Sunday Posters (11/13/2005) HCV Epidemiology 1 8:00AM 6:30PM
Abstract ID: 65122
Category: JO4: HCV: Epidemiology
CURRENT EPIDEMIOLOGICAL TRENDS AND OUTCOME IN A LARGE COHORT OF ACUTE HEPATITIS C PATIENTS.
T. Santantonio, Clinic of Infectious Diseases,
University of Bari, Italy, Bari, Italy, C. Ferrari, Department of Infectious
Diseases and Hepatology, University of Parma, Parma, Italy, P. Fabris,
Department of Infectious Diseases and Tropical Medicine, S. Bortolo Ho,
Vicenza, Italy, G. Cariti, Department of Infectious Diseases, University of
Turin, Italy, Torino, Italy, M. Massari, Clinic of Infectious Diseases , S.
Maria Nuova Hospital, Reggio Emilia, Reggio Emilia, Italy, S. Babudieri,
Institute of Infectious Diseases,University of Sassari, Italy., Sassari, Italy,
M. Toti, Dipartimento Prevenzione, USL 9 di Grosseto, Italy., Grosseto, Italy,
R. Francavilla, Division of Infectious Diseases, Bisceglie Hospital, Italy,
Bisceglie, Italy, F. Ancarani, Institute of Infectious Diseases and Public Health,
University of Anco, Torrette di Ancona, Italy, G. Antonucci, National Institute
of Infectious Diseases, L. Spallanzani, Rome, Italy, Roma, Italy, G. Scotto,
Clinic of Infectious Diseases, University of Foggia, Italy, Foggia, Italy, V.
Di Marco, Cattedra e Unita Operativa Complessa di Gastroenterologia ed
Epatologi, Palermo, Italy, T. Stroffolini, Department of Gastroenterology, San
Giacomo Hospital, Rome., Roma, Italy
Introduction
The worldwide epidemiological pattern of acute HCV infection has changed requiring a re-evaluation of risk factors and preventive measures. Furthermore, the actual rate of chronicity of the current forms of acute hepatitis C must also be updated. The aims of this study were to investigate the current HCV transmission routes in a large number of patients with acute hepatitis C (AHC) and to assess the factors influencing spontaneous resolution of infection and the time-span involved.
Methods
214 HCV acutely infected patients including 140 males (65%)
and 74 females (35%), mean age 37.5 years (range 17-83), observed in the last
five years (1999-2004) in 12 Italian centres were enrolled. Diagnosis of acute
hepatitis C was based on the following criteria:
a) documented seroconversion to HCV antibodies (135 pts =
63%) or alternatively b) an abrupt increase of transaminase serum levels (more
than 20 times the upper normal value), active HCV infection, and absence of any
other cause of acute liver damage in previously healthy individuals (79 pts =
37%). Symptomatic disease was noted in 146/214 patients (68%) of whom 121 with
jaundice (57%). Genotype was as follows: 1a = 24 patients (11.2%), 1b = 66
patients (30.8%), 2a/2c = 41 patients (19.2 %), 3 = 35 patients (16.4%),
genotype 4 = 4 patients (1.9%) and unknown in 44 (20%). The potential
non-mutually exclusive risk factors for HCV transmission were: medical
procedures (hospitalization, surgical intervention, endoscopy, dialysis, dental
therapy) 144 patients (67%), iv drug abuse 84 patients (39%), sexual contact 67
patients (31%), unknown 28 patients (13%), accidental exposure 14 patients (7%)
household HCV carrier 9 patients (6%), other parenteral exposures (ear
piercing, tattooing, acupuncture) 8 patients (4%).
Results
The outcome was available in 202 patients; a spontaneous resolution
was observed in 73 patients (36.1%) while a chronic evolution occurred in 129
(63.9). The average time-span required for resolution was 72 days (range
21-173). Multiple logistic regression analysis showed that only asymptomatic
disease was independently associated with the likelihood of chronicity (OR=
4.0, 95% C.I.: 1.6-10.3), while sex, age, genotype, anti-HBc positivity, and
route of transmission resulted all unassociated.
Conclusion
· A waiting period of 2-3
months before treatment avoids therapeutical administration to those who would
spontaneously resolve the disease, thereby limiting necessary treatment to
patients actually requiring it.
· The study identified
I.V. drug use and medical procedures is the main present day routes of HCV
transmission in Itally.
· Currently, the
chronicity rate of acute HCV is 64%.
· The average time-span
required for resolution was 72 days (range 21-73)
· The only factor
independently associated with spontaneous resolution was symptomatic disease.
Implications
· Knowledge of recent
epidemiological patterns may help to define more effective prevention
strategies and surveillance programs in high risk populations, thus permitting
early detection and eventual treatment of newly acquired HCV cases.
· As spontaneous
resolution occurs within 4 months from disease onset in most patients (90%), a
waiting period of 3-4 months would limit treatment to patients actually
requiring it.
Abstract ID: 65906
Category: JO4: HCV: Epidemiology
PREVALENCE OF DIABETES MELLITUS AND INSULIN RESISTANCE IN JAPANESE PATIENTS WITH CHRONIC HEPATITIS C.
F. IMAZEKI, Chiba
University, Chiba City, Japan, O. YOKOSUKA, Chiba University, Chiba City,
Japan, K. FUKAI, Chiba University, Chiba City, Japan, T. KANDA, Chiba
University, Chiba City, Japan, H. SAISHO, Chiba University, Chiba City, Japan
Background:
A close association has been reported between hepatitis C
virus (HCV) infection and development of diabetes mellitus (DM). We
investigated the prevalence of DM and insulin resistance in Japanese patients with
chronic hepatitis C in comparison with that in chronic hepatitis B patients.
Materials and Methods:
This study included 1076 outpatients who visited our hospital
from Jan 2003 to Dec 2004, 544 HCV infected (group C; 257 males and 287 females
with a mean age of 58.4 ±13.0 years), 122 patients who have cleared HCV after
interferon treatment (group CC; 82 males and 40 females with a mean age of 53.2
±13.0 years), and 286 HBV infected patients (group B; 164 males and 122 females
with a mean age of 45.1±13.6 years). Insulin resistance was evaluated as
HOMA-IR in patients without overt DM and defined as HOMA-IR more than 2.0.
Results:
A prevalence of DM in groups B, C and CC was 6.3%, 13.6% and 9.0%
respectively (groups B vs C; p=0.001, groups C vs CC; p=0.229). A prevalence of
DM in clinical stage of asymptomatic carrier, chronic hepatitis and cirrhosis
was 6.2%, 10.3 % and 20.3 %, respectively (p=0.0003). Multivariate logistic
regression analysis showed the independent factors associated with development
of DM were age (odds ratio (OR) 1.027; p=0.005), male sex (OR 2.404; p=0.0003)
and cirrhosis (OR 2.370; p=0.029) but OR of HCV infection was 1.637 without
statistical significance (p=0.107). HOMA-IR was investigated in 421 patients
without overt DM. A prevalence of insulin resistance in HBV infected, HCV
infected and HCV eradicated patients was 36.3% of 135, 54.3% of 232 and 35.7%
of 56 patients, respectively (groups B vs C; p=0.0006, groups C vs CC;
p=0.009). Multivariate logistic regression analysis showed the independent
factors associated with insulin resistance were body mass index (BMI)(OR 1.484;
p<0.0001) and cirrhosis (OR 4.630; p=0.006) but OR of HCV infection was
1.736 without statistical significance (p=0.089).
Conclusion:
HCV infected patients showed a higher prevalence of DM and insulin resistance than those with HBV infection. However, other factors such as age, male sex, BMI and cirrhosis seemed more important risk factors for development of glucose intolerance in Japan.
Abstract ID: 67712
Category: JO4: HCV:
Epidemiology
Analysis of the HCV genotype 5a molecular epidemiology in Belgium using a Bayesian approach.
J. Verbeeck, Rega
Institute for Medical Research, Leuven, Belgium, P. Maes, Rega Institute for
Medical Research, Leuven, Belgium, P. Lemey, Rega Institute for Medical
Research, Leuven, Belgium, O. Pybus, Department of Zoology, Oxford, United
Kingdom (Great Britain), E. Song, Department of Internal Medicine,
Witwatersrand, South Africa, F. Nevens, Division of Hepatology, Leuven,
Belgium, S. Van der Merwe, Hepatology/GI-research laboratory, Pretoria, South
Africa, M. Van Ranst, Rega Institute for Medical Research, Leuven, Belgium
Introduction
Epidemiological and phylogenetic studies have proven useful
to characterize the spread and the origin of HCV infections. This study reports
an unexpected cluster of HCV genotype 5a, which is assumed to be restricted to
South Africa, in the West-Flanders province in Belgium. In order to characterize
the origin of this cluster, a phylogenetic analysis of Belgian and South
African HCV genotype 5a samples was performed.
