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Background@#The association between hepatitis C virus (HCV) infection and chronic kidney disease (CKD) still remains controversial. We aimed to investigate whether HCV really affects renal function, and to analyze the association between clinical effects of CHC and decreased kidney function (assessed by glomerular filtration rate (eGFR) level).@*Aim@#Study of renal dysfunction in chronic hepatitis C virus infection@*Materials and Methods@#An estimated 222 patients with HCV infection and 222 age- and sex-matched community-based control individuals without HCV were enrolled (1:1, case and control ratio) in this study between from June 2022 to March 2023. We used the modification of diet in renal diseases to calculate eGFR. This study was approved by the review board of the Ethics Subcommittee of Ach Medical University and followed the Declaration of Helsinki. All statistical analysis was performed with SPSS version 26.0 software (SPSS Inc., Chicago, IL, USA), and a P value < 0.05 was considered statistically significant. Continuous variebles were presented as mean ± standard deviation, while categorical data was represented as numbers and percentages. Independent t-tests were used to compare the differences in parametric variables. The Mann-Whitney U test was performed to compare the follow-up period. Pearson’s chi-squared and Fisher’s exact tests were used to compare categorical variables. Multivariate logistic regression was used to identify the risk factors associated with recurrence. @*Results@#The median age of the respondents was 40 (range 21-70). In the case group, the speed of hanging judgment was 105.3±24.5, and in the control group, it was 118.7±18.5, which was a statistically significant difference (p<0.05, p<0.05). It was observed that the rate of filtration of the renal is below 90 or the loss of renal function increases with age (47.50±9.3 vs 40.21±11.1; p<0.01). In order to reduce the effect of age, when evaluating the renal function of participants over 45 years of age in the case-control group, the HCV was 99.69 in the case group and 111.05 in the control group, although there was an age effect on the decline in HCV in both groups, but it decreased more in the HCV-infected group. When comparing two groups (<3.25, >3.25) with liver fibrosis degree above and below 3.25, the higher degree of fibrosis affects the decrease in the rate of hepatic filtration (112.92±19.8 vs 105.23±27.1; p<0.01). The proportion of cryoglobulinemia was high when renal dysfunction was beginning or when the GFR was below 90 (<90). Logistic regression analysis showed that cryoglobulinemia had the greatest influence on the decrease in glomerular filtration rate (OR 4.22, 95% CI 1.97-9.00, p<0.05). The relationship between age and the decline in hanging judgment speed was statistically significant and directly moderate (r=0.95, p=0.009). On the other hand, there is a statistical relationship between gender and the decrease in the speed of hanging judgment, with a probable and weak correlation (r=0.07, p=0.01).@*Conclusion@#Our study found that the patients with HCV infection are associated with a low eGFR compared with non-HCV–infected patients. This association is consistent in age, gender, cryoglobulinemia and liver fibrosis patients.
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Introduction@#Studies have shown that hepatitis C virus (HCV) infection not only causes hepatitis, but also pathological changes in other organ systems. Therefore, it is necessary to study the relationship between chronic HCV and chronic kidney disease.@*Objective @#To determine the factors influencing renal glomerular function in chronic hepatitis C patients@*Materials and methods@#Patients with chronic hepatitis C virus were referred to Third Central Hospital, Tegsh Huslen Medical Center, two regional 2020 from August to October. Data on morbidity of patients with chronic hepatitis C were analyzed. The results were processed using SPSS-23 software. Statistical probabilities were determined by checking whether there were statistically significant differences between the groups, using logistic regression analysis and chi-square methods.@*Results @#There were 54 (46.9%) individuals whose renal glomerular filtration rate was reduced to less than 90 ml/min. In a linear regression analysis, a decrease in renal glomerular filtration rate with age was a significant correlation. Renal glomerular filtration rate is decreased in 37% patients by age-related manner (r2 = 0.37). To determine other causes, no significant correlations were observed when grouped by diabetes, cirrhosis, BMI, and hepatic steatosis (p>0.005). The older age of the patient and the high blood pressure were at 6.4 times higher risk to decrease the glomerular filtration rate in patients with chronic hepatitis C (OR 6.4 (95% CI 1.3-31.4), p=0.021) than the patients who have young age and normal blood pressure by multiple logistic regression analysis.@*Conclusion@#The age of the patient and high blood pressure are contributing factors to the decline in the incidence of low glomerular filtration rate in patients with chronic hepatitis C.
