Evaluation of a general practice based hepatitis C virus screening intervention.

BACKGROUND: In 2003 an estimated 37,500 of Scotland's population was chronically infected with HCV; 44% were undiagnosed former injecting drug users (IDU)--a priority group for antiviral therapy. AIM: To evaluate a hepatitis C virus (HCV) screening intervention. DESIGN: Outcome measures among two similar General Practice populations in an area of high HCV and drug use prevalence, one of which was exposed to an HCV screening intervention, were compared. METHODS: Thirty to fifty four year old attendees of the intervention practice were opportunistically offered testing and counselling, where clinically appropriate, (November 2003-April 2004). OUTCOMES: HCV test uptake, case detection, referral and treatment administration rates. RESULTS: Of 584 eligible attendees, 421 (72%) were offered and 117 (28%) accepted testing in the intervention practice; no testing was undertaken in the comparison practice. Prevalences of HCV antibody were 13% (15/117), 75% (3/4) and 91% (10/11) among all tested persons, current IDUs and former IDUs respectively. For 4/15 (27%) evidence of binge drinking following the receipt of their positive result, was available. Of the 11 referred to specialist care because they were HCV RNA positive, nine attended at least one appointment. Two received treatment: one had achieved a sustained viral response as of February 2008. CONCLUSION: While non targeted HCV screening in the general practice setting can detect infected former IDU, the low diagnostic yield among non IDUs limited the effectiveness of the intervention. A more targeted approach for identifying former IDUs is recommended. Additionally, the low uptake of treatment among chronically infected persons four years after diagnosis demonstrates the difficulties in clinically managing such individuals. Strategies, including support for those with a history of problem alcohol use, to improve treatment uptake are required.

Locomotion of human lymphoblasts towards glucose and other sugars. Effects of pH, temperature and oxygen.

The effect of basic physical and chemical changes in the environment on the locomotion of human lymphoblasts was studied. The lymphoblasts were obtained by culture of human blood lymphocytes either with mitogens or in mixed lymphocyte culture. Lymphoblasts required glucose for optimal locomotion, and, if placed in glucose free media, they migrated towards glucose sources. A filter checkerboard assay showed chemokinesis and was suggestive of chemotaxis to glucose. Among other sugars tested only mannose enhanced locomotion, and products of glycolysis such as lactate and pyruvate inhibited locomotion. Lymphoblast locomotion was inhibited by azide, fluoride and 2-deoxyglucose but the effect of 2-deoxyglucose could be reversed by the addition of glucose. Lymphoblasts migrated faster at 40 degrees C than at 37 degrees C and their pH optimum was between 7.1 and 7.4. They migrated well in anaerobic conditions.