Methods
Using a one-step reverse transcription PCR, we amplified 584
nt in the E1-E2 (HVR-1) region and 573 nt in the NS4B region. Maximum
likelihood (ML) phylogenetic trees were inferred under the
Hasegawa-Kishino-Yano model of nucleotide substitutions with gamma distributed
rate variation among sites using the program PhyML. Mean pairwise nucleotide
diversities were calculated using the ML trees that only included a single
viral strain per patient. Divergence dates and population history were
simultaneously estimated from the temporary spaced sequence data using a
Bayesian coalescent method. This approach is implemented in the computer
program BEAST v1.2. Analysis of the complete data set resulted in a date for
the most recent common ancestor (MRCA) around 1851 (CI: 1779-1909) and 1852
(CI: 1788-1902) for E1 and NS4B respectively. The date for the MRCA of the
Belgian subcluster was estimated around 1882 (CI: 1826-1927) and 1878
(1825-1919) for E1 and NS4B respectively. The South African clade was estimated
to be marginally older (1867 (CI: 1804-1908) and 1873 (1819-1916) for E1 and
NS4B respectively).
Results
The existence of the two clades indicates that the virus
spread independently in two different directions. Both clades also have similar
nucleotide diversity (mean pairwise nucleotide diversity of 0.14 0.03
and 0.16 0.04
in E1 for the Belgian and South African sequences respectively; 0.10 0.03
and 0.12 0.03
in NS4B). The relatively high degree of genetic diversity between the HCV
genotype 5a strains suggests that this genotype has been evolving in both
populations independently for a considerable time.
We propose that these Belgian and South African clusters
originate from a hitherto unknown common ancestor and that the virus has spread
from one common pool in two directions at the same time. This finding shines a
new light on the hypotheses concerning the origin of HCV genotype 5a. Study of
the genetic diversity of other HCV genotype 5a clusters will be necessary to
learn more about the origin and spread of this uncommon HCV genotype.
Abstract
ID: 61796
Category: JO4: HCV:
Epidemiology
A systematic review of panels of surrogate non-invasive markers of liver fibrosis in Hepatitis C.
I. Guha, Southampton
university, Southampton, United Kingdom (Great Britain), J. Parkes, Southampton
University, Southampton, United Kingdom (Great Britain),P. Roderick,
Southampton University, Southampton, United Kingdom (Great Britain), w.
Rosenberg, Southampton, Southampton, United Kingdom (Great Britain)
Background:
Assessing fibrosis in the context of chronic hepatitis C (CHC)
is important to ascertain prognosis and aids management and monitoring of the
disease. Liver biopsy is the current "gold standard" but has
limitations. There is considerable interest in finding surrogate markers in the
serum for liver fibrosis. Single marker tests have gradually been superseded by
panel tests in an attempt to improve diagnostic accuracy.
Methods:
We conducted a systematic review of the performance of panel
markers in CHC. Data were extracted from electronic databases 1985 October 2004:
Cochrane Library 2004, MEDLINE and EMBASE. Key measures of diagnostic accuracy
were extracted or derived where possible: area under the curve (AUC),
sensitivity, specificity, predictive values (PV), likelihood ratios (LR) and
diagnostic ratios (DOR). Clinically relevant predictive values (NPV 95 % and
PPV 90 %) were used to illustrate the percentage of the population to which the
scores can be accurately applied in each study. Inclusion criteria: panels of
>2 markers that produced a composite score, interferon naive patients with
CHC, N>30 and biopsy as a reference standard.
Results:
Electronic search yielded 2,766 abstracts; 14 primary studies
in separate populations with 10 different panels were included in final
analysis. Median age 44.5 (range 39-47), median proportion of male subjects was
64% (range 45-71%) and the median with moderate/severe fibrosis (F2/F3/F4) was
43% (range 17-80%). Median AUC in
validation populations was 0.77 (range 0.73 to 0.9). LR ranged from -ve LR of
0.1 to 0.9, to + ve LR of 1.2 to 33.1, median DOR was 9.0 (range of 5 to 27).
In general, tests performed well at the extreme published thresholds,
demonstrating a high sensitivity and low specificity or vice versa. The median
number of biopsies that could be definitely avoided was 38 % ( range across
studies 23 % to 47 %).
Conclusions:
ROC curves and its summary measure the AUC are the most
widely used and quoted assessments of diagnostic accuracy, but may be over
optimistic. With a median AUC of 0.77 these panels do not perform well in the
majority of patients as evidenced by more appropriate measures of accuracy such
as LRs and DORs. No test approached 100, the accepted value of diagnostic
excellence. Panel markers are accurate at the extreme thresholds, with either a
high specificity or sensitivity. A significant proportion of the population
tested will have values that lie between the extreme thresholds. Currently
available panels are not sufficiently robust to replace liver biopsy although
they may obviate the need for between 23 to 47 % of liver biopsies depending on
the panel used and prevalence of fibrosis.
Abstract
ID: 64154
Category: JO4: HCV:
Epidemiology
Outbreak of hepatitis C virus infection during sclerotherapy of varicose veins: long-term follow-up of 160 patients (3775 patient-years).
V. de Ledinghen, Hopital
Haut-Leveque, Pessac, France, J. Vergniol, Hopital Haut Leveque, Pessac,
France, P. Mannant, Clinique Bordeaux Nord, Bordeaux, France, F. Dumas,
Clinique du Tondu, Bordeaux, France, P. Champbenoit, Clinique Saint Martin,
Pessac, France, J. Vergier, Clinique Tivoli, Bordeaux, France, C. Baldit,
Hopital Robert Boulin, Libourne, France, P. Talbi, Hopital Bagatelle, Talence,
France, J. Foucher, Hopital haut-Leveque, Pessac, L. Castera, Hopital
Haut-Leveque, Pessac, N. Le Provost, Hopital Haut Leveque, Pessac, France, P.
Trimoulet, Hopital Pellegrin, Bordeaux, France, P. Couzigou, Hopital Haut
Leveque, Pessac, France, P. Bernard, Hopital Saint-Andre, Bordeaux, France, A.
Aquitaine-Gastro, Hopital Saint-Andre, Bordeaux, France
Introduction
Recently, we have provided evidence for patient-to-patient
nosocomial HCV genotype 2 transmission (by the same physician) during
sclerotherapy of varicose veins in 43 patients (J Med Virol 2005). The method
by which infection was likely to have been transmitted was the use of a single
vial on multiple patients.
Aim
The aim of this study was to describe the natural history of
HCV infection in patients who had sclerotherapy.
Methods
246 HCV-infected patients who had a past history of
sclerotherapy by this physician were evaluated. A detailed epidemiological
questionnaire on risk factors for HCV in infected patients were included. 29
patients (11.8%) had a risk factor of transfusion, were excluded of this study.
Futhermore, non-genotype 2 patients were excluded. So, 183 patients had a past history of
sclerotherapy by this physician. These sclerotherapy sessions were performed
from 1970 to 1993 (number of sessions for a patient: 1 to 2500 (median 50
sessions)), and 17 patients reported jaundice after a session. Characteristics
of the 246 patients were: 168 females (91.8%), age at contamination (first year
of sclerotherapy) 39.4 ± 11.6 years.
Results
F0F1 55.4 %, F2 33%, F3 5.4%, F4 6.2%. Mean follow-up was 23.8
± 11.6 years (range: 13-52). Mean fibrosis progression was 0.08 ± 0.06
units/year. No patient had HIV infection and one patient had HBV infection. HCV
treatment was performed in 54 patients, and response to treatment was:
sustained virological response 88.9%, relapse 9.3%, and non-response 1.8%. No
complication of liver disease was observed.
Conclusion
· To our knowledge, we
report the first large outbreak of HCV genotype 2 infection during
sclerotherapy of varicose veins. Therefore, all interviews concerning HCV
contamination should include a past history of sclerotherapy of varicose veins.
· Phyogenic analysis
confirms the probability of a common source of infection.
Abstract ID: 65377
Category: JO4: HCV:
Epidemiology
Sexual Dysfunction is Highly Prevalent Among Men with Chronic Hepatitis C Virus Infection and Negatively Impacts Health-Related Quality of Life.
D. Wan, NYU School of
Medicine, New York, NY, A. Danoff, VA New York Harbor Healthcare System and NYU
School of Medicine, New York, NY, O. Khan, NYU School of Medicine, NYU, NY, L.
Hurst, NYU School of Medicine, New York, NY, D. Cohen, NYU School of Medicine,
New York, NY, C. T. Tenner, VA New York Harbor Healthcare System and NYU School
of Medicine, New York, NY, E. J. Bini, VA New York Harbor Healthcare System and
NYU School of Medicine, New York, NY
Background
Sexual dysfunction has been reported in patients with
hepatitis C virus (HCV) infection, yet little is known about this association.
The aim of this study was to determine the prevalence of sexual dysfunction
among men with chronic HCV infection and to evaluate the impact of sexual
dysfunction on health-related quality of life (HRQOL).