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OBJECTIVE：To evaluate the cost-utility of the pan-genotypic direct-acting antivirals （DAAs）in the treatment of patients with chronic hepatitis C infection ，and to provide pharmacoeconomic evidence for relevant health care decisions. METHODS：A Markov model was established from a societal perspective with newly diagnosed chronic hepatitis C patients in China as the target population ，and analyzed quality-adjusted life years （QALYs）and incremental cost-utility ratios （ICERs）of patients with chronic hepatitis C with sofosbuvir/velpatasvir ，glecaprevir/pibrentasvir，sofosbuvir+coblopasvir. Sensitivity analysis was used to verity the robustness of the results. RESULTS ：Glecaprevir/pibrentasvir increased QALYs by 0.002 1 and costs by 25 021 RMB，compared to sofosbuvir/velpatasvir ；its ICERs was 12 129 031 yuan/QALY（willingness to pay threshold was 70 892 yuan/QALY），which had no cost-utility ；glecaprevir/pibrentasvir need to cut down the price by 64.65％ to have cost-utility. Sofosbuvir+coblopasvir increased QALYs by 0.002 0 and saved costs by 515 yuan，so it was the optimal regimen which was cost-saving. Sensitivity analysis showed that SVR rates and drug prices were the most influential factors. The probability of having cost-utility for sofosbuvir+coblopasvir was higher than glecaprevir/pibrentasvir. CONCLUSIONS ：Glecaprevir/pibrentasvir need to reduce the price to achieve better affordability. Sofosbuvir+coblopasvir shows economical advantage.
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Background: To ascertain the prevalence of Hepatitis C infection among patients visiting a tertiary care center in Jaipur, Rajasthan.Methods: An observation analytic study was done at a tertiary care center affiliated to Medical College with retrospective analysis of the hospital data of two calendar years. During this period HCV infection screening (anti-HCV) was offered to every suspected patient admitted in hospital and every pregnant women visiting antenatal care clinic.Results: The study prevalence of HCV infection was 0.05% (13/25311). The prevalence was more in female (0.03%) than male (0.02%). The study prevalence of anti-HCV among pregnant female was 0.02% (3/16224). Maximum positive cases (4/13, 30.77% positive cases) were in the age group of 21-30 years (sexually active group) and >50 years age group while minimum positivity was found in children (00 case, 0-20 years age).Conclusions: In this study, prevalence of HCV infection was 0.05%. The study prevalence of HCV among pregnant females was 0.02%. Maximum positive cases (4/13, 30.77% positive cases) were in the age group of >50 years and 21-30 years. This study aids in view to strengthen proper screening for HCV infection to reduce HCV related morbidity and mortality
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Introduction: Viral hepatitis is one of the common causes of chronic liver disease. Hepatitis C is the second most importantcause of chronic viral hepatitis. Globally, an estimated 71 million people have chronic hepatitis C infection. In 2015, there were1.75 million new hepatitis C virus (HCV) infections. Approximately 399,000 people die each year due to HCV-related cirrhosisand hepatocellular carcinoma. Highest numbers of infections are noted in Egypt. South East Asian region countries are alsohaving high prevalence. The prevalence in India is around 1%. In Tripura, blood bank-based study shows prevalence around0.1%. Higher prevalence was seen in patient on maintenance hemodialysis.Objectives: The study was designed to determine. (1) Mode of transmission of hepatitis C in Tripura, (2) To evaluate genotypicpattern of hepatitis C infection in Tripura, (3) To evaluate coinfection with human immune deficiency virus (HIV)/hepatitis B virus (HBV).Materials and Methods: It was a cross-sectional