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Medhi M, Sonowal A, Sonowal P, Neog BJ, Phukan C. Socio-demographic association with confirmed hepatitis C virus infection: A cross-sectional analysis from a teaching institute. J Family Med Prim Care 2024; 13:2060-2065. [PMID: 38948603 PMCID: PMC11213397 DOI: 10.4103/jfmpc.jfmpc_1794_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 01/03/2024] [Accepted: 01/05/2024] [Indexed: 07/02/2024] Open
Abstract
Introduction Hepatitis C virus (HCV) infection is the most common chronic blood-borne disease and is more commonly associated with chronic active hepatitis leading to cirrhosis, hepato-cellular carcinoma and end-stage liver disease. Methodology 160 consecutive screening positive (Enzyme linked immuno sorbent assay positive) Hepatitis C samples were tested by HCV RNA Real Time-PCR for confirmation. Result Prevalence of confirmed hepatitis C among screening positive patient in the present study was found to be 24.4%. Vaccinated individual with Hepatitis A and Hepatitis B had significant association with PCR positivity in screening positive Hepatitis C patient (p< 0.05). IV drug users and patient having multiple sex partners have significant association with PCR positivity among screening positive Hepatitis C patients (p< 0.05). Conclusion Due to the lack of an effective vaccine and the increased risk of serious complications, it is important to focus on prevention and early detection of HCV.
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Affiliation(s)
- Mithu Medhi
- Department of Microbiology, Kokrajhar Medical College, Rangalikhata, Assam, India
| | - Aparna Sonowal
- Department of Microbiology, Assam Medical College, Dibrugarh, Assam, India
| | - Pranjal Sonowal
- Department Community Medicine, Lakhimpur Medical College, Chowkham, Assam, India
| | - Bhaskar Jyoti Neog
- Department of Microbiology, Tinsukia Medical College, Luhari Bongali Gaon, Assam, India
| | - Chimanjita Phukan
- Department of Microbiology, Assam Medical College, Dibrugarh, Assam, India
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Shahanas SM, Verma R, Kumar K, Verma M, Srivastavsa DC, Budhwani P. A Study on the Prevalence of HCV Genotypes and the Effect of Direct-Acting Antiviral Therapy on Clinical and Laboratory Parameters in HCV-Infected Patients at a Tertiary Care Center in North India. Indian J Community Med 2024; 49:203-208. [PMID: 38425980 PMCID: PMC10900459 DOI: 10.4103/ijcm.ijcm_865_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 11/06/2023] [Indexed: 03/02/2024] Open
Abstract
Background The purpose of this study was to investigate the prevalence and distribution of different HCV genotypes, as well as to evaluate clinical and laboratory parameters in HCV-infected patients before and after DAA treatment. Material and Methods An open-label prospective study was conducted on 50 HCV-infected individuals. The HCV-infected patients underwent a baseline evaluation with complete history, examination, and other clinical investigations. These patients received the appropriate DAA according to the genotype for 3 months. At the end of 3 months, these patients were again evaluated clinically. Results The majority of instances were among younger age groups. Genotype 3 (66%) was the most common. There was a statistically significant difference found in clinical parameters regarding total bilirubin (p=0.008), SGOT (p=0.001), SGPT (p=0.035), ALP (p=<0.001) and Blood Urea Nitrogen (p = 0.004). When 1a vs 1b intragroup comparison was drawn, there was a significant mean difference found in SGOT (p value= 0.053) and Creatinine (p=0.050) parameters while rest shows no significant difference when associated. In the comparison of 1a vs 3 or 4, none of the parameters shows significant difference while; when 1b vs 3 or 4 comparison was laid out, SGOT and Creatinine was found near to significant. Conclusion This study concludes that with the availability of DAAs, highly effective, short-duration, and safe regimens have created better outcomes for patients with HCV infection, especially in those groups where SVR was low with prior therapies or in those where IFN-based treatment strategies were contraindicated.
