Epidemiology of hepatitis C virus infection in a large Israeli health maintenance organization.

Hepatitis C affects an estimated 130 million people worldwide and is a major cause of chronic liver disease. This retrospective database study aims to describe the epidemiology of HCV-infected patients in Maccabi Healthcare Services, a 2-million-member health maintenance organization in Israel. HCV was identified by cross-linking diagnoses, laboratory data, and dispensed HCV treatment (1993-2013). The point-prevalence of HCV in 2012 and annual incidence of newly-diagnosed HCV during 2003-2012 (index period) were calculated. The age-adjusted prevalence of HCV was 5.19/1,000 population (n = 10,648). The highest prevalence was found among males and in patients aged 35-54 years. Two thirds of HCV-infected patients were immigrants from the former Soviet Union (FSU). HCV genotype 1 was predominant (67%). A total of 6,150 patients were newly diagnosed with HCV infection during the index period. The age-standardized rate of newly-diagnosed HCV declined from over 50/100,000 (2003) to 15/100,000 (2012). This rate was highest in males from the FSU, particularly for birth cohorts in 1950-70. The study results suggest that the reported incidence of HCV infection in Israel is declining, while prevalence is particularly high among FSU immigrants and genotype 1 is predominant. As the HCV treatment landscape evolves, these estimates can inform future studies and health technology assessments.

Effect of heparin on tissue binding activity of fibroblast growth factor and heparin-binding epidermal growth factor in experimental colitis in rats.

There have been several reports implying a benefit for heparin therapy in patients with refractory ulcerative colitis. Although this effect has been attributed to the anti-inflammatory properties of heparin, other mechanisms have not been excluded. Heparin is a potent modulator of receptor binding of growth factors such as fibroblast growth factor (FGF), vascular endothelial growth factor, and heparin-binding epidermal growth factor (HB-EGF), that play a role in wound repair. We examined the effect of heparin on the functional levels of FGF and HB-EGF in a model of experimental colitis. Fifty-six Wistar rats were divided into four groups: group 1 was the control group, group 2 received s.c. heparin 50 units/kg/d, group 3 underwent induction of 3% iodoacetamide colitis, and group 4 underwent induction of colitis and heparin treatment. Rats were killed and evaluated for severity of colitis by macroscopic and microscopic colitis scores, area of inflammation, and myeloperoxidase levels. FGF and HB-EGF levels were functionally assessed in colonic tissue in each group. Heparin therapy resulted in significant improvement in macroscopic and microscopic features of colitis (p < 0.05), accompanied by a partial reduction in myeloperoxidase levels. FGF receptor binding activity was identical in groups 1 and 2 but increased more than 3-fold after colitis induction in group 3 (p < 0.05). Treatment with heparin caused a significant decrease in FGF concentration. Levels of HB-EGF binding activity were similar in groups 1 and 2 and decreased in group 3 (p < 0.01). Heparin caused a significant increase in HB-EGF content in group 4 (p < 0.05). Levels of growth factors are altered differently in experimental colitis. Colonic FGF binding activity increases with colitis, whereas HB-EGF binding decreases with colitis. These trends were reversed by heparin, concomitant with a clinical and pathologic improvement in colitis. We suggest that one mechanism of heparin-mediated improvement in colitis may involve tissue healing associated with changes in functional levels of colonic growth factors.