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Crowley D, Murtagh R, Cullen W, Lambert JS, McHugh T, Van Hout MC. Hepatitis C virus infection in Irish drug users and prisoners - a scoping review. BMC Infect Dis 2019; 19:702. [PMID: 31395032 PMCID: PMC6686252 DOI: 10.1186/s12879-019-4218-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 06/26/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Hepatitis C infection is a major public health concern globally. In Ireland, like other European countries, people who use drugs (PWUD) and prisoners carry a larger HCV disease burden than the general population. Recent advances in HCV management have made HCV elimination across Europe a realistic goal. Engaging these two marginalised and underserved populations remains a challenge. The aim of this review was to map key findings and identify gaps in the literature (published and unpublished) on HCV infection in Irish PWUD and prisoners. METHODS A scoping review guided by the methodological framework set out by Levac and colleagues (based on previous work by Arksey & O'Malley). RESULTS A total of 58 studies were identified and divided into the following categories; Epidemiology, Guidelines and Policy, Treatment Outcomes, HCV-related Health Issues and qualitative research reporting on Patients' and Health Providers' Experiences. This review identified significantly higher rates of HCV infection among Irish prisoners and PWUD than the general population. There are high levels of undiagnosed and untreated HCV infection in both groups. There is poor engagement by Irish PWUD with HCV services and barriers have been identified. Prison hepatology nurse services have a positive impact on treatment uptake and outcomes. Identified gaps in the literature include; lack of accurate epidemiological data on incident infection, untreated chronic HCV infection particularly in PWUD living outside Dublin and those not engaged with OST. CONCLUSION Ireland like other European countries has high levels of undiagnosed and untreated HCV infection. Collecting, synthesising and identifying gaps in the available literature is timely and will inform national HCV screening, treatment and prevention strategies.
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Affiliation(s)
- D. Crowley
- Irish College of General Practitioners, Dublin, Ireland
| | - R. Murtagh
- School of Medicine, University College, Dublin, Ireland
| | - W. Cullen
- School of Medicine, University College, Dublin, Ireland
| | - J. S. Lambert
- School of Medicine, University College, Dublin, Ireland
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - T. McHugh
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - M. C. Van Hout
- Public Health Institute, Liverpool John Moores University, Liverpool, UK
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2
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Fedorchenko SV, Klimenko A, Martynovich T, Liashok O, Yanchenko V. IL-28B genetic variation, gender, age, jaundice, hepatitis C virus genotype, and hepatitis B virus and HIV co-infection in spontaneous clearance of hepatitis C virus. THE TURKISH JOURNAL OF GASTROENTEROLOGY : THE OFFICIAL JOURNAL OF TURKISH SOCIETY OF GASTROENTEROLOGY 2019; 30:436-444. [PMID: 31060998 PMCID: PMC6505656 DOI: 10.5152/tjg.2019.18328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 09/08/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND/AIMS Spontaneous viral clearance observed in some patients is one of the variants of the hepatitis C virus (HCV) infection natural history. We aimed to look at the complexity of factors affecting the spontaneous clearance of HCV (SC HCV). MATERIALS AND METHODS A total of 357 anti-HCV positive patients (309 with chronic hepatitis C and 48 patients with SC HCV) were included into the study. We studied the effects of the interleukin-28B (IL-28B) gene polymorphism, gender, age, the routes of virus transmission, past hepatitis C with jaundice, HCV genotype, and hepatitis B virus (HBV) and HIV co-infection on the outcome of HCV infection. RESULTS Based on the study results, the SC HCV was found in 48 individuals (13.4%). The most significant positive factors affecting the SC HCV included IL-28B single nucleotide polymorphism (SNP) rs12979860 (CC) and SNP rs8099917 (TT) (OR 4.03, p<0.001) and (OR 3.14, p<0.002), female gender (OR 2.72, p<0.001), young age (OR 2.30, p<0.008), and past history of jaundice (OR 5.12, p<0.001). The markers of a past HBV infection were found significantly more often in SC. CONCLUSION Positive predictors of the SC HCV include favorable IL-28B genotype, female gender, young age, a history of jaundice, markers of a past HBV infection, the absence of HIV infection, but not the viral genotype.
