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, 1.49–4.41). 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, patient’s 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 1990’s, 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 Women’s Hospital hematology clinic from 1995 through 2005 were included in this study. Data was abstracted from the patient’s 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, Besançon Cedex, France, E. NAUDET, Hepatitis C Network, Besançon cedex, France, Metropolitan, S. BRESSON, service d'hépatologie, BESANCON cedex, France, A. MINELLO, service de gastroentérologie, DIJON, France, D. CAREL, URCAM, BESANCON, France, V. JOOSTE, centre épidémiologie de population, DIJON, France, Metropolitan, P. EVRARD, hepatitis C Network, BESANCON, France, J. MIGUET, service d'hépatologie, BESANCON cedex, France, P. HILLON, service de gastroentérologie, 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 patient’s ‘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 Fisher’s 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
Fibrosis/cirrhosis

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., Köln , Germany, G. Bemba, Deutsche Leberhilfe e.V., Köln

 

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 children’s 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 else’s 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 United States who have been infected with hepatitis C virus (HCV) has been estimated at 3.9 million, including 2.7 million currently infected. These estimates were derived from the National Health and Nutrition Examination Survey (NHANES), however, which excludes several high-risk populations from its sampling frame. The true number of HCV infections in the United States is therefore unknown.

 

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 U.S. residents who have been infected with HCV is probably 800,000 to 1,200,000 higher than the 3.9 million NHANES estimate, or approximately five million. Of these, approximately 3.4 million are currently infected.   The current mortality and morbidity estimates are based on the NHANES survey.  Now that there is a revised estimate of HCV infections, the previous estimate of HCV mortality and morbidity will need to be revised.

 


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 16.6–20.8; 18.55, 95%CI 16.9–20.3; 40.6, 95%CI 28.7–57.4 for HBV, HCV and HBV/HCV co-infected persons respectively) and drug induced death (SMRs 1.8, 95%CI 1.3–2.4, 22.5 95%CI 21.5–23.9; 22.4 95%CI 22.4–39.3 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 21.3–30.3; SMR M=16.9, 95%CI 15.2–18.8) and drug (SMR F= 31.6, 95%CI 28.0–35.6; SMR M=20.8, 95%CI 19.4–22.2) 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 7.33–42.4; SMR HCV 89.3, 95%CI 52.9–150.7).

 

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, Winnipeg, Canada

 

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, Sydney, Australia, M. G. Law, National Centre in HIV 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 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 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 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 16.6–20.8; 18.55, 95% CI 16.9–20.3; 40.6, 95% CI 28.7–57.4 for HBV, HCV and HBV/HCV co-infected persons respectively) and drug induced death (SMRs 1.8, 95% CI 1.3–2.4, 22.5 95% CI 21.5–23.9; 22.4 95% CI 22.4–39.3 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 21.3–30.3; SMR M=16.9, 95% CI 15.2–18.8) and drug (SMR F= 31.6, 95% CI 28.0–35.6; SMR M=20.8, 95% CI 19.4–22.2) 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 7.33–42.4; SMR HCV 89.3, 95% CI 52.9–150.7).

 

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 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.