study done on 60 consecutive hepatitis C patients attended the liver clinic ofHepatitis Foundation of Tripura between January 2018 and December 2018.Results: The study reveals that in this group, 65% hepatitis C patients were males and 35% were females and 63.3% patientsare from rural areas whereas 36.7% patients are from urban areas. Study shows that there is shift of age among hepatitis Cpatients from older to the younger group. It was observed that 5% of hepatitis C patients had coinfection with HIV infectionbut no coinfection with HBV. Regarding mode transmission of hepatitis C, 30% are through blood transmission, 20% throughdrug abuse, 16.7% patients through sexual route, 11.6% patients through dialysis, 1.7% prenatal transmission, and 20%remain unknown. Genotype 3 was 75% (3a was found in 55% and 20% were genotype 3b,) and genotype 1 was 25% (21.7%genotype 1a and 3.3% were genotype 1b). In the study group, 18% were in decompensated chronic liver disease.Discussion: The prevalence of HCV infection seems to be increasing among people who inject drugs in Tripura. Malepreponderance in this study may be due to more exposure to drugs among males. Higher prevalence of Hepatitis C amongthe rural people may be due to increase quackery practice in the rural areas.
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Natural killer T cells are innate-like and tissue-resident lymphocytes, which recognize lipid antigens and are enriched in the liver. Natural killer T cells play important roles in infections, tumors, autoimmune diseases, and metabolic diseases. In this study, we summarize recent findings on biology of natural killer T cells and their roles in hepatitis B virus and hepatitis C virus infection, autoimmune liver diseases, alcoholic liver disease, nonalcoholic fatty liver disease, and hepatocellular carcinoma. Controversial results from previous studies are discussed, and indicate the dynamic alteration in the role of natural killer T cells during the progression of liver diseases, which might be caused by changes in natural killer T subsets, factors skewing cytokine responses, and intercellular crosstalk between natural killer T cells and CD1d-expressing cells or bystander cells.
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Animals , Humans , Autoimmune Diseases , Allergy and Immunology , Liver , Pathology , Liver Diseases , Allergy and Immunology , Natural Killer T-Cells , Allergy and ImmunologyABSTRACT
BACKGROUND/AIMS: Changes in lipid profiles in patients infected with hepatitis C virus (HCV) during direct-acting antiviral therapy have been reported in recent years. However, the clinical aspects of disturbed lipid metabolism in chronic HCV infection have not been fully elucidated. METHODS: Dynamic changes in serum total, low-density lipoprotein (LDL), and high-density lipoprotein (HDL) cholesterol and apolipoprotein levels in patients infected with HCV genotype 1b were examined during combination therapy with daclatasvir (DCV) and asunaprevir (ASV). RESULTS: Total, LDL−, and HDL-cholesterol levels increased rapidly and persistently after week 4. Apolipoprotein (apo) A-I, apo B, apo C-II, and apo C-III levels were significantly higher at week 4 than at week 0. In contrast, apo A-II and apo E levels were significantly lower. The differences in LDL− and HDL-cholesterol levels were positively correlated with those of apo B and apo A-I, respectively. Interestingly, in patients with non-sustained virological response, these cholesterol levels decreased rapidly after viral breakthrough or viral relapse. Furthermore, similar changes were observed for apo A-I, apo B and apo C-III levels. CONCLUSIONS: Clearance of HCV using combination therapy with DCV and ASV results in rapid changes in serum lipid profiles, suggesting an influence of HCV infection on disturbed lipid metabolism.