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Affiliation(s)
- Sergii V Fedorchenko
- Department of Viral Hepatitis and AIDS, The L.V. Gromashevskyi Institute of Epidemiology and Infectious Disease, Kiev, Ukraine
| | - Anna Klimenko
- Department of Viral Hepatitis and AIDS, The L.V. Gromashevskyi Institute of Epidemiology and Infectious Disease, Kiev, Ukraine
| | - Tetyana Martynovich
- Department of Viral Hepatitis and AIDS, The L.V. Gromashevskyi Institute of Epidemiology and Infectious Disease, Kiev, Ukraine
| | - Olga Liashok
- Department of Viral Hepatitis and AIDS, The L.V. Gromashevskyi Institute of Epidemiology and Infectious Disease, Kiev, Ukraine
| | - Vitaliy Yanchenko
- Department of Viral Hepatitis and AIDS, The L.V. Gromashevskyi Institute of Epidemiology and Infectious Disease, Kiev, Ukraine
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Aisyah DN, Shallcross L, Hully AJ, O'Brien A, Hayward A. Assessing hepatitis C spontaneous clearance and understanding associated factors-A systematic review and meta-analysis. J Viral Hepat 2018; 25:680-698. [PMID: 29345844 DOI: 10.1111/jvh.12866] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 12/14/2017] [Indexed: 12/11/2022]
Abstract
New advances in the treatment of hepatitis C provide high levels of sustained viral response but their expense limits availability in publicly funded health systems. The aim of this review was to estimate the proportion of patients who will spontaneously clear HCV, to identify factors that are associated with clearance and to support better targeting of directly acting antivirals. We searched Ovid EMBASE, Ovid MEDLINE and PubMed from 1 January 1994 to 30 June 2015 for studies reporting hepatitis C spontaneous clearance and/or demographic, clinical and behavioural factors associated with clearance. We undertook meta-analyses to estimate the odds of clearance for each predictor. Forty-three studies met the inclusion criteria, representing 20 110 individuals, and 6 of these studies included sufficient data to estimate spontaneous clearance. The proportion achieving clearance within 3, 6, 12 and 24 months following infection were, respectively, 19.8% (95% CI: 2.6%-47.5%), 27.9% (95% CI: 17.2%-41.8%), 36.1% (95% CI: 23.5%-50.9%) and 37.1% (95% CI: 23.7%-52.8%). Individuals who had not spontaneously cleared by 12 months were unlikely to do so. The likelihood of spontaneous clearance was lower in males and individuals with HIV co-infection, the absence of HBV co-infection, asymptomatic infection, black or nonindigenous race, nongenotype 1 infection, older age and alcohol or drug problems. This study suggests that patients continue to spontaneously clear HCV for at least 12 months following initial infection. However, injecting drug users are comparatively less likely to achieve clearance; thus, they should be considered a priority for early treatment given the continuing risks that these individuals pose for onwards transmission.