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Affiliation(s)
| | - Rajeev Verma
- Department of Medicine, All India Institute of Medical Sciences, Raebareli, Uttar Pradesh, India
| | - Kanishka Kumar
- Department of Medicine, All India Institute of Medical Sciences, Gorakhpur, Uttar Pradesh, India
| | - Manisha Verma
- Department of Pediatrics, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | | | - Priyanka Budhwani
- Department of Medicine, All India Institute of Medical Sciences, Gorakhpur, Uttar Pradesh, India
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Shalimar, Priya S, Gupta H, Bansal B, Elhence A, Krishna Kishore RV, Goel A. A Systematic Review of Risk Factors for Hepatitis C Virus Infection Among Low-Risk Population in India. J Clin Exp Hepatol 2022; 12:1438-1444. [PMID: 36340297 PMCID: PMC9630020 DOI: 10.1016/j.jceh.2022.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 06/04/2022] [Indexed: 12/12/2022] Open
Abstract
Background Identification of risk factors for hepatitis C virus (HCV) transmission will help in targeted screening of people who are at risk for HCV. Method Indian studies, published between January 1989 and June 2020, were systematically reviewed to identify the relevant studies. We searched electronic databases including PubMed/Medline, Embase, Scopus, and Google scholar to identify the original data published in English language. The full-text studies, published in any form, which reported data on risk factors for HCV transmission among low-risk population were selected. The studies which exclusively included high-risk groups were excluded. Results Data were extracted from 31,176 participants included in 25 studies (median [range] 40 [7-20,113). The participants were HCV infected patients who visited the hospital (n = 10), community population (n = 6), pregnant women (n = 5), blood donors (n = 2), people with diabetes mellitus (n = 1), army recruits (n = 1), or slum dwellers (n = 1). These studies provided data on blood transfusion, use of unsafe injections, minor or major surgery, unsafe dental procedures, tattooing, body piercing, obstetrical procedures, unsafe shaving, intravenous drug use, and unsafe sexual practices as risk factors for HCV transmission. Conclusion Unsafe injections, body piercing, unsafe dental procedure, unsafe shaving, and tattooing were identified as major risk factors for reported by HCV population participants.More data are needed to identify the risk factors for HCV in Indian population. Risk-factor-targeted screening may increase the yield and reduce the cost of HCV screening in India.
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Affiliation(s)
- Shalimar
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Sai Priya
- Department of General Medicine, Kalyan Singh Super Specialty Cancer Institute, Lucknow, India
| | - Hardik Gupta
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Bhavik Bansal
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Anshuman Elhence
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Ravi V. Krishna Kishore
- Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Amit Goel
- Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
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Patwa AK, Deep A, Kumar S, Rungta S, Atam V, Swaroop S. Previous history of surgery in females and roadside shaving in males are the commonest risk factors for hepatitis C infection: A cross-sectional retrospective study. J Family Med Prim Care 2021; 10:407-413. [PMID: 34017762 PMCID: PMC8132844 DOI: 10.4103/jfmpc.jfmpc_1313_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/13/2020] [Accepted: 10/28/2020] [Indexed: 11/04/2022] Open
Abstract
Background and objectives Hepatitis C virus (HCV) is a causative agent of hepatitis C disease of the liver. We have analysed the major risk factors including demographic, clinical and genotypic distribution among HCV seropositive patients and their distribution in Uttar Pradesh, India. Methods This study was conducted by a questionnaire-based proforma, filled in Hepatobiliary Clinic, Department of Medicine, King Georg's Medical University, Lucknow, from 2014 to 2017. Demographic, clinical and laboratory data were recorded. Seropositivity was demonstrated through an anti-HCV IgG ELISA kit. Positive patients were further examined for HCV RNA by RT-PCR. Results A total of 31,440 patients attended the hepatobiliary clinic. Among these, 310 (0.99%) patients were confirmed for HCV infection and there was no significant difference between males and females (50.3% vs. 49.7%). Previous surgery (49.0%), dental extraction (41.0%) and roadside shaving (38.1%) were the major risk factors for HCV infection. We also observed that previous surgery 143/154 (92.9%) in female and roadside shaving 118/156 (75.6%) in male was the commonest factor for HCV, however; dental extraction was comparable among male and female (65 [51.8%] vs 62 [48.2%], P value = 0.818). HCV RNA genotype 3 (81.6%) was the most frequent followed by 3a (11.3%), 3b (5.8%), 1 (0.7%) and 4 (0.7%). In the district-wise analysis, frequent cases were included from Lucknow with previous surgery and dental extraction as the commonest risk factor. Interpretation and Conclusions Previous surgery among female and roadside shaving among males are the commonest risk factors for HCV. This study suggests a powerful and strict guideline, to avoid HCV infection.
