) was ≤2.0: 0.0, 0.0, 0.0, 0.0, and 0.0%; for those whose LFI was 2-2.8: 0.0, 7.4, 7.4, 13.2 and 19.9%; and for those whose LFI was >2.8: 12.9, 12.9, 21.7, 31.4, and 31.4% (p = 0.011; log-rank test). Conclusions: Measurements of LFI by strain imaging can effectively predict liver cancer risk in patients with chronic HCV infection.

scholarly journals Interferon treatment for chronic hepatitis C infection in hemophiliacs-- influence of virus load, genotype, and liver pathology on response

Blood ◽  
1996 ◽  
Vol 87 (5) ◽  
pp. 1704-1709 ◽  
Author(s):  
JP Hanley ◽  
LM Jarvis ◽  
J Andrew ◽  
R Dennis ◽  
PC Hayes ◽  
...  
Keyword(s):  
Chronic Hepatitis ◽  
Hepatitis C ◽  
Chronic Hepatitis C ◽  
Early Stage ◽  
Hcv Infection ◽  
Hcv Rna ◽  
Interferon Treatment ◽  
Hepatitis C Infection ◽  
Virus Load ◽  
Chronic Hcv

In this study, we assessed the effectiveness of interferon treatment in 31 hemophiliacs with chronic hepatitis C virus (HCV) infection. Interferon alfa-2a (3 MU three times weekly) was administered for 6 months. Response was assessed by both serial alanine transaminase (ALT) and HCV RNA levels measured by a sensitive semiquantitative polymerase chain reaction (PCR) method. HCV genotype was determined by restriction fragment length polymorphism (RFLP), and evidence of changing genotypes during interferon therapy was sought. Severity of liver disease was assessed by both noninvasive and invasive methods, including laparoscopic liver inspection and biopsy. Sustained normalization of ALT levels occurred in eight patients (28%), and seven (24%) became nonviremic as assessed by PCR (<80 HCV/mL). Responders universally cleared HCV RNA within 2 months of starting interferon. Genotype 3a was associated with a favorable response to interferon. No evidence was found for a change in circulating genotype in patients who failed to respond to interferon or who relapsed. This study confirms that response rates to interferon are low in hemophiliacs as compared with other groups with chronic HCV infection. We have also demonstrated that virus load measurement over the first 8 to 12 weeks of treatment is an extremely useful method to identify responders at an early stage.

scholarly journals Acute hepatitis C infection among adults with HIV in the Netherlands between 2003 and 2016: a capture–recapture analysis for the 2013 to 2016 period

2020 ◽  
Vol 25 (7) ◽  
Author(s):  
T. Sonia Boender ◽  
Eline Op de Coul ◽  
Joop Arends ◽  
Maria Prins ◽  
Marc van der Valk ◽  
...  
Keyword(s):  
Hepatitis C ◽  
The Netherlands ◽  
Global Strategy ◽  
Hcv Infection ◽  
Acute Hepatitis C ◽  
Hepatitis C Infection ◽  
Acute Hcv ◽  
Hiv Serostatus ◽  
Capture Recapture ◽  
Acute Hcv Infection

Background With regards to the global strategy towards eliminating viral hepatitis, reliable surveillance systems are essential to assess the national response for eliminating hepatitis C virus (HCV). Aim We aimed to assess the completeness of the two national registries with data on acute HCV infection in people with HIV, and estimated the number of acute HCV infections among adults (aged ≥ 18 years) with HIV in the Netherlands. Methods In this observational study, cases of HCV infection and reinfection among adults with a positive or unknown HIV-serostatus were identified from 2003 to 2016 in two national registries: the ATHENA cohort and the National Registry for Notifiable Diseases. For 2013–2016, cases were linked, and two-way capture–recapture analysis was carried out. Results During 2013–2016, there were an estimated 282 (95% confidence interval (CI): 264–301) acute HCV infections among adults with HIV. The addition of cases with an unknown HIV-serostatus increased the matches (from n = 107 to n = 129), and subsequently increased the estimated total: 330 (95%CI: 309–351). Under-reporting was estimated at 14–20%. Conclusion Under-reporting of acute HCV infection among people with HIV could partially be explained by an unknown HIV-serostatus, or by differences in HCV stage (acute or chronic) at first diagnosis. Surveillance data should ideally include both acute and chronic HCV infections, and enable to distinguish these as well as initial- and re-infections. National surveillance of acute HCV can be improved by increased notification of infections.

scholarly journals Acute hepatitis C virus infection

2008 ◽  
Vol 13 (21) ◽  
Author(s):  
W L Irving ◽  
D Salmon ◽  
C Boucher ◽  
I M Hoepelman
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Hcv Infection ◽  
Acute Hepatitis C ◽  
Acute Hcv ◽  
Chronic Hcv Infection ◽  
Chronic Hcv ◽  
The Individual ◽  
Acute Hcv Infection ◽  
Subsequent Risk

Around 25% of people infected with hepatitis C virus (HCV) are able to clear the infection spontaneously, while the majority become chronically infected, with a subsequent risk for the individual patient of progressive inflammatory liver disease, cirrhosis, hepatocellular carcinoma and liver-related death (Figure 1). Much is known about the epidemiology, pathogenesis, diagnosis and management of chronic HCV infection. In comparison, knowledge about acute HCV infection is patchy. In this article, we will highlight concerns relating to acute HCV infection and suggest that public health bodies responsible for managing the HCV epidemic should redirect at least some of their resources to dealing with these issues.

Assessing County-Level Vulnerability for Opioid Overdose and Rapid Spread of Human Immunodeficiency Virus and Hepatitis C Infection in South Dakota

2020 ◽  
Vol 222 (Supplement_5) ◽  
pp. S312-S321
Author(s):  
Chelsea A Wesner ◽  
Weiwei Zhang ◽  
Sandra Melstad ◽  
Elizabeth Ruen ◽  
Cassandra Deffenbaugh ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Hepatitis C ◽  
South Dakota ◽  
Composite Index ◽  
Hcv Infection ◽  
Opioid Overdose ◽  
County Level ◽  
Hepatitis C Infection ◽  
Immunodeficiency Virus ◽  
Chronic Hcv

Abstract Background Key indicators of vulnerability for the syndemic of opioid overdose, human immunodeficiency virus (HIV), and hepatitis C virus (HCV) due to injection drug use (IDU) in rural reservation and frontier counties are unknown. We examined county-level vulnerability for this syndemic in South Dakota. Methods Informed by prior methodology from the Centers for Disease Control and Prevention, we used acute and chronic HCV infections among persons aged ≤40 years as a proxy measure of IDU. Twenty-nine county-level indicators potentially associated with HCV infection rates were identified. Using these indicators, we examined relationships through bivariate and multivariate analysis and calculated a composite index score to identify the most vulnerable counties (top 20%) to this syndemic. Results Of the most vulnerable counties, 69% are reservation counties and 62% are rural. The county-level HCV infection rate is 4 times higher in minority counties than nonminority counties, and almost all significant indicators of opioid-related vulnerability in our analysis are structural and potentially modifiable through public health interventions and policies. Conclusions Our assessment gives context to the magnitude of this syndemic in rural reservation and frontier counties and should inform the strategic allocation of prevention and intervention services.

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