Methods
We prospectively enrolled 112 HCV+ men without decompensated
cirrhosis who were not taking interferon/ribavirin and 239 HCV negative
controls from our GI and Primary Care clinics. Patients were excluded if they
had diabetes, HIV, prostate or other cancer, prostate surgery, thyroid disease,
alcohol or drug abuse, or were on methadone. A medical history was obtained,
and all patients completed validated questionnaires to assess sexual function
(Brief Male Sexual Function Inventory [BMSFI]), depression (Beck Depression
Inventory), and HRQOL (Medical Outcomes Study SF-36). The BMSFI assessed sexual
drive (0-8), erection (0-12), ejaculation (0-8), sexual problem assessment
(0-12), and overall sexual satisfaction (0-4), with lower scores indicating
greater dysfunction.
Results
Although HCV+ patients were younger than control subjects
(median age, 55.0 vs 62.0 years, P<0.001), they had significantly more
sexual dysfunction across all BMFSI domains: sex drive (see table)
|
|
Mean |
Score |
|
|
|
HCV Positive |
HCV Negative |
P value |
|
Sex drive |
3.4 |
4.6 |
P<0.001 |
|
Erectile function |
5.1 |
7.2 |
P<0.001 |
|
Ejaculation |
4.4 |
5.7 |
P<0.001 |
|
Sexual problem assessment |
5.6 |
8.6 |
P<0.001 |
|
Overall
sexual satisfaction |
1.5 |
2.2 |
P<0.001 |
For overall sexual satisfaction, the proportion of subjects who
were not sexually satisfied was higher in the HCV+ patients than in controls
(53.6% vs 28.9%, P<0.001) and this remained significant after adjusting for
age, race, and other potential confounding variables (OR = 2.56; 95% CI,
1.494.41). In addition, HCV+ patients were more likely to use sildenafil
citrate within the last 30 days as compared with control subjects (19.6% vs
9.6%, P = 0.009). Among HCV+ patients, the proportion of subjects who were not
sexually satisfied did not differ (P = 0.52) among those with none (47.5%),
mild-moderate (64.0%), moderate-severe (59.1%), and severe depression (50.0%).
HCV+ patients who were not sexually satisfied scored significantly worse in 6
of 8 domains of HRQOL as compared with HCV+ patients who did not report being
sexually dissatisfied.
Conclusions
Sexually dysfunction is highly prevalent in men with chronic
HCV infection, is independent of depression, and is associated with a marked
reduction in HRQOL. Additional studies are needed to determine the
pathophysiological Mechanism underlying the association between chronic HCV
infection and sexual dysfunction and evaluate the impact of HCV eradication on
sexual function.
Abstract ID: 66574
Category: JO4: HCV:
Epidemiology
Self-reported hepatitis C virus antibody status and risk behavior in young injectors.
H. Hagan, NDRI, New York,
NY, J. Campbell, Public Health Seattle and King County, Seattle, WA, H. Thiede,
Public Health Seattle and King County, Seattle, WA, S. Strathdee, University of
California San Diego School of Medicine,, San Diego, CA, L. Ouellet, University
of Illinois at Chicago, Chicago, IL, F. Kapadia, New York Academy of Medicine,
New York, NY, S. Hudson, Health Research Agency, Los Angeles, CA, R. Garfein,
University of California San Diego School of Medicine, San Diego, CA
Objective:
To assess the accuracy of self-reported hepatitis C virus
(HCV) antibody status in injection drug users (IDUs), and examine whether
self-reported HCV serostatus was associated with recent injection risk
behavior.
Methods:
In 5 US cities (Baltimore, Chicago, Los Angeles, New York,
and Seattle), 3106 young IDUs (15-30 years old) were recruited into a baseline
interview to determine eligibility for a randomized controlled trial of a
behavioral intervention. HIV and HCV antibody testing were performed, and
subject data (e.g., demographics, drug and sexual risk behavior, and history of
HIV and HCV testing) were collected via audio computeradministered
self-interview. Risk behavior during the previous 3 months was compared to
self-reported anti-HCV serostatus.
Results:
Anti-HCV prevalence in this sample of young IDUs was 34.1%.
Sensitivity and specificity of self-reported HCV status were low, as only 28%
of all HCV-positive IDUs knew their HCV-status vs. 54% of HCV-negative IDUs. A
history of drug treatment or needle exchange use was associated with increased
awareness of HCV-serostatus. Anti- HCV negative IDUs who knew their serostatus
were less likely than those unaware of their status to inject with a syringe
used by another IDU or to share cottons to filter drug solutions. Similar
associations were not observed among the anti-HCV positive IDUs.
Conclusions:
Few anti-HCV seropositive IDUs in this study were aware of
their serostatus. Expanded availability of HCV screening with high quality
counseling and testing is clearly needed for this high-risk population to
promote the health of HCVpositive IDUs and to decrease risk behaviors among
injectors susceptible to either acquiring or transmitting HCV.
Abstract
ID: 61650
Category: JO4: HCV:
Epidemiology
Racial Disparities in Hepatitis C Testing.
S. B. Trooskin, Thomas
Jefferson University, Philadelphia, PA, S. Herrine, Thomas Jefferson
University, Philadelphia, PA, D. Axelrod, Thomas Jefferson University,
Philadelphia, PA, R. Winn, Thomas Jefferson University, Philadelphia, PA, V.
Navarro, Thomas Jefferson University, Philadelphia, PA
Background:
Previous studies showed that physicians do not adequately
screen and test for hepatitis C (Sehab, 2003). To explore the possibility that
additional barriers exist to HCV testing, we examined whether race, trust in
physicians, health beliefs, and knowledge of hepatitis C are associated with
rates of testing for HCV, in the presence of an identified risk factor for HCV
acquisition.
Methods:
We prospectively enrolled all patients, 18 or older, who had
a risk factor for acquisition of HCV, and were being seen for the first time at
any of four primary care practices within the greater Philadelphia area. These
practices included two federally qualified health clinics serving predominantly
minority populations and two university based primary care practices, one of
which was a family medicine practice and the other was an internal medicine
practice. Questionnaires assessing demographic information, trust in
physicians, patients fatalistic beliefs about their health, and knowledge of
HCV were completed by participants. Chart reviews were conducted 2 months after
the physician visit to assess if HCV testing was planned or performed.
Results:
Of the 1415 patients enrolled in this study, 512 participants
identified themselves as Caucasian, 468 as Latino or Hispanic origin, and 435
as African American. Risk factor status differed by race, with 39% of
Caucasians, 31% of Hispanics, and 48% of African Americans reporting a risk
factor. Eight percent of African American patients with a risk factor were
tested for HCV as compared to 11% of Caucasians and 20% of Hispanics. After
adjusting for insurance status and education in the multiple covariate model,
both increasing age and race remain significant predictors of HCV testing.
Hispanics born in the United States (including Puerto Rico)
were no more likely to be tested in the presence of a risk factor than non-US born
Hispanics We found that trust in physicians, patients health beliefs, and HCV
knowledge were not significant predictors of testing.
Discussion:
Race alone is a major barrier to HCV testing, even in the
presence of a risk for acquisition; patients trust in physicians, health
beliefs, and HCV knowledge do not affect their willingness to be tested.
Further investigation is required to explain low testing rates among African
Americans at risk for HCV.
Abstract ID: 65573
Category: JO4: HCV:
Epidemiology
Prevalence of risk Factors for HCV transmission in HIV Infected and HIV/HCV Co-Infected Patients.
S. Bollepalli, Maricopa
Medical Center, Phoenix, AZ, K. Mahthieson, Maricopa Medical Center, Phoenix,
AZ, J. Post, Maricopa Medical Center, Phoenix, AZ, A. Hillier, Maricopa Medical
Center, Phoenix, AZ, A. Nadir, Maricopa Medical Center, Phoenix, AZ
Background:
Sexual transmission of HCV remains a contentious topic. 22%
HIV/HCV co-infected Arizonans are MSM, but do not report IVDU raising the possibility
that other HCV transmission risk factors are important. The aim of this study
was to compare prevalence of sexual and non-sexual risk factors between HIV
infected and HIV/HCV coinfected patients in Arizona.
Methods:
A sample of HIV patients completed a questionnaire in clinic
waiting area about demographic characteristics, HIV/ hepatitis status as well
as sexual non-sexual
risk factors. Information gathered included:
Birth outside the U.S., needle stick injury, use of IV or inhalation
drugs, sharing of razors or tooth brushes, body piercing, exposure to blood or
blood products, hemodialysis, sexual preference, number of sexual partners, age
at first intercourse, unsafe anal intercourse, sex with an IVDU, commercial
tattoos, history of sexually transmitted diseases, and being in prison. A chart
review was conducted to confirm information obtained from the questionnaire.
Data associated with co-infection status at the 0.1 alpha level in univariate
analyses were entered into a multivariate Cox regression model. A sub-analysis
was conducted on MSM.