Subject(s)
Humans , Apolipoprotein A-I , Apolipoprotein A-II , Apolipoprotein C-II , Apolipoprotein C-III , Apolipoproteins , Apolipoproteins B , Apolipoproteins E , Cholesterol , Genotype , Hepacivirus , Hepatitis C , Hepatitis , Lipid Metabolism , Lipoproteins , RecurrenceABSTRACT
Arteriosclerosis is a chronic inflammatory vascular pathology that features a leading cause of coronary artery disease contributing to significant mortality and reduced quality of life. The recent identification of the possible role of infections in the initiation of a serious of inflammatory events represents an interesting development towards the better understanding of immune mediated vascular injury and premature atherosclerosis in patients with chronic HCV infection. A number of factors related to chronic HCV infection have been hypothesized to contribute to arteriosclerosis. The current review displays some of the aspects of interaction between the chronic viral infection, the immune system and cytokine networks and its relation to the increased risk of coronary artery disease.
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OBJETIVO: Avaliar a contribuição da ultrassonografia no estudo das alterações histopatológicas encontradas na hepatite crônica pelo vírus C, com ênfase para a esteatose hepática. MATERIAIS E MÉTODOS: Foram comparados os resultados dos exames ultrassonográficos do fígado de 192 pacientes portadores de hepatite crônica pelo vírus C, com os achados histopatológicos dos fragmentos obtidos por biópsia hepática. Todos os exames ultrassonográficos obedeceram a um mesmo protocolo, sendo analisados os seguintes critérios: ecogenicidade, ecotextura e atenuação. Os pacientes foram agrupados considerando-se os com alterações ultrassonográficas e os sem alterações ultrassonográficas, sendo comparados com as alterações histopatológicas presentes. RESULTADOS: Entre as alterações histopatológicas presentes, apenas os graus 0 e 3 de alteração arquitetural e a esteatose hepática apresentaram diferença estatística significante entre os dois grupos. Dentre os critérios ultrassonográficos avaliados, a atenuação foi o que apresentou melhor correlação com a esteatose hepática. CONCLUSÃO: Os resultados do trabalho demonstraram que, em pacientes com hepatite crônica pelo vírus C, a ultrassonografia apresentou limitações à caracterização das alterações histopatológicas, apresentando concordância regular com o diagnóstico de esteatose hepática. Destaca-se a capacidade do método em mostrar a probabilidade de inexistência de esteatose hepática, tendo em vista a especificidade de 77,9 por cento e o valor preditivo negativo de 95,5 por cento.
OBJECTIVE: To evaluate the role of ultrasonography in the assessment of histopathological changes in patients with chronic hepatitis C, with emphasis on hepatic steatosis. MATERIALS AND METHODS: Liver ultrasonography results were compared with histopathological findings of liver biopsy of 192 patients with chronic hepatitis C virus infection. All the US examinations followed a single protocol, analyzing the following aspects: echogenicity, echotexture and attenuation. The patients sample was divided into two groups as follows: patients with sonographic changes and patients with no sonographic changes. Sonographic findings of both groups were compared with histopathological findings after liver biopsy. RESULTS: Statistically significant intergroup differences were observed just regarding architectural changes grades 0 and 3 and hepatic steatosis. Attenuation was the sonographic criterion that was best correlated with hepatic steatosis. CONCLUSION: The results of the present study demonstrate that, in patients with chronic hepatitis C, ultrasonography has limitations in the characterization of histopathological changes, with an intermediate rate of agreement with the diagnosis of hepatic steatosis. Considering the specificity of 77.9 percent and the negative predictive value of 95.5 percent, the authors highlight the capacity of the method to demonstrate the probability of absence of hepatic steatosis.
