Routes of infection, viremia, and liver disease in blood donors found to have hepatitis C virus infection

Ethnicity, socioeconomic status, transfusions and risk of hepatitis B and hepatitis C infection

This study identifies the risk factors for hepatitis B virus (HBV) and hepatitis C virus (HCV) and measures the prevalence of hepatitis B surface antigen (HBsAg) and antibody to hepatitis C (anti-HCV) in the general population of Jakarta. A population-based sample of 985 people aged 15 and above was surveyed. Risk factors were identified through questionnaires and home visits. Serum was analysed for HBsAg, antibody to hepatitis B surface antigen (anti-HBs), anti-HCV, aspartate aminotransferase (AST) and alanine aminotransferase (ALT). The seroprevalence was: 4.0% (39/985) for HBsAg, 17.2% (170/985) for anti-HBs, and 3.9% (38/985) for anti-HCV. The risk factors for hepatitis B and hepatitis C infection had little in common. Low socioeconomic status was a strong risk factor for HBsAg (adjusted odds ratio (OR) 18.09; 95% confidence interval (CI) 2.35-139.50). In addition, the Chinese group has 2.97 higher risk of having HBV infection compared with the Malayan ethnic group (adjusted OR 2.97; 95% CI 1.22-7.83). There was moderate positive trend between family size and risk of HBsAg positivity (P = 0.130). Age over 50 (adjusted OR 14.72; 95% CI 4.35-49.89) and history of transfusion were significant risk factors for hepatitis C (adjusted OR 3.03; 95% CI 1.25-7.33). Hepatitis B and hepatitis C infections have different risk factors in Jakarta, a high risk in population for both diseases. Hepatitis B transmission is associated with low socioeconomic status, Chinese ethnic group and large family size, while hepatitis C is associated with an older age and a history of transfusions.

Clinical manifestations of hepatitis C

Hepatitis C is a common cause of viral hepatitis that progresses to chronic infection in the majority of patients. Clinically, the infection is generally asymptomatic, but it may present with a wide variety of symptoms. Cirrhosis, hepatocellular carcinoma, cryoglobulinemia, auto-antibodies, and glomerulonephritis have been strongly associated with HCV. There is a probable association with autoimmune disease and NHL. More information is needed to determine whether lichen planus, PCT, and other disorders are part of the growing clinical spectrum or just coincidental associations with chronic liver disease.

The epidemiology of acute and chronic hepatitis C

Although the incidence of newly acquired acute hepatitis C virus (HCV) infection has declined, an estimated 3.9 million Americans are chronically infected with HCV, most of whom are young adults who will be at risk of the severe consequences of their infection in the next 10 to 20 years. The relative importance of the two most common exposures associated with the transmission of HCV has changed over time. Blood transfusions, which account for a substantial proportion of HCV infections acquired more than 10 years ago, account for only a small portion of recently acquired infections. In contrast, injection drug use has accounted for a substantial portion of HCV infections during both the remote and recent past. Sexual exposures, which have been poorly ascertained particularly among patients with chronic hepatitis C, may account for 10% to 20% of HCV transmissions. Physicians and other health care professionals need to be educated not only about the appropriate medical management of HCV infected patients, but also about the known and potential risks for HCV infection, the need to ascertain complete risk behavior histories from their patients, the appropriate evaluation of high-risk patients for evidence of infections, and the recommendations for prevention.

Hepatitis in alcohol and drug misusers: practical issues

Viral hepatitis, particularly that due to HBV or HCV, is a significant problem in the UK population of IVDUs and alcohol misusers. Patients attending drug rehabilitation clinics should be screened for HBV and HCV infection. All those found to be HBcAb negative should be vaccinated against HBV. Those found to be HBsAg or HCV antibody positive should have their liver function tests (LFTs) checked and be referred to a specialist liver clinic for further evaluation. Interferon treatment of HBV or HCV infection is effective in a proportion of cases but it is an expensive agent that requires careful monitoring. Current management regimes are centred around the modification of risk behaviour and the identification of those most in need of, and most likely to respond to, anti-viral treatment. Several new anti-viral agents are currently undergoing clinical evaluation and this together with the prospect of vaccines designed to clear an established infection means that the next few years are likely to see some major advances in the treatment of chronic viral hepatitis.