Results:
Out of a total of 234 HIV positive patients analyzed, 165
(70.5%) were HIV infected and 69 (29.5%) were HIV/HCV co-infected. Risk factors
found significant in univariate analyses included IVDU, snorting drugs, sharing
razors or toothbrushes, prison, one or more tattoos, sex for money or drugs,
and sex with an IVDU and were put into a multivariate Cox regression model
(table 1). Risk factors associated with coinfected MSM patients included: Born in
a foreign country, IVDU, snorting drugs, sharing razors/toothbrushes, tattoos,
sex for money or drugs, and sex with an IVDU.
Having a history of STD and 11 or greater sex partners were
more prevalent among HIV mono-infected patients. In the multivariate model for
MSM, foreign- born status and IVDU were 3
and 8 times more likely to be co-infected with HCV respectively.
Conclusions:
IVDU remained the only significant transmission risk factor
that predicted HIV/HCV co-infection rather than HIV infection. Sexual
transmission of HCV among HIV patients is extremely rare.
Table 1 Multivariate Cox
Regression Predicting HIV/HCV Co-infection
|
|
Odds
Ratio |
5% CI |
p
value |
|
Non-Sexual Risk Factors |
|||
|
IVDU |
5.05 |
2.24, 11.36 |
.000 |
|
Snorting Drugs |
1.07 |
5.14, 2.22 |
.861 |
|
Shared Razors or Toothbrush |
.991 |
.487, 2.02 |
.981 |
|
Prison |
1.022 |
.514, 2.03 |
.950 |
|
Tattoo |
1.03 |
.563, 1.87 |
.935 |
|
|
|
|
|
|
Sexual Risk Factors |
|||
|
Sex for money or drugs |
1.12 |
.567, 2.21 |
.745 |
|
Sex with IV drug user |
1.07 |
.461, 2.25 |
.877 |
Abstract ID: 67763
Category: JO4: HCV:
Epidemiology
Alcohol use in US Veterans: A Multicenter Study of 4,061 Hepatitis C-infected Patients.
B. S. Anand, Michael E. DeBakey
VA Medical Center, Houston, TX, S. Currie, San Francisco VA Medical Center, San
Francisco, CA, E. J. Bini, VA New York Harbor Healthcare System, New York, NY,
H. Shen, San Francisco VA Medical Center, San Francisco, CA, S. B. Ho ,
Mineapolis VA Medical Center, Mineapolis, MN, E. Dieperink, Mineapolis VA
Medical Center, Mineapolis, MN, T. L. Wright, San Francisco VA Medical Center,
San Francisco, CA
Background/Aims:
Alcohol use is highly prevalent in the U.S. Veteran
population. The extent of this problem and its association with various risk
factors has not been well examined. The aim of this study was to compare
demographic behaviors and risk factors associated with alcohol use in a large
cohort of Hepatitis C (HCV)-infected patients.
Methods:
This was a multicenter study involving 24 Veterans
Administration hospitals throughout the U.S. All patients completed a detailed
questionnaire on alcohol use including the type of alcoholic beverage usually
consumed [beer, wine, mixed drinks]; the highest number of drinks consumed on a
regular basis, and the total duration of alcohol use. The results obtained in
chronic alcohol users were compared with a group of nondrinkers.
Results:
Out of 4,061 HCV RNA positive patients, a total of 3,340
admitted to being regular drinkers (consuming at least one drink a day on a
regular basis). Several differences were observed between regular drinkers and
nondrinkers (n=721). Regular drinkers were younger in age (p=0.01) but did not
differ from non-drinkers with respect to race, high school education or income
level. Regular drinkers were more likely to have served in Vietnam (p=0.001),
and were more likely to have had a history of injection drug use (p<0.0001),
snorting cocaine (p<0.0001) and incarceration (p<0.0001). Moreover,
regular drinkers were more likely to have participated in high risk sexual
(p=0.06), multiple (>50) sexual partners (p=0.0002), sex with a prostitute
(=<0.001) and sex with people using injection drugs (p<0.0001). The
difference between mild/moderate drinkers (<6 drinks/day; n=893) and heavy
drinkers (≥ 6 drinks/day; n=2447) was also analyzed. Heavy drinkers were
more likely to be younger (p=0.0004), Caucasian (p=0.0003), have less high
school education (p=0.0003) and have served in Vietnam (p<0.0001).
Comments:
· Alcohol use is very
common in the US veteran population with HCV infection and the majority of
these subjects belong to the category of heavy drinkers (73% vs. 27%
mild/moderate drinkers).
· There was a significant
association between alcohol use and service in Vietnam, as well as high risk
lifestyle such as the use of drugs, needles and sexual activity.
· In order to reduce
future liver-related morbidity and mortality in this patient population we
believe greater emphasis should be placed on:
a. Early identification
and discussion of alcohol use
b. Targeting young persons
and other populations at great risk of heavy alcohol use
c.
Providing alcohol and risk behaviour modifications programs
d.
A multidisciplinary approach to HCV antiviral treatment.
Abstract ID: 62454
Category: JO4: HCV:
Epidemiology
Prevalence and Characteristics of Hepatitis C Virus Infection in a Population of Patients with Sickle Cell Disease at a Tertiary Care Teaching Hospital
S. Fink, Brigham and
Women's Hospital, Boston, MA, A. Fretts, Brigham and Women's Hospital, Boston,
MA, R. Maurer, Brigham and Women's Hospital, Boston, MA, S. I. Reddy, Brigham
and Women's Hospital, Boston, MA, E. Mandell, Brigham and Women's Hospital,
Boston, MA, W. H. Churchill, Brigham and Women's Hospital, Boston, MA, N.
Grace, Brigham and Women's Hospital, Boston, MA
Background:
Frequently reliant on blood transfusion therapy, patients
with sickle cell disease (SCD) had been thought to be disproportionately
affected by bloodborne transmission of viral infection. As a result, the
prevalence of hepatitis C virus (HCV) infection has been shown to be greater in
this population than in the general population. These observations, however,
are based partly on patients who had received blood transfusions prior to compulsory
testing in blood banks for HCV and to advances in HCV testing technology. With
the implementation of widespread screening of blood products for HCV infection
in the early 1990s, this prevalence should have diminished. Advances in
therapy for SCD patients have also resulted in patients surviving longer and
becoming potential candidates for treatment of their chronic HCV disease.
Efforts to characterize the nature and epidemiology of HCV disease in this
population are therefore highly relevant.
Objective:
Determine the prevalence and characteristics of HCV in
patients with SCD and characterize infection in patients with SCD.
Methods:
All patients with SCD who were seen and followed at the Dana Farber
Cancer Institute/Brigham and Womens Hospital hematology clinic from 1995
through 2005 were included in this study. Data was abstracted from the
patients electronic longitudinal medical record.
Results:
83 SCD patients were identified and eligible for inclusion in
the study. The mean age was 33.6 years (SD =9.9). 85.6% (71 patients) of the patients were
African-American and 7% (6 patients) were Hispanic. 79 (96.2%) patients were
tested for HCV antibody using an ELISA assay. 6 patients (7.2%) were positive
and 73 (88%) were negative for HCV antibodies (4 patients (14.8) were
unavailable. All six patients who tested
positive underwent confirmatory quantitative HCV RNA testing by PCR. Two of
these patients had undetectable levels of virus indicating that 4 (4.8%) of the
79 patients were infected with HCV. Of the four viremic patients, three
patients had RNA levels greater than 105, and one had a level
greater than 106. Subgroup analysis showed no statistically significant
difference in median age between the 4 patients who had HCV present and the 75
who did not. Three of the four viremic patients had genotype testing performed.
Two patients were genotype 1a and one was genotype 2b. Four patients had viral
load to low to perform genotype.
Conclusions:
Based on quantitative RNA testing, only 6 out of 85 patients
(7%) of SCD patients in our study group were shown to be infected with HCV.
These data suggest that a much lower percentage of patients with SCD have
chronic HCV than had been previously reported during the era prior to
widespread testing of the blood supply.
Abstract
ID: 63941
Category: JO4: HCV:
Epidemiology
How place of residence and distance to medical care influence hepatitis C (HC) detection : a population-based study.
E. MONNET, faculty of
medicine and pharmacy, Besanηon Cedex, France, E. NAUDET, Hepatitis C Network,
Besanηon cedex, France, Metropolitan, S. BRESSON, service d'hιpatologie,
BESANCON cedex, France, A. MINELLO, service de gastroentιrologie, DIJON,
France, D. CAREL, URCAM, BESANCON, France, V. JOOSTE, centre ιpidιmiologie de
population, DIJON, France, Metropolitan, P. EVRARD, hepatitis C Network,
BESANCON, France, J. MIGUET, service d'hιpatologie, BESANCON cedex, France, P.
HILLON, service de gastroentιrologie, DIJON, France
Introduction
For more than ten years now, HC screening has been
recommended in the French primary care setting. However, in 2001, only 38% of
all screening tests were prescribed in France by general practitioners (GP),
most of the tests being requested by private specialists and hospital doctors.