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Humans , Male , Female , Adolescent , Young Adult , Middle Aged , Fatty Liver , Fatty Liver/pathology , Hepatitis C, Chronic , Biopsy , Liver/pathology , Hepatitis C, Chronic/diagnosisABSTRACT
Introdução: A infecção pelo vírus da hepatite C (VHC) está associada com várias manifestações extra-hepáticas, sendo a patogenia da maior parte baseada em mecanismos autoimunes ou linfoproliferativos. Objetivo: Identificar a prevalência de crioglobulinemia entre os pacientes com infecção pelo VHC. Pacientes e métodos: Foram estudados de forma prospectiva e consecutiva 67 pacientes com hepatite crônica pelo VHC, e avaliados quanto a presença de crioglobulinas, autoanticorpos e quanto a sintomas relacionados a crioglobulinemia. Resultados: Foi detectada a presença de crioglobulinas em 18 pacientes (27%). Quando comparados os pacientes com crioglobulinas com os demais, foi observado sexo feminino: 72% × 51%; média de idade: 49,8± 9,3 × 46,3± 13; nível de ALT: 114,05 × 119,18; genótipo: 1: 67% × 37%; cirrose: 22% × 14%; Artralgia em 39% × 28%; FAN em 11% × 6%; FR em 53% × 29%; anticorpo anti-tireoglobulina em 5% × 8% e anticorpo antimicrossoma em 5% × 2%. A síndrome clínica de crioglobulinemia mista foi diagnosticada em 2 pacientes (11%) e um deles apresentava glomerulonefrite crioglobulinêmica. Conclusão: A prevalência de crioglobulinemia mista em pacientes com infecção pelo VHC é elevada, porém a síndrome clínica é infreqüentemente detectada (AU)
Introduction: The hepatitis C vírus (HCV) infection is associated with many extrahepatic manifestations. The mechanisms are autoimmunes or limphoproliferatives. Objective: To identify the prevalence of cryoglobulinemia in the patients with HCV infection. Pacients and methods: Sixty seven patients with HCV chronic hepatitis were prospectively and consecutively studied. They were evaluated for the presence of cryoglobulins, autoantibodies and symptoms related to cryoglobulins. Results: The presence of cryoglobulins was detected in 18 patients (27%). When this group with cryoglobulins was compared to the others it was observed: women were more prevalent in the cryoglobulin group (72% × 51%); the mean age was 49,8± 9,3 × 46,3± 13; mean ALT was 114,05 × 119,18; genotype ? 1: 67% × 37%; cirrhosis: 22% × 14%; artralgia: 39% × 28%; FAN: 11% × 6%; reumathoid factor: 53% × 29%; anti-thyreoglobulin antibody: 5% × 8%; and anti-microssomal antibody: 5% × 2%. Clinical cryoglobulinemic syndrome was diagnosed in 2 patients (11%) and one of them presented cryoglobulinemic glomerulonephritis. Conclusion: The prevalence of mixed cryoglobulinemia in patients with HCV infection is high, however the clinical syndrome is not frequently detected (AU)
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Humans , Male , Female , Adult , Middle Aged , Hepatitis C/immunology , Cryoglobulinemia/epidemiology , Brazil/epidemiology , Prospective StudiesABSTRACT
To estimate the prevalence of hepatitis B virus(HBV) and hepatitis C virus(HCV) infection and to determine associated risk factors, a population-based seroepidemiologic study was carried out. In 1993, a health examination survey of the population was carried out in rural area known to have a high incidence of liver cancer. The study population were those who volunteered to participate in a health survey over 10 years of age. Examinees were interviewed by specially trained staffs. Sera from 1,033 study subjects were tested for hepatitis B surface antigen (HBsAg) by reverse passive hemagglutinin (RPHA) estimation and for hepatitis C virus antibody (anti-HCV) by 2nd generation passive hemagglutinin (PHA) estimation, The age and sex standardized prevalence of HBsAg was 6.3% which was similar to national average, but that of anti-HCV was 5.1% which was 4 to 5 times higher than that of blood or other health examinees in Korea. In a multivariate analysis, transfusion history, surgical operative history, and acupuncture history were not associated with HBsAg positivity. In contrast, acupuncture history (adjusted odds ratio[OR]=2.2 : 95% Confidence interval[CI] 1.0-4.7) and surgical operative history(adjusted OR=2.0 : 95% CI 1.0-4.1) were associated with anti-HCV positivity. The present study suggest that there is an highly endemic area of HCV infection in Korea and probably this endemicity is associated with a parenteral source of HCV infection other than blood transfusion.