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Affiliation(s)
- Ajay Kumar Patwa
- Department of Medicine, King George's Medical University, Lucknow, India
| | - Amar Deep
- Experimental and Public Health Lab, Department of Zoology, University of Lucknow, Lucknow, India.,Department of Medical Gastroenterology, King George's Medical University, Lucknow, India
| | - Sushil Kumar
- Department of Zoology, Deen Dayal Upadhyaya Gorakhpur University, Gorakhpur, India
| | - Sumit Rungta
- Department of Medical Gastroenterology, King George's Medical University, Lucknow, India
| | - Virendra Atam
- Department of Medicine, King George's Medical University, Lucknow, India
| | - Suchit Swaroop
- Experimental and Public Health Lab, Department of Zoology, University of Lucknow, Lucknow, India
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Sood AK, Manrai M, Thareja S, Shukla R, Patel A. Epidemiology of hepatitis C virus infection in a tertiary care hospital. Med J Armed Forces India 2020; 76:443-450. [PMID: 33162654 PMCID: PMC7606104 DOI: 10.1016/j.mjafi.2019.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 08/25/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND There are epidemiological lacunae in literature of hepatitis C virus (HCV) infection. We report a prospective observational study of asymptomatic HCV infected patients from a tertiary care Government Hospital. METHODS All consecutive asymptomatic antibodies to hepatitis C virus (anti-HCV) positive patients were studied from July 2011 to April 2016. Patients were reviewed for demographic factors including symptom profile, risk factors, family screening, and point prevalence in relation to various districts of Punjab and Haryana. RESULTS One thousand twelve patients were studied with median age of 52 years (range:13-85) with a male to female ratio of 0.87. Eight hundred (79.25%) patients were from Punjab and 110 (10.67%) from Haryana. Forty percent patients were in 40-60 age group. Six hundred seventy patients (66.21%) did not have any apparent risk factor, 274 (27.08%) had one risk factor, and 68 patients (6.72%) had > 2 risk factors. Commonest risk factor was h/o surgery in 243 patients (24.01%), 32 patients had h/o IV drug abuse and 29 among them were < 30 years. Three hundred and sixty-seven families and children were screened, and 27 spouses and 16 children were found to be anti-HCV positive. The risk factor of IV drug abuse was more common in the younger adults with age ≤ 30 years as compared with age > 30 years (p = 0.001). CONCLUSION HCV infection was common in certain districts of Punjab and common in adults of 40-60 years. This finding needs to be confirmed in larger population-based study. The IV drug abuse is the risk factor of concern among young adults.
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Affiliation(s)
| | - Manish Manrai
- Associate Professor, Department of Internal Medicine, Armed Forces Medical College, Pune 411040, India
| | | | - Rajat Shukla
- Commandant, Military Hospital Namkum, Ranchi, Jharkhand, India
| | - Amol Patel
- Classified Specialist (Medicine) & Medical Oncologist, Army Hospital (R&R), New Delhi-110010, India
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Banga RK, Singh J, Garg S, Bhaskaran S, Dahuja A. Seropositivity Load in Orthopedic Surgery at Tertiary Care Hospitals in North India - An Observational Study. J Orthop Case Rep 2020; 10:48-52. [PMID: 33312979 PMCID: PMC7706445 DOI: 10.13107/jocr.2020.v10.i05.1834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Exposure to blood and blood-borne viruses is major concern for orthopedic surgeons and operation theater staff because of constant exposure to sharp instruments and bodily fluids. The objective of this study was to assess the burden of seropositive patients in the orthopedic department of tertiary care hospitals in North India. MATERIALS AND METHODS This retrospective study was carried out in author's institute on indoor patients admitted from January 2015 to December 2017. A total of 8914 patients were included in the study and relevant clinical data were collected for seropositivity of hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) in patients admitted in the orthopedic emergency department. These patients were routinely tested for seropositivity before undergoing various surgical procedures. RESULTS A total of 8914 patients included in the study, out of which 7193 (80.7%) were male and 1721 (19.3%) were female. Out of total patients, 262 (2.9%) were found to be seropositive. Out of these patients, 31 (11.8%) were found to be positive for HIV, 190 (72.5%) for HCV, and 41(15.7%) for HBV. About 35.90% of patients with highest prevalence of seropositivity were truck drivers. CONCLUSION HIV, HBsAg, and HCV are common in this region with HCV infection being the major concern in Punjab. Screening for viral markers will help in adequate pre-operative planning, timely precautions, and immediate post-exposure prophylaxis in case of contact with blood or body fluids of seropositive patients.