These results raise the question of equal access to HC screening, as people
living in rural areas tend to consult private specialists less often than their
urban counterparts. The aim of this study, conducted in a population-based HC
registry, was 1) to compare the detection rates in urban and rural areas by
taking into account geographic access to GP and specialist care, and 2) to
analyze the influence of the urban-rural place of residence on the
circumstances of diagnosis and on patients epidemiological and clinical
characteristics.
Methods
Between 1994 and 2001, 1938 new cases of HC were diagnosed in
two French administrative areas
numbering 1,005,817 inhabitants. A patients canton of residence was
classified as urban or rural by using data of the National Institute of
Statistics and Economic Studies. Cantons were distributed into tertiles of
mean distance to the nearest GP and to the nearest hepato-gastroenterologist.
Age and sex-adjusted detection rates (DR) for 100,000 inhabitants were
estimated for urban and rural cantons and for each class of distance to a
physician. The Poisson model was used for multivariate analysis. Circumstances
of diagnosis and patient characteristics were compared by using logistic
regressions adjusted for age and sex.
Results
DR were lower in rural than in urban cantons [14.1, 95%
confidence interval (95CI) (12.5-15.7) versus 24.7, 95CI (23.5-26)] and
decreased as the distance to the GP increased : 27, 95CI (25.5-28.4) for cantons
with a mean distance less than 1.5 kms, versus 13.7, 95CI (12.1-15.3) for
cantons with a greater mean distance. After taking into account distance to
GP in multivariate analysis, the difference between urban and rural cantons
was no longer significant [detection rates ratio 0.87, 95CI (0.71-1.05]. DR
decreased as the mean distance to hepato-gastroenterologist increased, but only
in urban cantons [detection rate ratio 0.65, 95CI (0.5-0.74) for cantons
with distance exceeding 10.8 kms]. No characteristics differed between urban
and rural patients, except for screening by GP and history of transfusion, more
frequent in the latter group. Our study highlights the importance of geographic
accessibility to medical care in the detection of HC, with a lower HC detection
in rural areas, related to greater distance to a GP. Nevertheless, we did not
find evidence of a more delayed diagnosis in rural areas.
Abstract ID: 64163
Category: JO4: HCV:
Epidemiology
CHANGING EPIDEMIOLOGY OF HCV AND HBV INFECTIONS IN NORTHERN ITALY: A SURVEY IN THE GENERAL POPULATION.
A. Floreani, Dpt.of
Surgical and Gastroenterological Sciences, University of Padova, Padova, Italy,
T. Baldovin, Dpt.of Surgical and Gastroenterological Sciences, University of
Padova, Padova, Italy, P. Fabris, Dpt. of Infectious Diseases and Tropical
Medicine, Vicenza, Italy, V. Baldo, Dpt.of Environmental Medicine and Public
Health, Institute of Hygiene, Padova, Italy, G. Tositti, Dpt. of Infectious Diseases
and Tropical Medicine, Vicenza, Italy, R. Trivello, Dpt. of Environmental
Medicine and Public Health, Institute of Hygiene, Padova, Italy, F. de Lalla,
Dpt. of Infectious Diseases and Tropical Medicine, Vicenza, Italy
Introduction
Seroepidemiological studies carried out ten years ago in the
Italian general population demonstrated that the proportion of anti-HCV
increases by age, with a rate of HCV infection of people over 65-yrs as high as
33%. As for HBV infection, the HBsAg prevalence was reported ranging from 2% to
7%. Aim: to evaluate the modification of HBV and HCV epidemiology in the
general population of Northern Italy.
Materials and methods:
A cohort of 965 subjects (452 males and 513 females)
residents in a district of Northern Italy was anonymously tested for HBV and
HCV infections. All serum samples were assayed for: 1. anti-HCV by ELISA
(BIO-RAD, France); HCV-RNA by PCR and positive cases genotyped; 2. HBsAg (and,
when positive, for HBeAg/anti-HBe); 3. anti-HBs and anti-HBc by ELISA (BIO-RAD,
France).
Results:
The overall rate of anti-HCV was 2.6% (25/965), showing a
gradual increasing trend after 60 years of age, with the highest prevalence
(12%) in subjects over 75 years. None of the subjects under 25 years was
anti-HCV positive, but a peak of 2.1% was seen between 35-44 years in both sex.
Anti-HCV positivity was similar in males and females (2.4% vs 2.7%). HCV-RNA
was positive in 40% of cases. Genotype 1b was detected in 7 subjects (70%), 2a
in 1 (10%); 2 subjects were infected with more than one genotype 1 patient
1b/2b and 1 patient 1a/2c). The overall HBsAg prevalence was 1% (10/965). The
rate showed a significant age trend (p<0.02). Only one subject was HBeAg
positive. The prevalence of anti-HBs was 23.8% (vaccinated subjects); anti-HBs+/anti-HBc+
was found in 8.4%, anti-HBc isolated was found in 4.2% of cases. No subject
resulted coinfected with HBV and HCV.
Conclusions:
A marked changing of both HCV and HBV epidemiological figures
has been observed in Northern Italy:
1) A peak of HCV prevalence in young adults possible related
to new risk factors;
2) A cohort effect
showing a reduction of HCV infection in old age due to age-related mortality;
3) A decline in HBV infection in Northern Italy, which can be
categorized now at low prevalence (<2%), according to the CDC, Atlanta.
4) Immigrants from underdeveloped countries still carry a
risk of HBV.
Abstract
ID: 65681
Category: JO4: HCV:
Epidemiology
Disparities in the clinical characteristics, evaluation and outcomes of African American and Caucasian patients with Hepatitis C.
A. Yudovich, Henry Ford
Hospital, Detroit, MI, R. Vachhani, Henry Ford Health System, Detroit, MI, L.
Lamerato, Henry Ford Health System, Detroit, MI, D. Moonka, Henry Ford Health
System, Detroit, MI
Purpose:
The aim of this study was to identify disparities that may
exist in the clinical presentation, evaluation and treatment of African
American (AA) patients infected with hepatitis C when compared to Caucasian
patients in our health care system.
Methods:
The health system database of a single integrated health care
system was queried to identify patients with a positive hepatitis C antibody
test discovered since 1997. 7588 patients were identified and 395 were randomly
selected for retrospective chart reviews. Of these, 199 were AA and 165 were
Caucasian. The two groups were compared for characteristics at presentation,
the likelihood of referral, the rate and results of liver biopsy, and the rate
of treatment and response to treatment. Differences were assessed using
Fishers exact test and T-test.
Results:
AA were older at diagnosis than Caucasian patients (49.3 v. 44.3 years: p<0.001). The groups were comparable in terms of gender and route of transmission. 85% of AA and 75% of Caucasian patients who were tested were HCV RNA positive (p=0.199). AA patients were less likely to be seen by a gastroenterologist (24 % v. 34 %: P = 0.035). AA patients seen by a gastroenterologist who were HCV RNA positive were as likely to undergo biopsy (32% v. 34%) as Caucasians and had significantly more benign histology. Only 4% had bridging fibrosis or cirrhosis vs 30% of Caucasians (p=0.047). In addition, 3% of AA patients presented with hepatic decompensation as opposed to 7% of Caucasian patients (p=0.072). AA patients seen by a gastroenterologist were less likely to receive therapy (20% v. 47%: P = 0.009) and less likely to respond to therapy (22 % v. 46 %: p = 0.264). Of all patients identified with hepatitis C antibody, 11 out of 165 (7%) Caucasians and 2 out of 199 (1%) AA received care leading to a sustained viral response.
|
|
African-American |
Caucasian |
p value |
|
Age (years) |
49.3 ± 10.2 |
44.3 ± 9.8 |
<0.001 |
|
GI evaluation |
24% (47/199) |
34% (56/165) |
0.035 |
|
Bridging |
4% (1/23) |
30% (7/23) |
0.047 |
Conclusions:
AA patients with hepatitis C are less likely than Caucasians
to be seen by a gastroenterologist. AA had more benign disease on presentation.
They were less likely to receive therapy and to respond to therapy though the latter
difference was not significant. In this analysis, the likelihood that an AA
patient identified with hepatitis C antibody would receive management and
therapy leading to eventual viral eradication is very low (1%). The etiology of
these discrepancies is unclear and warrants further investigation.
Abstract
ID: 60731
Category: JO4: HCV:
Epidemiology
How well informed are HCV-infected German subjects about their disease and how do they perceive the public information status about hepatitis C.
C. Niederau, St. Josef Hospital Oberhausen, Germany, 46045 Oberhausen,
Germany, A. Kautz, Deutsche Leberhilfe e.V., Kφln , Germany, G. Bemba, Deutsche
Leberhilfe e.V., Kφln
Background:
Although a good information about HCV infection is crucial
both for preventive and therapeutic consequences, little is known about how
well patients are informed about their disease.
Aims and Methods:
The present study prospectively analyzed questionnaires about
the information status of patients concerning hepatitis C in general and their
individual disease, and about their view on the public information status about
hepatitis C; the study included the SF12 quality-of-life analysis. Overall 1500
questionnaires were distributed by clinics (30%), practioneers (20%), patient
support groups (30%) and the internet (20%); 714 questionnaires were sent back
and analyzed.