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Affiliation(s)
- D N Aisyah
- UCL Infectious Disease Informatics, Farr Institute of Health Informatics, London, UK.,Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - L Shallcross
- UCL Infectious Disease Informatics, Farr Institute of Health Informatics, London, UK
| | - A J Hully
- Kings College London School of Medicine, London, UK
| | - A O'Brien
- UCL Division of Medicine, London, UK
| | - A Hayward
- UCL Infectious Disease Informatics, Farr Institute of Health Informatics, London, UK.,Institute of Epidemiology and Health Care, University College London, London, UK
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4
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Crowley D, Cullen W, Laird E, Lambert JS, Mc Hugh T, Murphy C, Van Hout MC. Exploring Patient Characteristics and Barriers to Hepatitis C Treatment in Patients on Opioid Substitution Treatment Attending a Community Based Fibro-scanning Clinic. J Transl Int Med 2017; 5:112-119. [PMID: 28721344 PMCID: PMC5506411 DOI: 10.1515/jtim-2017-0017] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Hepatitis C virus (HCV) infection is a major public health issue. There is substandard uptake in HCV assessment and treatment among people who inject drugs (PWID). Community fibroscanning is used to assess disease severity and target treatment. METHODS A survey was administered to a cohort of chronically HCV infected patients attending a community fibroscanning clinic. Questions targeted diagnosis of HCV, suitability, willingness and barriers to engagement in treatment. Descriptive and regression analysis, with thematic analysis of open-ended data was conducted. RESULTS There was high acceptance of community fibroscanning among this cohort with over 90% (68) attending. High levels of unemployment (90%) and homelessness (40%) were identified. Most patients were on methadone treatment and had been HCV infected for greater than 10 years with length of time since HCV diagnosis being significantly longer in patients with fibroscan scores > 8.5 kPa (P = 0.016). With each unit increase in methadone dose, the odds of the >8.5 fibroscan group increased by 5.2%. Patient identified barriers to engagement were alcohol and drug use, fear of HCV treatment and liver biopsy, imprisonment, distance to hospital and early morning appointments. CONCLUSION The study highlights the usefulness of community fibroscanning. Identifying barriers to treatment in this cohort affords an opportunity to increase the treatment uptake. The availability of afternoon clinics and enhanced prison linkage are warranted.
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Affiliation(s)
| | | | - Eamon Laird
- Trinity College Dublin, University College Dublin, Dublin2, Ireland
| | - John S Lambert
- Infectious Disease Department, Mater Hospital, Dublin7, Ireland
| | | | - Carol Murphy
- Infectious Disease Department, Mater Hospital, Dublin7, Ireland
| | - Marie Claire Van Hout
- Public Health Institute, Liverpool John Moore’s University, Liverpool, United Kingdom
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Robaeys G, Bielen R, Azar DG, Razavi H, Nevens F. Global genotype distribution of hepatitis C viral infection among people who inject drugs. J Hepatol 2016; 65:1094-1103. [PMID: 27520879 DOI: 10.1016/j.jhep.2016.07.042] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 07/28/2016] [Accepted: 07/30/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND & AIMS Hepatitis C viral infection (HCV) after injection drug use is very prevalent. The kind of genotype determines the response to treatment. However, no systematic review update on the global genotype distribution of HCV in people who inject drugs (PWID) is currently available. METHODS A systematic review was performed by using the keywords: Genotype, Hepatitis C, Injection drug user/Intravenous drug user/Substance user/ PWID, Name of countries in Pubmed, Embase and PsycINFO. The results were compared with the review of Gower et al. in 2014, concerning the distribution of HCV genotypes in the general HCV population. RESULTS Using these keywords, 132 studies in 48 countries (from 1995 to 2015) were collected. After grading these results, the data of 48 studies were used to determine the distribution of genotypes in PWID. Genotype 1 is the most prevalent genotype all over the world in PWID. In Europe, genotypes 1, 3 and 4 are highly prevalent. In North and South America and in Australia genotype 1 and 3 are most prevalent. In Asia genotype 2 and 6, and Africa genotype 1a and 4 are mostly observed. Overall, the most important differences comparing with the general population are a lower prevalence of genotype 1b in the PWID population and higher prevalence of genotype 1a and 3. CONCLUSIONS There is a different prevalence of genotype distribution in PWID than in the general population. Genotype 3 is especially highly prevalent in the Western countries. LAY SUMMARY Hepatitis C viral infection after injection drug use is very prevalent. The most important genotype causing HCV infection in PWID globally is genotype 1, as is the case in the general population, but also genotype 3 is highly prevalent in PWID. Genotype 4 is most prevalent in Africa, spreading into Europe, whereas genotype 2 and 6 are more located in Asia. The most important difference comparing to the general population are generally lower prevalence of genotype 1b, and higher prevalence of genotype 1a and 3 in PWID. As the genotype nowadays still determines the treatment, and as there is a different genotype distribution than in the general population, it is important to identify the genotype also in PWID.