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Affiliation(s)
- Ravinder Kumar Banga
- Department of Orthopaedics, Government Medical College and Hospital, Patiala, Punjab, India
| | - Jagdeep Singh
- Department of Orthopaedics, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Sorabh Garg
- Department of Orthopaedics, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Swarnesh Bhaskaran
- Department of Orthopaedics, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Anshul Dahuja
- Department of Orthopaedics, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
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Sarin SK, Kumar M, Eslam M, George J, Al Mahtab M, Akbar SMF, Jia J, Tian Q, Aggarwal R, Muljono DH, Omata M, Ooka Y, Han KH, Lee HW, Jafri W, Butt AS, Chong CH, Lim SG, Pwu RF, Chen DS. Liver diseases in the Asia-Pacific region: a Lancet Gastroenterology & Hepatology Commission. Lancet Gastroenterol Hepatol 2020; 5:167-228. [PMID: 31852635 PMCID: PMC7164809 DOI: 10.1016/s2468-1253(19)30342-5] [Citation(s) in RCA: 310] [Impact Index Per Article: 77.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 07/20/2019] [Accepted: 08/02/2019] [Indexed: 02/06/2023]
Abstract
The Asia-Pacific region is home to more than half of the global population and accounted for 62·6% of global deaths due to liver diseases in 2015. 54·3% of global deaths due to cirrhosis, 72·7% of global deaths due to hepatocellular carcinoma, and more than two-thirds of the global burden of acute viral hepatitis occurred in this region in 2015. Chronic hepatitis B virus (HBV) infection caused more than half of the deaths due to cirrhosis in the region, followed by alcohol consumption (20·8%), non-alcoholic fatty liver disease (NAFLD; 12·1%), and chronic infection with hepatitis C virus (HCV; 15·7%). In 2015, HBV accounted for about half the cases of hepatocellular carcinoma in the region. Preventive strategies for viral hepatitis-related liver disease include increasing access to clean drinking water and sanitation. HBV vaccination programmes for neonates have been implemented by all countries, although birth-dose coverage is extremely suboptimal in some. Availability of screening tests for blood and tissue, donor recall policies, and harm reduction strategies are in their initial stages in most countries. Many governments have put HBV and HCV drugs on their essential medicines lists and the availability of generic versions of these drugs has reduced costs. Efforts to eliminate viral hepatitis as a public health threat, together with the rapid increase in per-capita alcohol consumption in countries and the epidemic of obesity, are expected to change the spectrum of liver diseases in the Asia-Pacific region in the near future. The increasing burden of alcohol-related liver diseases can be contained through government policies to limit consumption and promote less harmful patterns of alcohol use, which are in place in some countries but need to be enforced more strictly. Steps are needed to control obesity and NAFLD, including policies to promote healthy lifestyles and regulate the food industry. Inadequate infrastructure and insufficient health-care personnel trained in liver diseases are issues that also need to be addressed in the Asia-Pacific region. The policy response of most governments to liver diseases has thus far been inadequate and poorly funded. There must be a renewed focus on prevention, early detection, timely referral, and research into the best means to introduce and improve health interventions to reduce the burden of liver diseases in the Asia-Pacific region.
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Affiliation(s)
- Shiv K Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, Vasant Kunj, New Delhi, India.