Results:
The 714 HCV-infected patients (56% female, 44% male) had a
mean age of 52 years and a duration of hepatitis of 18 years. Only 4% of the
subjects considered the public information about hepatitis C as good or very
good, but 80% as bad or very bad. Of the subjects 4% did not know how they had
been infected; 39% remembered to have received blood products and only 10%
indicated that drug abuse might have been the route of infection. Almost all
subjects knew that HCV cannot be transmitted via shaking hands, use of
bathrooms, kisses of food (< 1%, respectively). Surgery (17%) and the
dentist (15%) however were mentioned often as a major risk for infection. About
80-85% of subjects knew recent quantitative data on ALT and HCV-RNA, their
genotype and the results of liver biopsy. Mental and physical SF12 scores were
reduced in the patients by about one SD when compared with the general age- and
sex-matched population, but were not associated with the information status of
the patients regarding HCV-RNA, ALT, genotype or histological grading and
staging.
Conclusions:
The data shows that opinions are wrong which pretend that
hepatitis C today is just a disease of drug addicts. German subjects with HCV
infection are well informed about their infection including genotype, liver
histology, ALT and HCV-RNA; on the other hand there are information deficits
and fears concerning the mode of infection since many subjects consider
dentists and surgeons as major risks to get hepatitis C. Mental and physical
quality-of-life is not associated with the information status of the patients
about their disease; patients without knowledge about the degree of
replication, inflammation and fibrosis did not feel better or worse than
patients who exactly knew this information. The recent analysis also clearly
shows that HCV infected subjects consider the public information about the HCV
infection as catastrophically bad.
Supported by the federal German hepatitis-compentence-network
projec.
Abstract
ID: 62781
Category: JO4: HCV:
Epidemiology
HEPATITIS B AND C: PREVALENCE AND SOCIAL FACTORS ASSOCIATED WITH SERO-POSITIVITY AMONG CHILDREN IN KARACHI, PAKISTAN.
W. Jafri, Aga Khan
University Hospital, Karachi, Pakistan, N. Jafri, Aga khan University Hospital,
Karachi, Pakistan, J. Yakoob, Aga Khan University Hospital, Karachi, Pakistan,
M. Islam, Aga khan University Hospital, Karachi, Pakistan, S. F. Tirmizi, Aga
Khan University Hospital, Karachi, Pakistan, T. Jafar, Aga Khan University
Hospital, Karachi, Pakistan, S. Akhtar, Aga Khan University Hospital, Karachi,
Pakistan, S. Hamid, Aga Khan University Hospital, Karachi, Pakistan, H. A.
Shah, Aga Khan University Hospital, Karachi, Pakistan, S. Abid, Aga Khan
University Hospital, Karachi, Pakistan, Q. Nizami, Aga Khan University
Hospital, Karachi, Pakistan
Aim:
Infections with hepatitis C virus (HCV) and hepatitis B virus
(HBV) lead to hepatocellular carcinoma. This cross-sectional study estimated
the prevalence and identified risk factors associated with HCV and HBsAg
sero-positivity among children 1 to 15 years of age in Karachi, Pakistan.
Methodology:
The study targeted the low to middle socioeconomic population
that comprises 80% to 85% of the population. Consent was obtained from parents
of the eligible children before administering questionnaire and collected a
blood sample for anti-HCV and HBsAg serology.
Results:
3533 children were screened for HBV and HCV. 1862 (52 %) were
males and 1707 (48%) females. 65 (I.8 %) were positive for HBV, male to female
ratio 38:27; mean age 10 ± 4 years. 55 (1.6 %) were positive for HCV, 32 (58%)
boys and 23 (42%) girls; mean age 9 ± 4 years. 4 (0.11%) boys were positive for
both HBV and HCV. The educational status of HBV and HCV positive childrens and
their parents was low. 60 (92 %) HBV positive children parents and 51 (93 %)
HCV positive have not heard of hepatitis B and C viruses. 45 (69%) HBV positive
(p< 0.04) received therapeutic injections as compared to HCV 28 (51%). 29
(45%) HBV and 17 (31%) HCV received therapeutic injections from local doctor.
45 (68%) HBV and 28 (51%) HCV claimed to be given therapeutic injection by a
new plastic needle and syringe every time with odd ratio (OR) 2.0 95%
confidence interval (CI) 1.0-4.2 p=0.05. 46 (71%) HBV and 33 (60%) HCV received
vaccination in the government hospital OR 4.6 CI 2.6-10.7 p< 0.001. A new
needle and syringe was used for this purpose in 32 (49%) with HBV and in 45
(82%) with HCV OR 1.6 CI 0.08- 3.5 p=0.21. The prevalence of HBV in the east of
the city was 24 (6%) OR 4.8 CI 2.7-8.7 p<0.001 and in the south 18 (2 %) OR
1.8 CI 0.3-3.3 with p=0.08. The odds of HBV were 2.2 times higher than HCV with
CI 1.1-4.6.
Conclusion:
There is a need to educate low socio-economic strata
population regarding HBV and HCV infection and dangers associated with
unsterilized therapeutic injections
Abstract ID: 64490
Category: JO4: HCV:
Epidemiology
Factors associated with the presence of hepatitis C (HCV) RNA among anti-HCV positive young injecting drug users (IDUs) in metropolitan Chicago.
B. Boodram, University of
Illinois@ Chicago, Chicago, IL, R. C. Hershow, University of Illinois, Chicago,
IL, L. J. Ouellet, University of Illinois, Chicago, IL, W. Gao, University of
Illinois, Chicago, IL
Objective:
To identify factors associated with viremic HCV infection in
a cohort of young (18-32) IDUs seropositive for HCV antibodies (HCVAb+).
Methods:
HCVAb+ IDUs (EIA 3.0 signal-tocut-off ratio >3.8) were
enrolled from 2002 to 2005 in a prospective NIDA-funded HCV natural history
study. Quantitative HCV RNA was measured by polymerase chain reaction using
SuperQuantTM (National Genetics Institute, Los Angeles, CA) and HCV genotyping
was performed. After excluding participants with HIV-infection or HCV treatment
history, a crosssectional analysis was conducted on 118 HCVAb+ participants (84
[71.2%] with and 34 [28.8%] without detectable HCV RNA [<100 copies/ml]).
Risk factors were obtained from self-interview, computerized baseline
questionnaires. Univariable and multivariable analyses were performed. A test
for trend assessed ordinal variables.
Results:
Among 118 participants, 55.9% were Caucasian, 26.3% Hispanic
and 17.8% Black/other races. In univariable analyses, participants with and
without detectable HCV RNA were similar on age (mean=24.4 vs. 25.4, p=0.98) and
gender (male=60.7% vs. 52.9%, p=0.44); however, Caucasians were more likely
than all others to have detectable HCV RNA (77.3% vs 63.5%, p=0.10). Estimated
years of HCV infection did not differ between the groups (1.3 vs. 1.3, p=0.64).
Viremic participants tended to engage in higher risk injection practices
including having longer injection careers (<3 yrs, >3 yrs, OR=2.2,
p=0.15), higher number of injections per year (< median of 910, >910,
OR=1.7, p=0.23), injecting with syringes or paraphernalia used by others
(OR=1.8, p=0.21) and using drugs first mixed or divided in someone elses
syringe (OR=3.7, p=0.08). An injection risk scale including these 4 dichotomous
variables was constructed with a point added for each high-risk category
fulfilled and a risk score from 0-4 was assigned. In logistic regression, a
higher risk score was significantly associated with HCV RNA presence using an
ordinal ranking of scores (0, 1-2, >2).
A significant trend was noted (OR0=1.0, OR1-2=2.7,
OR>2=6.9, p-trend <0.001). Adjusting for age, race, gender, and other
variables did not significantly confound or modify the risk score association
with HCV RNA presence. Among participants with detectable HCV RNA, genotype
could be determined in 65 (77.4%). Most common genotypes were 1a (50.0%), 1b
(11.5%), and 3A (11.5%). The distribution of genotypes was not significantly
associated with HCV RNA level, age, gender, race or injection risk score.
Conclusion:
This cross-sectional analysis suggests that higher risk
injection practices are associated with HCV viremia among HCV-infected IDUs.
Abstract ID: 65885
Category: JO4: HCV:
Epidemiology
Comparative molecular analysis of HVR1 and HVR2 to detect transmission of HCV genotype 2 from an anesthesiologist to 32 patients.
Y. Shemer-Avni , Ben
Gurion University, Beer Sheva, Israel, M. Cohen, Rabin Medical Center, Petach
Tikva, Israel, A. K. Naos, Ben Gurion University, Beer Sheva, Israel, E.