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Affiliation(s)
- Geert Robaeys
- Ziekenhuis Oost-Limburg, Dept. of Gastro-enterology and Hepatology, Schiepse Bos 6, 3600 Genk, Belgium; Hasselt University, Faculty of Medicine and Life Sciences, Martelarenlaan 42, 3500 Hasselt, Belgium; KULeuven, Dept. of Gastro-enterology and Hepatology, Herestraat 49, 3000 Leuven, Belgium
| | - Rob Bielen
- Ziekenhuis Oost-Limburg, Dept. of Gastro-enterology and Hepatology, Schiepse Bos 6, 3600 Genk, Belgium; Hasselt University, Faculty of Medicine and Life Sciences, Martelarenlaan 42, 3500 Hasselt, Belgium.
| | - Darush Ghezel Azar
- Ziekenhuis Oost-Limburg, Dept. of Gastro-enterology and Hepatology, Schiepse Bos 6, 3600 Genk, Belgium; KULeuven, Dept. of Gastro-enterology and Hepatology, Herestraat 49, 3000 Leuven, Belgium
| | - Homie Razavi
- Center for Disease Analysis, 1120 W South Boulder Road, Suite 102, Louisville, CO 80026, USA
| | - Frederik Nevens
- KULeuven, Dept. of Gastro-enterology and Hepatology, Herestraat 49, 3000 Leuven, Belgium
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6
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Smith DJ, Jordan AE, Frank M, Hagan H. Spontaneous viral clearance of hepatitis C virus (HCV) infection among people who inject drugs (PWID) and HIV-positive men who have sex with men (HIV+ MSM): a systematic review and meta-analysis. BMC Infect Dis 2016; 16:471. [PMID: 27595855 PMCID: PMC5011802 DOI: 10.1186/s12879-016-1807-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 08/25/2016] [Indexed: 12/14/2022] Open
Abstract
Background Hepatitis C virus (HCV) infection causes significant morbidity and mortality among people who inject drugs (PWID) and HIV+ men who have sex with men (MSM). Characterizing spontaneous viral clearance of HCV infection among PWID and HIV+ MSM is important for assessing the burden of disease and treatment strategies in these populations. Methods Electronic and other searches of medical literature were conducted. Reports were eligible if they presented original data from upper-middle- and high-income countries on laboratory-confirmed HCV infection and spontaneous viral clearance among PWID or HIV+ MSM. Pooled estimates of spontaneous viral clearance were generated using fixed-effect and random-effects models. Meta-regression examined potential predictors related to individual characteristics and research methodology. Results The meta-analysis estimated that spontaneous viral clearance occurs in 24.4 % of PWID and 15.4 % of HIV+ MSM. In univariate meta-regression among PWID, male sex and age were significantly associated with spontaneous viral clearance, and in multivariate analysis, male sex and HIV positivity were predictors of spontaneous viral clearance; among HIV+ MSM no variables were found to affect spontaneous viral clearance. Conclusion The variability in estimates of spontaneous viral clearance between HIV+ MSM and PWID suggests the impact of HIV co-infection and HCV re-infection. Due to limited data on additional factors that may affect the natural history of HCV, more research is needed to further understand spontaneous viral clearance in these risk groups. Protocol registration The protocols for the PWID and HIV+ MSM research were registered with PROSPERO (CRD42014008805; CRD42013006462). Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-1807-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Daniel J Smith
- Rory Meyers College of Nursing, New York University, New York, NY, 10010, USA.
