ABSTRACT
The risk factors related to hepatitis C virus (HCV) infection showed geographic and temporal differences. We investigated HCV-related risk factors in Korea where intravenous drug use (IVDU) is uncommon. The HCV-related risk factors were investigated in a prospective, multicenter chronic HCV cohort (n = 711) using a standardized questionnaire in four university hospitals. The results were compared with those of 206 patients with chronic liver diseases not related to either of HCV or hepatitis B virus infection (comparison group). The IVDU was found in 3.9% and remote blood transfusion (> or = 20 yr ago) in 18.3% in HCV cohort group, while that in comparison group was in none and 5.3%, respectively. In a multivariate logistic analysis, transfusion in the remote past (odds ratio [OR], 2.99), needle stick injury (OR, 4.72), surgery (OR, 1.89), dental procedures (OR, 2.96), tattooing (OR, 2.07), and multiple sexual partners (2-3 persons; OR, 2.14, > or = 4 persons; OR, 3.19), were independent risk factors for HCV infection. In conclusion, the major risk factors for HCV infection in Korea are mostly related to conventional or alterative healthcare procedures such as blood transfusion in the remote past, needle stick injury, surgery, dental procedure, and tattooing although multiple sex partners or IVDU plays a minor role.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Attitude to Health , Blood Transfusion , Case-Control Studies , Cohort Studies , Health Behavior , Hepatitis C, Chronic/etiology , Hospitals, University , Injections, Intravenous , Logistic Models , Needlestick Injuries/complications , Odds Ratio , Prospective Studies , Surveys and Questionnaires , Republic of Korea , Risk Factors , Sexual Partners , Tattooing , Tooth Diseases/complicationsABSTRACT
The risk factors related to hepatitis C virus (HCV) infection showed geographic and temporal differences. We investigated HCV-related risk factors in Korea where intravenous drug use (IVDU) is uncommon. The HCV-related risk factors were investigated in a prospective, multicenter chronic HCV cohort (n = 711) using a standardized questionnaire in four university hospitals. The results were compared with those of 206 patients with chronic liver diseases not related to either of HCV or hepatitis B virus infection (comparison group). The IVDU was found in 3.9% and remote blood transfusion (> or = 20 yr ago) in 18.3% in HCV cohort group, while that in comparison group was in none and 5.3%, respectively. In a multivariate logistic analysis, transfusion in the remote past (odds ratio [OR], 2.99), needle stick injury (OR, 4.72), surgery (OR, 1.89), dental procedures (OR, 2.96), tattooing (OR, 2.07), and multiple sexual partners (2-3 persons; OR, 2.14, > or = 4 persons; OR, 3.19), were independent risk factors for HCV infection. In conclusion, the major risk factors for HCV infection in Korea are mostly related to conventional or alterative healthcare procedures such as blood transfusion in the remote past, needle stick injury, surgery, dental procedure, and tattooing although multiple sex partners or IVDU plays a minor role.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Attitude to Health , Blood Transfusion , Case-Control Studies , Cohort Studies , Health Behavior , Hepatitis C, Chronic/etiology , Hospitals, University , Injections, Intravenous , Logistic Models , Needlestick Injuries/complications , Odds Ratio , Prospective Studies , Surveys and Questionnaires , Republic of Korea , Risk Factors , Sexual Partners , Tattooing , Tooth Diseases/complicationsABSTRACT
It was a community based, cross-sectional study undertaken to assess the frequency of HCV infection and to find out the risk factors associated with its spread. Study was carried out from Oct 2004 to Mar 2005. One hundred and twenty five apparently healthy consecutive subjects not known to be infected with HBV or HCV, between the ages 13 and 60 years with equal sex distribution were selected from the population of the Village Mera Kalan near Rawalpindi. They were screened for Anti HCV antibodies using ELISA and interviewed in detail. Subjects found positive for Anti HCV Ab were tested for ALT [Alanine aminotransferase] levels and HCV RNA by PCR. The frequency of HCV was found to be 53.6%. The most important risk factor associated with the transmission of HCV infection was unsafe injection therapy with contaminated equipment. Other risk factors include ear and nose piercing by unsterilized means in females and sharing of razors in males. The prevalence of HCV infection in our population is significantly higher than in the developed world. Public awareness programs should target the identified risk factors to prevent HCV transmission