Sikuler, Ben Gurion University, Beer Sheva, Israel, N. Hanuka, Ben Gurion
University, Beer Sheva, Israel, A. Yaari, Ben Gurion University, Beer Sheva,
Israel, E. Hayam, Ben Gurion University, Beer Sheva, Israel, L. Bachmatov,
Rabin Medical Center, Petach Tikva, Israel, R. Zemel, Rabin Medical Center,
Petach Tikva, Israel, R. Tur-Kaspa, Rabin Medical Center, Beilinson campus,
Petach-Tikva, Israel
Introduction
Hepatitis C virus (HCV) is efficiently transmitted by direct
percutaneous exposure to infectious blood and can be transmitted in the health
care setting. Although a rare event, transmission of HCV from infected health
care workers to patients may occur. Here we describe a study on HCV infection
outbreak that lasted for 2 years in a regional hospital. HCV transmission
occurred due to an intravenous drug-user anesthesiologist that was infected
with HCV genotype 2a/c. In response to the hospital call, 2000 persons were
tested for the presence of HCV infection, 1200 of them were treated by the
anesthesiologist (provider-group) and 800 were non-relevant group. The
screening included testing anti-HCV antibodies, HCV-RNA detection by PCR, and
genotyping.
Results
In the provider-group, 32 patients were found to be infected
with HCV type 2a/c while in the non-relevant group only one was infected with
this genotype. To establish further the source of infection, HCV RNA was
isolated from the patients sera, amplified and the sequence diversity of HCV
E1-E2 region, including the HVR1 and HVR2, was analyzed. As controls we used
sera from patients infected with HCV genotype 2a/c previous to the outbreak and
non-relevant sequences from genotype 2a/c retrieved from the database. The HCV
sequences were aligned with the isolated HCV sequence from the serum of the
anesthesiologist. The genetic distance differences between the sequences
isolated from the provider-group sera and those isolated from the control group
were highly statistically significant. The genetic distances were: 1.4-4.4% in
the HVR1 and 0-3% in the HVR2 in the provider-group sera while in the control
group it was 22-45% and 10-35% respectively. It is of interest that the
sequence homology, determined in the various isolates from the infected sera,
was conserved both in the HVR1 (95.6-98.6%) and HVR2 (97-100%) regions. Further
analysis of the double-stranded RNA-activated PKR-eIF2a phosphorylation
homology domain (PePHD), which is considered to be a predictor of Interferon
response in HCV treated patient was performed.
Conclusion
This analysis, revealed that the sequenced motif of the PePHD domain in all the provider group isolates predicted good response to Interferon. Our findings suggest that the anesthesiologist with chronic HCV infection genotype 2 may have transmitted HCV to 32 of his patients during the administration of anesthetic procedure.
Abstract ID: 67707
Category: JO4: HCV:
Epidemiology
Five Million Americans Infected with the Hepatitis C Virus: A Corrected Estimate.
B. R. Edlin, Weill Medical
College of Cornell University, New York , NY
Background:
The number of persons in the
Methods:
Using data from the U.S. Census, the Centers for Medicare
& Medicaid Services, the Bureau of Justice Statistics, and the published
medical literature, we estimated the number of persons in five populations
groups excluded from the NHANES sampling frame and the prevalence of HCV
antibodies in each: incarcerated persons, homeless persons, hospitalized
persons, active duty military, and nursing home residents. We used the NHANES
estimate for the proportion of antibody-positive persons who are currently
infected (73.9%).
Results:
An estimated 800,000 to 1,200,000 persons excluded from the NHANES sampling frame have HCV antibody, of whom 733,000 (592,000 to 868,000) are currently infected.
Conclusions:
The number of
Abstract
ID: 67040
Category: JO4: HCV:
Epidemiology
Evidence for sexual transmission of HCV in recent epidemic in HIV-infected men in South-East England.
M. Danta, Centre for
Hepatology, London, United Kingdom (Great Britain), D. Brown, Centre for
Hepatology, London, United Kingdom (Great Britain), O. Pybus, Department of
Zoology, Oxford, United Kingdom (Great Britain), M. Nelson, Department of HIV
Medicine, London, United Kingdom (Great Britain), M. Fisher, Department of HIV
Medicine, Brighton, United Kingdom (Great Britain), C. Sabin, Department of
Primary Care and Population Sciences, London, United Kingdom (Great Britain),
A. Johnson, Department of Primary Care and Population Sciences, London, United
Kingdom (Great Britain), G. Dusheiko, Centre for Hepatology, London, United
Kingdom (Great Britain), S. Bhagani, Department of HIV medicine, London, United
Kingdom (Great Britain)
Aims:
To characterise the mode of acute HCV transmission in
HIV-infected individuals using linked molecular and clinical epidemiological
analysis.
Methods:
Patients enrolled were diagnosed with acute HCV, as defined
by seroconversion to anti-HCV within six months of a negative result and/or a
positive HCV RNA, between October 2002 and May 2005. The E1/E2 region of the
HCV genome from each patient's serum was amplified with RT-PCR and sequenced.
Using PAUP* software, phylogenetic trees were constructed from the amplified
sequences, comparing them with unrelated E1/E2 sequences. Past population
dynamics of the largest independent HCV lineage (clade) were analysed using
BEAST software. A case-control study using a questionnaire instrument to
determine transmission factors was performed using two HIV monoinfected
controls for each case matching; sexuality, age, race, length of HIV infection
and HAART. Mann-Whitney U and Chi-squared tests were used to compare the characteristics
of the cases (n=37) and controls (n=78).
Results:
100 HIV-positive homosexual males (mean age 35 yrs, CD4 552
cells/mcl, 65% on HAART) with acute HCV (HCV genotype 1: 75%, genotype 3a: 17%,
genotype 4: 8%) have been identified. Phylogenetic analysis of 80 E1/E2
sequences reveals multiple monophyletic clades signifying that several
independent HCV lineages are co-circulating in this population. The largest
clade involves 31 patients. Provisional population dynamic analysis of this
clade suggests that there has been an increase in the transmission of HCV since
the late 1990's, after the introduction of HAART. Cases had more sexual
partners than controls (median number of partners 30 vs 10, p<0.001) in the
preceding 12 months. Preliminary factors identified more commonly in cases
(n=37) vs controls (n=78) are: unprotected receptive and insertive anal
intercourse (p<0.001), mucosally traumatic practices including
"fisting" (p<0.001) and use of sex toys (p<0.001), group sex
(87% vs 52.3%, p=0.01), and sexual activity under the influence of drugs (100%
vs 64%, p<0.003).
Conclusions:
High risk and mucosally traumatic sexual factors are
significantly associated with the recent transmission of HCV. The
co-circulating HCV lineages identified by phylogenetic analysis belong to
different subtypes and genotypes, indicating that the epidemic is not
attributable to viral genetic change, but rather patient factors such as sexual
or drug behaviour. This is supported by the population dynamic analysis. These
patient factors should be the focus of education-based public health
interventions.
Abstract
ID: 65599
Category: JO4: HCV:
Epidemiology
CAUSES OF DEATH IN PEOPLE WITH HEPATITIS B OR C INFECTION: A POPULATION BASED COHORT STUDY.
J. Amin, National Centre
in HIV Epidemiology and Clinical Research, Sydney, Australia, M. G. Law,
National Centre inHIV Epidemiology and Clinical Research, Sydney, Australia, M.
Bartlett, NSW Health, Sydney, Australia, J. M. Kaldor, National Centre in HIV
Epidemiology and Clinical Research, Sydney, Australia, G. J. Dore, National
Centre in HIV Epidemiology and Clinical Research, Sydney, Australia
Aim:
To determine causes of death in a population based cohort of
people diagnosed with hepatitis B and C virus (HBV HCV) infection.
Methods:
The analysis cohort consisted of 39109 people with HBV, 75834
people with HCV and 2604 people with HBV/HCV co-infection, notified to the NSW
State health department between 1990 and 2002. Their data were
probabilistically linked to the National Death Index. Causes of death were
grouped by ICD 10 category. Standardised mortality ratios (SMRs) for liver
related and drug related deaths were calculated using standard NSW death rates,
and were adjusted for age, sex and calendar period.
Results:
The number of deaths identified by the linkage were 1233(3.2
%) for HBV, 4008 (5.3)% for HCV and 186(7.1)% for HBV/HCV co-infection. The
most frequently reported causes of death were neoplasms (38%) for HBV, and
external causes (28% and 27%) for HCV and HBV/HCV co-infection respectively.
Relative risk of liver related death (SMRs 18.6, 95%CI 16.620.8; 18.55, 95%CI
16.920.3; 40.6, 95%CI 28.757.4 for HBV, HCV and HBV/HCV co-infected persons
respectively) and drug induced death (SMRs 1.8, 95%CI 1.32.4, 22.5 95%CI
21.523.9; 22.4 95%CI 22.439.3 respectively) were elevated in all groups.
People with HCV were at significantly greater relative risk of dying from drug
rather than liver related causes. Women with HCV infection were at greater
increased risk than men from both liver (SMR F= 25.4, 95%CI 21.330.3; SMR
M=16.9, 95%CI 15.218.8) and drug (SMR F= 31.6, 95%CI 28.035.6; SMR M=20.8,
95%CI 19.422.2) related death. SMRs of death from a drug related causes was
highest for people notified with infection at age 15-19 years (SMR HBV 17.6,
95%CI 7.3342.4; SMR HCV 89.3, 95%CI 52.9150.7).
