Hepatitis C virus cascade of care in the general population, in people with diabetes, and in substance use disorder patients

Background

The aim was to evaluate the hepatitis C virus (HCV) cascade of care in the general population (GP) and in two high-risk populations: patients with diabetes mellitus (DM) and substance users (AS) in treatment in Reggio Emilia Province, Italy.

Methods

A population-based cross-sectional study was conducted that included 534,476 residents of the Reggio Emilia Province, of whom 32,800 were DM patients and 2726 AS patients. Age-adjusted prevalence was calculated using the direct method of adjustment based on the age-specific structure of EU population.

Results

The prevalence of HCV testing was 11.5%, 13.8%, and 47.8% in GP, DM, and AS patients respectively, while HCV prevalence was 6.5/1000, 12.6/1000, and 167/1000, respectively. The prevalence of HCV RNA positivity was 4.4/1000, 8.7/1000, and 114/1000 in the three populations, respectively. The rates of HCV RNA-positive individuals not linked to care were 27.9%, 27.3%, and 26% in GP, DM, and AS patients, respectively, while the rates of those cured or cleared were 70.9%, 71%, and 69.9%, respectively. The prevalence of HCV testing was higher for females of reproductive age than for males the same age: 218.4/1000 vs. 74.0/1000, respectively. While more foreigners than Italians underwent the HCV test and were HCV positive, fewer foreigners than Italians received HCV treatment and were cured.

Conclusions

The low HCV testing and linkage to care rates remain an important gap in the HCV cascade of care in Northern Italy. The prevalence of cured/cleared residents remains lower among foreigners than among Italians.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13027-021-00345-8.

Are Individuals with Substance Use Disorders at Higher Risk of SARS-CoV-2 Infection? Population-Based Registry Study in Northern Italy

BACKGROUND AND AIM

This study assesses whether individuals with substance use disorder are at greater risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection than people in the general population.

METHODS

A population-based study was conducted including 3,780 individuals, diagnosed with alcohol or other drug dependence and cared for by the addiction service (AS) in the province of Reggio Emilia. Standardised incidence ratios (SIRs) and relative 95% confidence intervals (CIs) of being tested and of being SARS-CoV-2 positive in the population of interest compared with those in the general population of Reggio Emilia were calculated.

RESULTS

Both individuals with alcohol and those with other drug use disorders had a lower risk of being SARS-CoV-2 positive (SIR = 0.69; 95% CI 0.32-1.30, SIR = 0.56; 95% CI 0.24-1.10, respectively), despite higher rates of being tested than the general population (SIR = 1.48; 95% CI 1.14-1.89, SIR = 1.51; 95% CI 1.20-1.86, respectively). Among HIV-negative persons, 12.5% were positive to SARS-CoV-2, while none was positive among HIV-positive persons. HCV-infected AS clients had a higher risk of both being tested for SARS-CoV-2 (SIR = 1.99; 95% CI 1.26-2.98) and of resulting positive (SIR = 1.53; 95% CI 0.50-3.58).

CONCLUSIONS

Individuals with alcohol and/or other drug use disorders are at higher risk of being tested for SARS-CoV-2 infection but at lower risk of resulting positive than the general population. Further research is warranted in order to support our findings and to address plausible factors underpinning such associations.

Spread of hepatitis C virus among sexual partners of HCVAb positive intravenous drug users

Recent studies suggest that the seroprevalence of hepatitis C virus antibodies (HCVAb) among sexual partners of those who are HCVAb positive is higher than in the general population. Moreover some studies seem to indicate that transmission of hepatitis C virus (HCV) occurs more readily when there is HIV infection in the couple. We studied the prevalence of HCVAb seropositivity among the regular sexual partners of 84 HCVAb positive intravenous drug users (IVDUs), by means of ELISA confirmed by radio immuno-adsorbent assay, 11 generation (RIBA II). The couples were subdivided into three groups: group 1: 30 HIV negative IVDUs and their HIV negative partners (HIV-/HIV-); group 2: 47 HIV positive IVDUs and their HIV negative partners (HIV+/HIV-); group 3: seven HIV positive IVDUs and their HIV positive partners (HIV+/HIV+). The seroprevalence of HCVAb among the partners of IVDUs was 28.6% in the couples of group 3, 12.8% in the couples of group 2 and no partner was positive among the couples of group 1. There was no statistically significant difference in HCV transmission between the couples who never used a condom and those who always used one. The couples of group 1 never used a condom. We found HCVAb seropositivity only in the partners who were in couples in whom HIV was present. We did not demonstrate that sexual intercourse is a means of HCV transmission because none of the HIV-/HIV- couples of group 1 used a condom and no partner was HCVAb positive.(ABSTRACT TRUNCATED AT 250 WORDS)

What is the effect of a cytomegalovirus infection when superimposed on HBsAg-positive chronic hepatitis?

A non-transfusion-related cytomegalovirus infection was observed in two patients with chronic HBsAg-positive liver disease. Both patients were immunodepressed and died of acute hepatic failure. A superimposed CMV infection has a high fatality rate in the case of underlying chronic type B liver disease.