Subject(s)
Humans , Female , Male , Hepatitis C, Chronic/etiology , Risk Factors , Cross-Sectional Studies , Data Collection , Hepatitis C Antibodies , Polymerase Chain Reaction , Enzyme-Linked Immunosorbent Assay , HepacivirusABSTRACT
OBJETIVO: Determinar a recurrência da hepatite C em pacientes submetidos a transplante hepático de doador vivo comparados com os submetidos a transplante hepático de doador falecido. MÉTODOS: Do total de 333 transplantes hepáticos, 279 (83,8 por cento) eram de doador falecido e 54 (16,2 por cento) de doador vivo. Hepatopatia crônica pelo vírus da hepatite C foi a indicação mais comum tanto de transplante hepático de doador falecido (82 pacientes) como de doador vivo (19 pacientes). O protocolo de estudo eletrônico de todos pacientes com hepatopatia crônica pelo vírus da hepatite C foi avaliado. Os dados coletados foram analisados estatisticamente conforme a idade, sexo, resultado dos exames laboratoriais, recidiva do vírus da hepatite C e rejeição aguda. RESULTADOS: O total de 55 transplantes hepáticos de doador falecido e 10 de doador vivo realizados em pacientes com cirrose hepática pelo vírus da hepatite C, foi incluído no estudo. As características clínicas e laboratoriais pré-transplante dos dois grupos foram similares, exceto o tempo de atividade de protrombina que foi maior no grupo de transplante hepático de doador falecido do que no de doador vivo (P = 0,04). A recidiva da hepatite C foi similar nos grupos de transplante hepático de doador falecido (n = 37; 69,3 por cento) e de doador vivo (n = 7; 70 por cento) (P = 0,8). A incidência de rejeição aguda foi igual no grupo de transplante hepático de doador falecido (n = 27; 49 por cento) e no grupo de doador vivo (n = 2; 20 por cento) (P = 0,08). A recurrência do vírus da hepatite C nos pacientes do grupo de transplante hepático de doador falecido que receberam pulsoterapia (9 de 11 pacientes) foi similar aos demais pacientes (28 de 44 pacientes) (P = 0,25). A recurrência também foi similar nos pacientes do grupo de transplante hepático de doador vivo que receberam pulsoterapia (1 de 1 paciente) em relação aos que não receberam (6 de 9 pacientes) (P = 0,7). CONCLUSÕES: A recurrência...
OBJECTIVE: To determine the recurrence of hepatitis C in patients subjected to living donor liver transplantation compared to those subjected to cadaveric liver transplantation. METHODS: Of a total of 333 liver transplantations, 279 (83.8 percent) were cadaveric liver transplantation and 54 (16.2 percent) living donor liver transplantation. Hepatic cirrhosis due to hepatitis C virus was the most common indication of both cadaveric liver transplantation (82 patients) and living donor liver transplantation (19 patients). The electronic study protocols of all patients with hepatic cirrhosis due to hepatitis C virus were reviewed. All data, including patients' age and sex, laboratory tests, hepatitis C virus recurrence and acute rejection were evaluated statistically. RESULTS: A total of 55 cadaveric liver transplantation and 10 living donor liver transplantation performed in patients with liver cirrhosis due to hepatitis C virus was included in the study. Clinical and laboratory characteristics of the two groups before the transplantation were similar, except for the prothrombin time that was higher for the cadaveric liver transplantation than the living donor liver transplantation (P = 0.04). Hepatitis C virus recurrence was similar in the cadaveric liver transplantation (n = 37; 69.3 percent) and living donor liver transplantation (n = 7; 70 percent) groups (P = 0.8). The incidence of acute rejection was similar in cadaveric liver transplantation (n = 27; 49 percent) and living donor liver transplantation (n = 2; 20 percent) groups (P = 0.08). Hepatitis C virus recurrence in patients of the cadaveric liver transplantation group who received bolus doses of corticosteroids (9 of 11 patients) was similar to the remained patients (28 of 44 patients) (P = 0.25). Recurrence was also similar in patients of the living donor liver transplantation group who received bolus doses of corticosteroids (one of one patient) in relation to those who did...
