Outcome of a hepatitis C outbreak among patients in a pain management clinic.

BACKGROUND AND AIMS: The aims of this study are to evaluate the natural history and response to therapy of patients following a hepatitis C outbreak in a pain management clinic. METHODS: A retrospective cohort study was conducted on patients who acquired hepatitis C virus (HCV) at a pain management clinic. Medical records were retrospectively reviewed for 77% of patients with hepatitis C included in the outbreak to obtain data regarding laboratory results, treatment, and outcomes. Chi-square, Fisher's exact, and Student's t-test were used to determine variables that were significantly associated with spontaneous clearance or sustained virologic response to therapy. RESULTS: Fifty Caucasian patients (31 women, 19 men; mean age 52 years) were included. Eleven of 50 (22%) patients cleared HCV spontaneously (clearers). The mean age of clearers was 47 years as compared with 57 years for nonclearers (P = 0.04). Liver biopsies were obtained by treating gastroenterologists in 31 patients with mean grade and stage of 2.1 and 1.7, respectively. Gastroenterologists treated 31 of 39 patients with pegylated interferon and ribavirin after a median of 354 (range 140-1,099) days post exposure. Sustained viral response (SVR) was observed in 65% (20/31) on an intention-to-treat basis. In patients who completed therapy, 91% (20/22) achieved SVR. Age, sex, weight, pretreatment alanine aminotransferase (ALT), and histologic parameters were not associated with SVR. CONCLUSIONS: In this large cohort of US immunocompetent patients with recent HCV infection, 22% resolved spontaneously. Younger age was the only predictor of spontaneous clearance. In patients with early chronic HCV, 65% achieved SVR.

Multiplex cytokine profiling of initial therapeutic response in patients with chronic hepatitis C virus infection.

Currently available prognostic tools are inadequate to discern the molecular basis of the heterogenic response in hepatitis C virus (HCV)-infected patients treated with the current standard of therapy. The expression and biological function of immune mediators have been shown to be critical in all phases of the immune response to HCV infection and likely therefore influence host response. Herein, a biometric multiplex serum cytokine assay was utilized to characterize the immunomodulatory effects of host response in 10 HCV patients. Serum levels of 17 cytokines were compared before and after 1 month of treatment and against controls. Overall serum cytokine levels were significantly higher in patients (P < 0.05) than controls. Additionally, viral titers decreased in all patients after 1 month of therapy, as did overall serum cytokine levels in the cohort (P < 0.05). To assess relationships between changes in cytokine levels and changes in viral titer, the cohort was divided into three statistically distinct subgroups based on changes in viral titers. Specific sets of cytokines decreased in each group: decreases in CCL4, interleukin (IL)-2, CXCL8, and IL-1beta correlated with the greatest drops in viral titer, decreases in IL-5, granulocyte colony stimulating factor (G-CSF), and CCL4 correlated with moderate drops in viral titer, and only CCL2 correlated with the lowest drops in viral titer. Interestingly, decreases in CCL4 levels correlated with decreases in viral titers in all patients. CCL4 controls leukocyte influx and thus propagates inflammation. In conclusion, these data raise the possibility that characteristic changes in host response modulate the therapeutic response, demonstrating the prognostic power of serum cytokine profiling in chronic HCV.