Conclusions:
This is the first study to describe the risk of liver and
drug related deaths in a population based HBV/HCV infected cohort. All groups
experienced increased risk of liver related death. It is estimated that 80% of
HCV infections in Australia are acquired through injecting drug use. We show a
very high mortality risk associated with drug use in people with HCV,
especially for young people. Our data highlight that young people with HCV face
a higher mortality risk from continued drug use than from their HCV infection.
Abstract
ID: 67163
Category: JO4: HCV:
Epidemiology
Mass Screenings in New York City reveal high prevalence of Hepatitis B in an urban Asian population.
A. Sherman, New York
University School of Medicine, New York, NY, T. Tsang, Charles B. Wang
Community Health Center, New York, NY, G. Villaneuva, New York University
School of Medicine, New York, NY, H. Pollack, New York University School of
Medicine, New York, NY, M. Rey, New York University School of Medicine, New
York, NY, H. Tobias, New York University School of Medicine, New York, NY, A. ,
Asian American Hepatitis B Program, New York, NY
Introduction
Mass screening of the New York City Asian population in
Manhattan, Brooklyn and Queens for hepatitis B was undertaken with funding
provided by New York's City Council. The Asian American Hepatitis B Program
(AAHBP) aims to screen 5000 Asian Americans to determine the prevalence of
chronic hepatitis B and organize a treatment model. Through April 1, 2005 1348
persons have been screened. Overall, 21% were HBsAg+. Preliminary analysis of
this group was undertaken. 53.2% were men, 8.5% were 18 to 25, 74% were 26 to
59, and 16.2% were over 60. Infection was significantly correlated with age and
gender (p<0.001). Men were more than twice as likely to be infected (28.8%
vs. 12.2%). Young adults were significantly more likely to be infected (35.1%)
vs under 18 (18.8%), 26 to 59 (22.8%) and over 60 (8.3%).
Additional detailed demographic data is available for the
first 372 patients screened at the Charles B Wang Community Centers in
Manhattan and Queens through April 1, 2005. This group was 55.6% women, 72 %
Chinese and 22% Korean. Approximately 75% were 26 to 59 years old. All were
Asian immigrants: 27.2% were in the United States for less than 3 years, 30% for 4 to 10 years and
a third for over 10 years. Overall, in this subgroup, the rate of HBsAg+ was
16.3%; Chinese had a 18.6% positivity rate and Koreans 12.2%. Men had a positivity
rate over twice that of women(24% vs. 11%). There was a significantly lower
infection rate in those over 60 compared to younger age groups. There were no
significant differences in prevalence between established and more recent U.S.
immigrants.
Conclusion:
The incidence of HBsAg+ individuals in our survey is
significantly higher than in previously reported screenings of Asian Americans
where the incidence has been 10 to 15%. Preliminary results of mass screenings
in New York Asian American population for Hepatitis B reveals an prevalence of
21%, markedly higher than in previous U.S. screenings. Further investigation is
continuing as the AAHBP aims to screen 5000 persons and analyze demographic
data which will help guide management of this major public health problem.
(The study was sponsored by a New York City Council grant to
the AAHBP, a non-profit, public/private coalition working with the New York
University Center for the Study of Asian American Health).
Abstract ID: 65262
Category: JO4: HCV:
Epidemiology
Comparative epidemiology of hepatitis C and hepatitis B in Manitoba, Canada.
J. Uhanova, University of
Manitoba, Winnipeg, Canada, D. J. Tataryn, University of Manitoba, Winnipeg, Canada,
G. Y. Minuk, Head, Section of Hepatology, University of Manitoba,
Introduction:
An estimated 2% of Canadians are infected with hepatitis C
and B viruses. Reports comparing the epidemiology and natural history of HCV
and HBV in large North American populations are limited. This study examined
and compared the prevalence, demographics, and risk factors associated with
chronic hepatitis C [CHC] and chronic hepatitis B [CHB] in a Western Canadian
province.
Methods:
We linked clinical viral hepatitis data with provincial
databases of hospital
abstracts, physician utilization, pharmacare, communicable
diseases, and population
registry. Statistical analyses were carried out in SAS 8.0.
Results:
A total of 4477 cases of CHC and 1380 cases of CHB were
reported in Manitoba in 1992-2002. Rates of CHC (per 100,000 population)
increased sharply from 19.9 in 1994 to 57.7 in 2001; in contrast with the much
lower and slowly decreasing rates of CHB: 13.1 in 1994 to 10.0 in 2001.
Provincial rates of CHC were primarily driven by the 40-49 year old males, who
accounted for more than one quarter of all cases with rates 3 times the overall
Manitoba rates. Individuals with CHB were younger: 40% < 30 years, compared
to 20% for CHC (p<0.000). 90% of all CHC cases were among Canadian-born
populations. In sharp contrast, 54% of CHB infections were amongst immigrants
from SE Asia and another 6% from other countries (p<0.000). 13% of CHC cases
and 5% of CHB cases were among First Nations [FN] individuals. 15% of CHC and
22% of CHB reported hepatitis-related symptoms. The proportion of CHC
individuals with cirrhosis (18.5%) was twice that of CHB cirrhosis (9.4%).
Complications of cirrhosis (those with HRS, portal HTN, encephalopathy) were
also more frequent in CHC (3.6%) compared with CHB (2.2%), (p<0.011). There
were no differences in the frequency of HCC (1.0% vs. 1.5% respectively).
Compared to non-First Nations, FN with CHC had similar rates of cirrhosis (16.5
vs.17.4) and complications (2.9 vs. 3.6), while FN with CHB had significantly
higher rates of both cirrhosis (15.3 vs. 9.1) and complications (5.6 vs. 2.0),
(p<0.04).
|
Differences
in risk factors were as follows |
||
|
|
CHB |
CHC |
|
Residence in endemic area* |
47.9 |
1.8 |
|
Blood Tx recipient* |
2.3 |
11.7 |
|
Vertical* |
4.7 |
0.2 |
|
Incarceration* |
1.4 |
12.4 |
|
Sexual contact* |
14.3 |
8.9 |
|
IDU* |
11.0 |
25.9 |
|
Household contact |
6.6 |
5.4 |
|
Medical/Dental* |
4.3 |
13.1 |
|
Tattoo/Piercing* |
5.6 |
19.0 |
|
Occupational |
1.9 |
1.6 |
* p<0.000
Conclusions:
In this North American population, CHC is more often
associated with cirrhosis and its complications than CHB. However the risk of
HCC is similar in the two groups. The natural history of viral hepatitis in
North American Aboriginals appears to differ from that of non-aboriginals.
Abstract ID: 65599
Category: JO4: HCV:
Epidemiology
CAUSES OF DEATH IN PEOPLE WITH HEPATITIS B OR C INFECTION: A POPULATION BASED COHORT STUDY.
J. Amin, National
Centre in HIV Epidemiology and Clinical Research,
Aim
To determine causes of death in a population based cohort of
people diagnosed with hepatitis B and C virus (HBV and HCV) infection.
Methods
The analysis cohort consisted of 39,109
people with HBV, 75,834 people with HCV and 2,604 people with HBV/HCV
co-infection, notified to the
Results
The number of deaths identified by the linkage were 1,233(3.2 %) for HBV, 4,008 (5.3%) for HCV
and 186(7.1%) for HBV/HCV co-infection. The most frequently reported causes of
death were neoplasms (38%) for HBV, and external causes (28% and 27%) for HCV
and HBV/HCV co-infection respectively. Relative risk of liver related death
(SMRs 18.6, 95% CI 16.620.8; 18.55, 95% CI 16.920.3; 40.6, 95% CI 28.757.4 for
HBV, HCV and HBV/HCV co-infected persons respectively) and drug induced death (SMRs
1.8, 95% CI 1.32.4, 22.5 95% CI 21.523.9; 22.4 95% CI 22.439.3 respectively)
were elevated in all groups. People with HCV were at significantly greater
relative risk of dying from drug rather than liver related causes. Women with
HCV infection were at greater increased risk than men from both liver (SMR F=
25.4, 95% CI 21.330.3; SMR M=16.9, 95% CI 15.218.8) and drug (SMR F= 31.6,
95% CI 28.035.6; SMR M=20.8, 95% CI 19.422.2) related death. SMRs of death
from a drug related causes was highest for people notified with infection at
age 15-19 years (SMR HBV 17.6, 95% CI 7.3342.4; SMR HCV 89.3, 95% CI
52.9150.7).
Conclusions
This is the first study to describe the risk of liver and
drug related deaths in a population based HBV/HCV infected cohort. All groups
experienced increased risk of liver related death. People with HBV, HCV, and
HBV/HCV coinfections were 12, 17, and 33 more times likely to die from
liver-related deaths than the general population, with liver cancer deaths more
common in those with HBV. It is estimated that 80% of HCV infections in