Subject(s)
Female , Humans , Male , Middle Aged , Hepatitis C, Chronic/epidemiology , Liver Cirrhosis/surgery , Liver Transplantation/statistics & numerical data , Living Donors/statistics & numerical data , Brazil/epidemiology , Cadaver , Glucocorticoids/therapeutic use , Graft Rejection/drug therapy , Graft Rejection/epidemiology , Hepatitis C, Chronic/etiology , Liver Cirrhosis/virology , Methylprednisolone/therapeutic use , RecurrenceABSTRACT
Introdução: Para o tratamento de pacientes com o vírus da hepatite C, a terapêutica preconizada é baseada no interteron (IFN) combinado com a ríbavirína. Modificações introduzidas no IFN convencional por peguilação (PEG-INF) resultaram em resposta mais eficaz, proporcionando comodidade, adesão e melhora na qualidade de vida. O PEG-INF está disponível nos pólos de aplicação e por razões de farmacoeconomia, racionalização de dose e aplicação, a administração semanal deve ser praticada em serviços identifica- dos pelos órgãos de Saúde. Assim, as ampolas ficam em poder dos serviços já mencionados e não dos pacientes em tratamento. Objetivos. Em virtude disso, buscamos avaliar o nível de satisfação dos pacientes e profissionais paramédicos, com os serviços oferecidos nos pólos de aplicação do tratamento para hepatite C. Material e método: A pesquisa foi conduzida por um instituto de pesquisa independente, e foi implementada com base no método descritivo de pesquisa, com foco quantitativo. Foram realizadas coletas prospectivas de dados por meio de entrevistas pessoais com 253 pacientes em oito pólos de aplicação das regiões metropolitana, capital e cidades do interior. Resultados: Compartilhar experiências com pessoas portadoras da mesma doença estimula a grande maioria dos pacientes a continuar o tratamento e quase 90por cento destes pacientes se sentem satisfeitos em participar da possibilidade de compartilhar a aplicação do alfa PEG- INF 2b Na visão dos pacientes, o bom atendimento, a economia e a presença de enfermagem treinada e especializada foram os três pontos positivos mais mencionados. A vasta maioria tomou todas as doses de alfa PEG-INF 2b e, aqueles que deixaram de tomar, omitiram somente cerca de 10 por cento do total das doses prescritas. Conclusão: Pelos resultados da pesquisa pode concluir-se que é elevado o nível de satisfação com o trata- mento assistido e compartilhado do alfa PEG-INF2b,- fica mais evidenciado quando mais de 30por cento dos pacientes não encontram nenhum ponto que possa ser melhorado no tratamento assistido e compartilhado do alfa PEG-INF 2b
Subject(s)
Humans , Hepatitis C, Chronic/etiology , Hepatitis C, Chronic/therapy , Hepatitis C , Interferon-alphaABSTRACT
A evolução da recorrência da hepatie C pós-transplante hepático pode ter um curso bastante variável. Raramente a doença pode progredir para uma forma conhecida como hepatite recorrente colestática grave, cuja patogenia ainda não é bem conhecida. Nós estudamos nesse trabalho alguns aspectos virológicos, histológicos e imunohistoquímicos de seis pacientes com essa forma rara de recorrência da doença, tendo como comparação um grupo pareado de seis pacientes transplantados com a forma leve de hepatite C recorrente, e como controle imunocompetente, cinco pacientes não transplantados com hepatite crônica pelo vírus C. Foram avaliados como possíveis fatores preditivos de gravidade da progressão da recorrência: viremia do VHC, evolução de quasispécies, parâmetros histopatológicos, e imunoreatividade para o antígeno core do VHC.Following liver transplantation (OLT) HCV-related disease severity is highly variable, with a minority of cases progressing to an extremely severe form of cholestatic hepatitis, in which the pathogenesis is not yet understood. We aim to compare virological, histological and immunohistological changes in patients developing mild and severe post-OLT HCV recurrence. Twelve patients with recurrent HCV infection were studied (6 with severe and 6 with mild disease). Five HCV-infected immunocompetent patients were used as controls. We looked at viral load, quasispecies evolution of HCV, several histological parameters and immuno-reactivity of core antigens at three time-points (pre-OLT, early post-OLT and late post-OLT) as predictors of severity of recurrence post-OLT...