| | - Ashly E Jordan
- Rory Meyers College of Nursing, New York University, New York, NY, 10010, USA.,Center for Drug Use and HIV Research, New York University, New York, NY, 10010, USA
| | - Mayu Frank
- Rory Meyers College of Nursing, New York University, New York, NY, 10010, USA
| | - Holly Hagan
- Rory Meyers College of Nursing, New York University, New York, NY, 10010, USA.,Center for Drug Use and HIV Research, New York University, New York, NY, 10010, USA
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Wiessing L, Ferri M, Grady B, Kantzanou M, Sperle I, Cullen KJ, Hatzakis A, Prins M, Vickerman P, Lazarus JV, Hope VD, Matheï C. Hepatitis C virus infection epidemiology among people who inject drugs in Europe: a systematic review of data for scaling up treatment and prevention. PLoS One 2014; 9:e103345. [PMID: 25068274 PMCID: PMC4113410 DOI: 10.1371/journal.pone.0103345] [Citation(s) in RCA: 178] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 06/29/2014] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND People who inject drugs (PWID) are a key population affected by hepatitis C virus (HCV). Treatment options are improving and may enhance prevention; however access for PWID may be poor. The availability in the literature of information on seven main topic areas (incidence, chronicity, genotypes, HIV co-infection, diagnosis and treatment uptake, and burden of disease) to guide HCV treatment and prevention scale-up for PWID in the 27 countries of the European Union is systematically reviewed. METHODS AND FINDINGS We searched MEDLINE, EMBASE and Cochrane Library for publications between 1 January 2000 and 31 December 2012, with a search strategy of general keywords regarding viral hepatitis, substance abuse and geographic scope, as well as topic-specific keywords. Additional articles were found through structured email consultations with a large European expert network. Data availability was highly variable and important limitations existed in comparability and representativeness. Nine of 27 countries had data on HCV incidence among PWID, which was often high (2.7-66/100 person-years, median 13, Interquartile range (IQR) 8.7-28). Most common HCV genotypes were G1 and G3; however, G4 may be increasing, while the proportion of traditionally 'difficult to treat' genotypes (G1+G4) showed large variation (median 53, IQR 43-62). Twelve countries reported on HCV chronicity (median 72, IQR 64-81) and 22 on HIV prevalence in HCV-infected PWID (median 3.9%, IQR 0.2-28). Undiagnosed infection, assessed in five countries, was high (median 49%, IQR 38-64), while of those diagnosed, the proportion entering treatment was low (median 9.5%, IQR 3.5-15). Burden of disease, where assessed, was high and will rise in the next decade. CONCLUSION Key data on HCV epidemiology, care and disease burden among PWID in Europe are sparse but suggest many undiagnosed infections and poor treatment uptake. Stronger efforts are needed to improve data availability to guide an increase in HCV treatment among PWID.
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Affiliation(s)
- Lucas Wiessing
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal
| | - Marica Ferri
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal
| | - Bart Grady
- Cluster Infectious Diseases, Department of Research, Public Health Service, Amsterdam, The Netherlands
- Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, Amsterdam, The Netherlands
| | - Maria Kantzanou
- National Reference Centre for Retroviruses, Laboratory of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
| | - Ida Sperle
- Copenhagen HIV Programme (CHIP), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Katelyn J. Cullen
- HIV & STI Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, United Kingdom
| | | | - Angelos Hatzakis
- National Reference Centre for Retroviruses, Laboratory of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
| | - Maria Prins
- Cluster Infectious Diseases, Department of Research, Public Health Service, Amsterdam, The Netherlands
- Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, Amsterdam, The Netherlands
| | - Peter Vickerman
- London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Jeffrey V. Lazarus
- Copenhagen HIV Programme (CHIP), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Vivian D. Hope
- HIV & STI Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, United Kingdom
- London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
| | - Catharina Matheï
- Department of Public Health and Primary Care, KULeuven, Leuven, Belgium
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New tools in HCV diagnosis, in light of the enhanced awareness and the new drugs for treatment: SMARTube and stimmunology. ScientificWorldJournal 2013; 2013:389780. [PMID: 23476130 PMCID: PMC3586500 DOI: 10.1155/2013/389780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 12/02/2012] [Indexed: 12/18/2022] Open
Abstract
With improved HCV therapy, challenges regarding HCV diagnosis, such as seronegative window period, false positive readings, and differentiation between recent, chronic, and resolved infections, are of increasing importance. To
address these challenges an innovative device—SMARTube HIV & HCV—was used. Blood samples were tested for anti-HCV antibodies before and after incubation in the SMARTube, which promotes the in vitro stimulation of in vivo HCV primed lymphocytes, thus enhancing levels of anti-HCV antibodies. Comparing antibody levels, in concordant samples before and after SMARTube, yielded the Stimulation Index (SI). Among 5888 fresh blood samples, from various populations and regions worldwide, 641 were seropositive using plasma, while SMARTube processing (yielding enriched plasma, termed SMARTplasma) enabled diagnosis of 10 additional carriers in high-risk cohorts, that is, earlier detection. Using SMARTplasma eliminated all false positive results, using the current assays. In addition we show that SI calculation may serve as an important tool for differentiating between those who recently seroconverted, carriers of long-term infection, and those who have cleared the virus. SMARTube and the SI could lead to better, more informative diagnosis of HCV infections and play an important role in changing the way we treat both the infected individuals and the epidemic as a whole.