| | - Manoj Kumar
- Department of Hepatology, Institute of Liver and Biliary Sciences, Vasant Kunj, New Delhi, India
| | - Mohammed Eslam
- Storr Liver Centre, The Westmead Institute for Medical Research, University of Sydney and Westmead Hospital, Westmead, Australia
| | - Jacob George
- Storr Liver Centre, The Westmead Institute for Medical Research, University of Sydney and Westmead Hospital, Westmead, Australia
| | - Mamun Al Mahtab
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Sheikh M Fazle Akbar
- Department of Pathology, Ehime University Proteo-Science Center, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, Japan
| | - Jidong Jia
- Liver Research Center, Beijing Friendship Hospital, Capital Medial University, Beijing, China
| | - Qiuju Tian
- Liver Research Center, Beijing Friendship Hospital, Capital Medial University, Beijing, China
| | - Rakesh Aggarwal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | | | - Masao Omata
- Department of Gastroenterology, Yamanashi Central Hospital, Yamanashi, Japan; University of Tokyo, Tokyo, Japan
| | - Yoshihiko Ooka
- Department of Gastroenterology, Chiba University Hospital, Chiba, Japan
| | - Kwang-Hyub Han
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Hye Won Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Wasim Jafri
- Department of Medicine, Section of Gastroenterology, The Aga Khan University, Karachi, Pakistan
| | - Amna S Butt
- Department of Medicine, Section of Gastroenterology, The Aga Khan University, Karachi, Pakistan
| | - Chern H Chong
- Division of Gastroenterology & Hepatology, National University Health System, Singapore; Division of General Medicine, Woodlands Health Campus, Singapore
| | - Seng G Lim
- Division of Gastroenterology & Hepatology, National University Health System, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Raoh-Fang Pwu
- National Hepatitis C Program Office, Ministry of Health and Welfare, Taipei, Taiwan
| | - Ding-Shinn Chen
- Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan; Genomics Research Center, Academia Sinica, Taipei, Taiwan
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Nikitha S, Sabeena S, Robin S, Hiren D, Prasad V, Aswathyraj S, Devadiga S, Anup J, Arunkumar G. The prevalence of anti-hepatitis C antibody among acute febrile illness cases in Idar Taluk, Gujarat, West India. Indian J Med Microbiol 2019; 37:225-229. [PMID: 31745023 DOI: 10.4103/ijmm.ijmm_19_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Purpose The major cause of chronic hepatitis is infections with hepatitis B virus and hepatitis C virus (HCV) globally. However, there exists sparse epidemiological data regarding the prevalence of HCV infection from India. Methodology We carried out a cross-sectional study to estimate the prevalence of anti-HCV antibody among acute febrile illness cases aged between 1 and 65 years in Idar Taluk, Sabarkantha district, Gujarat state located in West India. A total of 702 serum samples collected from the study area during the year 2017, were screened for anti-hepatitis C IgG by enzyme-linked immunosorbent assay. The serum samples screened positive were then subjected to molecular testing for confirmation. Results Among the 702 study participants screened, 16 cases were reported to be anti-HCV IgG positive with an estimated seroprevalence rate of 2.3% (95% confidence interval: 1.4%-3.7%). Out of the 16 cases, two samples were confirmed positive by molecular testing indicating active infection. When analysed phylogenetically, one strain was genotyped as HCV1b genotype, and the other one was clustered along with HCV3a genotype. Both the patients with hepatitis C infection were observed to be having a probable 1-year survival rate of 100% and a 2-year survival rate of 85% when the Child-Turcotte-Pugh classification was applied. Conclusion The estimated seroprevalence of hepatitis C in Idar Taluk, Sabarkantha district, west India was 2.3%. HCV genotypes 1b and 3a were observed to be circulating in the study area.
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Affiliation(s)
- Shekara Nikitha
- Manipal Institute of Virology, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | | | - Sudandiradas Robin
- Manipal Institute of Virology, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Dodia Hiren
- Manipal Institute of Virology, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Varamballi Prasad
- Manipal Institute of Virology, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Sushama Aswathyraj
- Manipal Institute of Virology, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Santhosha Devadiga
- Manipal Institute of Virology, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Jayaram Anup
- Manipal Institute of Virology, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Sofosbuvir-velpatasvir single-tablet regimen administered for 12 weeks in a phase 3 study with minimal monitoring in India. Hepatol Int 2019; 13:173-179. [PMID: 30790229 PMCID: PMC6418070 DOI: 10.1007/s12072-019-09927-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 01/05/2019] [Indexed: 12/20/2022]
Abstract
Background and aims In clinical studies, sofosbuvir–velpatasvir has demonstrated high cure rates and favorable tolerability in patients chronically infected with chronic hepatitis C virus (HCV) of any genotype. We evaluated the effectiveness and safety of sofosbuvir–velpatasvir administered with minimal medical monitoring to patients in India.