Subject(s)
Humans , Hepatitis C, Chronic/etiology , Hepatitis C, Chronic/physiopathology , Hepatitis C, Chronic/virology , Liver Transplantation/pathology , Virus ReplicationABSTRACT
Up to 30% of Iranian adult multi-transfused thalassemic patients are infected with hepatitis C virus [HCV] which can intensify the progression of liver disease caused by iron overload in this group of patients. Our aim was to assess the biochemical and virological response of interferon alfa [INF-alpha] and its safety in thalassemic patients with chronic HCV infection. This trial was a single center, open label, single treatment prospective study of INF-alpha[Heberon alfa R, 3 MU, every other day] for a period of 12 months. 29 subjects, 13 to 56 years old [mean +/- SD: 25.1 +/- 10.4 years], whose serum HCV-RNA was positive and mean AlT remained greater than 1.5 times upper limit of normal in the last 6 months before the study were enrolled. A percutaneous liver biopsy was performed before treatment and all patients underwent monthly assessment for adverse events and monitoring of serum ALT. Qualitative serum HCV -RNA was obtained in months 3 and 6 and at the end of therapy. Pretreatment liver biopsy showed mild fibrosis in 33.3%, moderate fibrosis in 56.7% and cirrhosis in 10% of patients. Siderosis was severe in 14 patients [46.7%]. Two nonsplenectomized patients discontinued INF because of mild cytopenia, which resolved in less than one week after interruption of therapy. The following were some of the important adverse events observed during the study period: Flu syndrome in 29[100%], chills or fever>39°C in 14[48%], local pain in 14[48%], transient gastrointestinal symptoms in 13[44%], weakness in 5[17%], local induration in 3[10%] and edema in 2[7%] of the patients. By the end of 12 months of therapy, 15 patients out of 27 [55.6%] had a normal ALT and negative HCV -RNA [complete end-treatment response], they were followed up for a mean duration of 10.5 months [range: 6 to 22 months] and in 8 of them [53.3%] the condition relapsed [abnormal ALT with positive PCR]. Viral clearance was a delayed event in our patients [29% by the end of month 3 and 63% by month 7] but ALT normalization occurred in 94% of responders by the end of month 3. Our experience indicates that the cure of HCV -related liver disease in thalassemic patients is not an unrealistic aim and may be achieved with a safe and inexpensive INF preparation [Heberon Alfa R] in a sizeable portion of cases. As opposed to non-thalassemic patients, in whom most viral responses happen in the first 3 months of therapy, in this group of thalassemic patients we found that maximum virologic response happened between 3 to 6 months of therapy. Although INF-alpha is an effective drug for initial treatment in thalassemic patients infected with HCV, its efficacy with the above dose and duration, for maintaining long term remission is under question