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van den Berg CHBS, Grady BPX, Schinkel J, van de Laar T, Molenkamp R, van Houdt R, Coutinho RA, van Baarle D, Prins M. Female sex and IL28B, a synergism for spontaneous viral clearance in hepatitis C virus (HCV) seroconverters from a community-based cohort. PLoS One 2011; 6:e27555. [PMID: 22110669 PMCID: PMC3216978 DOI: 10.1371/journal.pone.0027555] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Accepted: 10/19/2011] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND & AIMS Since acute hepatitis C virus (HCV) infection is often asymptomatic, it is difficult to examine the rate and determinants of spontaneous clearance. Consequently, these studies are subject to bias, which can potentially lead to biased rates of viral clearance and risk estimates. We evaluated determinants of spontaneous HCV clearance among HCV seroconverters identified in a unique community-based cohort. METHODS Subjects were 106 drug users with documented dates of HCV seroconversion from the Amsterdam Cohort Study. Logistic regression was used to examine sociodemographic, behavioral, clinical, viral and host determinants, measured around acute infection, of HCV clearance. RESULTS The spontaneous viral clearance rate was 33.0% (95% confidence interval (CI) 24.2-42.8). In univariate analyses female sex and fever were significantly associated with spontaneous clearance. The favorable genotypes for rs12979860 (CC) and rs8099917 (TT) were associated with spontaneous clearance, although borderline significant. In multivariate analysis, females with the favorable genotype for rs12979860 (CC) had an increased odds to spontaneously clear HCV infection (adjusted OR 6.62, 95% 2.69-26.13), whereas females with the unfavorable genotype were as likely as men with the favorable and unfavorable genotype to clear HCV. Chronic Hepatitis B infection and absence of HIV coinfection around HCV seroconversion also favor HCV clearance. CONCLUSIONS This study shows that co-infection with HIV and HBV and genetic variation in the IL28B region play an important role in spontaneous clearance of HCV. Our findings suggest a possible synergistic interaction between female sex and IL28B in spontaneous clearance of HCV.
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Affiliation(s)
- Charlotte H. B. S. van den Berg
- Cluster Infectious Diseases, Department of Research, Center for Infection and Immunity Amsterdam (CINIMA), Public Health Service, Amsterdam, The Netherlands
- Department of Infectious Diseases, Tropical Medicine and AIDS, CINIMA, Academic Medical Center, Amsterdam, The Netherlands
| | - Bart P. X. Grady
- Cluster Infectious Diseases, Department of Research, Center for Infection and Immunity Amsterdam (CINIMA), Public Health Service, Amsterdam, The Netherlands
| | - Janke Schinkel
- Department of Medical Microbiology, CINIMA, Academic Medical Center, Amsterdam, The Netherlands
| | - Thijs van de Laar
- Cluster Infectious Diseases, Laboratory of Public Health, Public Health Service, Amsterdam, The Netherlands
- Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, The Netherlands
| | - Richard Molenkamp
- Department of Medical Microbiology, CINIMA, Academic Medical Center, Amsterdam, The Netherlands
| | - Robin van Houdt
- Cluster Infectious Diseases, Laboratory of Public Health, Public Health Service, Amsterdam, The Netherlands
- Center for Infectious Disease Control, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
| | - Roel A. Coutinho
- Center for Infectious Disease Control, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
| | - Debbie van Baarle
- Department of Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Internal Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maria Prins
- Cluster Infectious Diseases, Department of Research, Center for Infection and Immunity Amsterdam (CINIMA), Public Health Service, Amsterdam, The Netherlands
- Department of Infectious Diseases, Tropical Medicine and AIDS, CINIMA, Academic Medical Center, Amsterdam, The Netherlands
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