Absence of hepatitis C virus transmission but frequent transmission of HIV-1 from sexual contact with doubly-infected individuals

Hepatitis C virus (HCV) is transmitted through infected blood and blood products, but evidence of other routes of transmission is less clearly understood. In a study designed to examine human immunodeficiency virus (HIV) transmission, the prevalence of HCV has also been measured. Sixty-one couples were analysed, 30 in which partners were at risk through sexual contact alone, of whom 12 (40%) became infected with HIV and none with HCV. Thirty-one partners were exposed sexually and additionally through intravenous drug use. Of these, 16 (52%) became infected with HIV and 25 (80%) contracted HCV infection. These findings support the evidence of others that HCV is only rarely transmitted by sexual intercourse in heterosexual relationships and that HIV is not a co-factor for HCV transmission.

High rate of hepatitis C virus infection in an isolated community: persistent hyperendemicity or period-related phenomena?

We investigated underlying risks for hyperendemic hepatitis C virus (HCV) infection among the 1853 inhabitants of a mountainous village in Eastern Taiwan with high prevalence of HCV and hepatitis B virus (HBV). Among the 80 selected adults, we found that having resided away from the village before 1985 was protective against HCV infection, while residing in the village after 1985 posed little risk for HCV infection to children and young adults < 30 years of age. Among the 559 school children 7 through 14 years of age, anti-HCV prevalence was 1.9%, and the HBV carrier rate was 29%. Following up 270 children 1 year later, we found that new HCV infection occurred in 0.74% and new or repeated HBV infection occurred in 6.5% of the children, indicating distinct transmission patterns between HBV and HCV. Children of anti-HCV-positive mothers were either anti-HCV-negative or were infected by distinct genotypes of HCV from those infecting their mothers; most married couples in whom both were infected, were infected by HCV of discordant genotypes, indicating negligible importance of sexual or vertical HCV transmission. A case-control study comparing 13 anti-HCV-positive and 53 anti-HCV-negative children showed that having received parenteral medication in local clinics was a significant risk for HCV infection. Our data indicate that, unlike the case of HBV, HCV transmission by vertical or sexual route, or through casual contact are extremely inefficient, and our data further suggest that HCV hyperendemicity is unlikely to persist as a result of the more stringent practice of parenteral precautions in nearly all aspects of daily life.

How important is hepatitis C virus (HCV)-infection in persons with acute leukemia?

Hepatitis C virus (HCV)-infection is common in persons with leukemia. Blood transfusions are the typical source and HCV-related chronic hepatitis a common outcome. Development of HCV-infection and -related hepatitis raises important questions about subsequent leukemia treatment including the natural history of the infection and need for treatment modification. Although the natural history of HCV-infection and -related hepatitis in this setting is unknown, data from normal persons with HCV-infection suggest that short-term survival is not likely to be decreased in persons with leukemia and these complications. In contrast, long-term survival may decrease because of a high rate of chronic hepatitis, cirrhosis, and possibly hepatocellular carcinoma. There are no convincing data that HCV-infection or -related hepatitis or alterations in anti-leukemia drug dose or schedule prompted by abnormal liver function tests, alter leukemia outcome. Consequently, it is uncertain whether drug doses and/or schedule should be modified in persons with leukemia and HCV-infection or -related hepatitis. Short-term outcome of blood cell and bone marrow transplants is also unaffected by HCV-infection or -related hepatitis.

[Screening for markers of blood-borne diseases in donated units collected in France from 1993 to 1995]

A decrease of positive donation rates for antibodies to HIV, to HCV and for HBs Ag has been observed between 1993 and 1995 both in first-time and regular donations. In first-time donors, the most important decrease has been observed for HIV and in regular donors for HCV and HBs Ag. The interval between the negative and the positive donations was inferior to 1 year for 50% of regular donors and was superior to 2 years for 20 to 30%. About 30% of HIV positive donations were positive for other markers: 23% for anti-HBc and 10% for anti-HCV. About 40% of HCV positive donations had an elevated ALT level. Risk factors related to HIV heterosexual transmission appear to be the most difficult to identify during the donor selection and the least often associated with other markers. In recently HCV-infected donors, the main risk factors were IV drug addiction (25%) and nosocomial infection (30%). The major HTLV risk factor was directly or indirectly linked to the Caribbean area. Important differences between continental France and overseas territories were observed for HIV and HBs Ag rates.

Oxides, onions, and other matters gastrointestinal--1996--a perspective

A selection of landmark articles for a given year in any subject risks being somewhat subjective, and subjectivity is best avoided in scientific endeavor. However, the very nature of such a selection process invites judgment. Like most judges, I, too, claim to avoid conscious bias, but no one who has ever graced the bench can claim that at the subconscious level personal bias has never crept into a decision. Similarly, deep down in the vault of my subconscious, I love a maverick. That perhaps explains why so many articles that challenge long-held beliefs have especially found favor. Among them are those that question the strength of the association of Helicobacter pylori with gastric cancer, the usefulness of surveillance endoscopy in patients with Barrett's esophagus, a randomized trial that casts doubt on the preeminence of laparoscopic cholecystectomy, and a metaanalysis that concludes that corticosteroids may not be nearly as good for alcoholic hepatitis as we were once told. I have tried to resist the temptation to be too laudatory of technologic advancement, unless the benefit to the patient of such technology has been defined clearly. Thus, of all of the new technologies (endoscopic retrograde choledochopancreatography is no longer a new technology), only endoscopic ultrasonography finds a place. Articles that assess preventive strategies and are in the realm of epidemiology have received mention. All in all, 1996 was not a spectacular year for major therapeutic advances. In contrast, some notable advances have been made in the laboratory, and perhaps the most important has to do with the role of nitric oxide both in the regulation of normal function and in the genesis of disease.

The impact of renal transplantation on survival in hepatitis C-positive end-stage renal disease patients

Hepatitis C virus (HCV) infection is common in end-stage renal failure patients. It is not known whether the prognosis of HCV-positive patients differs depending on whether they remain on dialysis or receive a kidney transplant. To address this question, we compared the outcomes of HCV-positive renal transplant recipients and HCV-positive patients who were acceptable candidates but had not yet received transplants. We reviewed all patients referred to our institution for renal transplantation evaluation between January 1992 and December 1995. Anti-HCV antibody was detected in 151 of 2,053 (7.4%) patients. HCV-positive patients were more often male (74% v 56%; P < 0.0001), black (68% v 49%; P = 0.001), unemployed (87% v 74%; P = 0.0004), on dialysis (88% v 78%; P = 0.0026), and on dialysis longer (30 +/- 44 months v 13 +/- 23 months; P = 0.0001) than HCV-negative patients. We determined the outcomes of HCV-positive patients who had at least 2 years' follow-up. Thirty-three HCV-positive patients received kidney transplants (group I); 25 HCV-positive patients were acceptable transplant candidates but had not yet received an allograft (group II). Group I and II HCV-positive patients were similar with respect to age, race, duration of dialysis, cause of renal failure, prevalence of heart disease, and results of liver function tests. Survival was significantly decreased in group II versus group I (P = 0.043). Our study showed that HCV-positive renal transplant recipients had a better survival than similar HCV-positive patients awaiting transplantation.

[Descriptive epidemiology of hepatitis C virus infection in France in 1996]

This paper on the epidemiological aspects of the hepatitis C virus (HCV) infection in France presents the risk factors of the ways of contamination (transfusion, drug addiction, nosocomial, professional or sexual contamination, familial or mother-to-infant transmission). The estimated prevalence of HCV infection in France is comprised between 500,000 and 650,000 individuals, i.e. slightly above one percent of the French population. The epidemiological contribution of the study of HCV genotypes and the biological means evidencing HCV transmission are detailed, as well as the actual evolution of the HCV epidemy in France.