Methods At 16 sites in India, 129 adult patients with chronic HCV infection of any genotype initiated 12 weeks of once-daily sofosbuvir–velpatasvir (400–100 mg). Patients with compensated cirrhosis or prior treatment experience could be included in the study. Study drug was dispensed monthly, but there were no on-treatment study assessments. The primary efficacy endpoint was rate of sustained virologic response (HCV RNA < 15 IU/mL) 12 weeks after treatment (SVR12), which was compared to a pre-specified performance goal of 85%. Results The majority of patients had HCV genotype 3 infection (70%), followed by HCV genotype 1 (22%). The SVR12 rate was 93% (120/129; 95% CI, 87% to 97%) (p = 0.009 compared with the 85% performance goal). Of the nine patients who did not achieve SVR12, 1 experienced virologic failure, 2 relapsed after treatment, 1 withdrew consent after treatment, and 5 were lost to follow-up (1 during and 4 after treatment). Sofosbuvir–velpatasvir was well-tolerated, and no patients discontinued treatment because of an adverse event. The most frequently reported adverse events were headache (3% of patients), upper abdominal pain (2%), and pyrexia (2%). Conclusions In this study conducted at multiple sites in India, sofosbuvir–velpatasvir administered without genotype restriction or on-treatment safety assessments was well-tolerated and highly effective.
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Goel A, Seguy N, Aggarwal R. Burden of hepatitis C virus infection in India: A systematic review and meta-analysis. J Gastroenterol Hepatol 2019; 34:321-329. [PMID: 30176181 DOI: 10.1111/jgh.14466] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 08/29/2018] [Accepted: 08/30/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIM Burden of hepatitis C in India is not known. We therefore conducted a systematic review of the available data on anti-hepatitis C virus (HCV) seroprevalence in the Indian population. METHODS We searched several publication databases for English language papers that reported data on anti-HCV seroprevalence from India and also identified other unpublished sources of such data. Data on groups likely to represent seroprevalence in general population and in selected high-risk groups were extracted and subjected to meta-analysis. RESULTS Of the 3995 published papers and 94 additional data sources identified, 327 were selected; these provided 414 anti-HCV seroprevalence data points. Pooled anti-HCV seroprevalence rates in community-based studies, blood donors, and pregnant women were 0.85% (95% confidence interval: 0.00-3.98%), 0.44% (0.40-0.49), and 0.88% (0.21-1.90), respectively. Among groups considered at high risk of HCV, pooled anti-HCV seroprevalence rates were as follows: people living with HIV (40 studies from 17 states: 3.51% [2.43-4.76]), persons on maintenance hemodialysis (37, 13; 19.23% [13.52-25.65]), people who inject drugs (46, 14; 44.71% [37.50-52.03]), multi-transfused persons (38, 12; 24.06% [20.00-28.36]), persons with sexually transmitted diseases (7, 5; 4.10% [0.98-9.04]), and those with high-risk sex behavior (6, 5; 4.06% [1.79-7.10]). CONCLUSIONS Community-based data on HCV seroprevalence in India were limited. Large amount of data on blood donors and pregnant women were identified, with pooled anti-HCV seroprevalence rates of 0.44% and 0.88%, respectively. Among high-risk groups, anti-HCV prevalence was higher among people living with HIV, those with sexually transmitted diseases, high-risk sex behavior or injection drug use, and those receiving hemodialysis or frequent transfusions.
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Affiliation(s)
- Amit Goel
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Nicole Seguy
- World Health Organization India Country Office, New Delhi, India
| | - Rakesh Aggarwal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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Sood A, Midha V, Halli SS, Narang V, Mahajan R, Mehta V, Kaur K, Surlikar V, Kanchi S, Singh D. Impact of "Sambhav" Program (Financial Assistance and Counselor Services) on Hepatitis C Pegylated Interferon Alpha Treatment Initiation in India. Int J Health Policy Manag 2018; 7:1138-1144. [PMID: 30709089 PMCID: PMC6358661 DOI: 10.15171/ijhpm.2018.84] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 08/26/2018] [Indexed: 11/21/2022] Open
Abstract
Background: Financial constraints, social taboos and beliefs in alternative medicine are common reasons for delaying or
not considering treatment for hepatitis C in India. The present study was planned to analyze the impact of non-banking
interest free loan facility in patients affected with hepatitis C virus (HCV) in North India.
Methods: This one year observational, retrospective study was conducted in Department of Gastroenterology (January
2012-December 2013), Dayanand Medical College and Hospital Ludhiana, to evaluate the impact of program titled
"Sambhav" (which provided non-banking financial assistance and counselor services) on treatment initiation and
therapeutic compliance in HCV patients. Data of fully evaluated patients with chronic hepatitis, and/or cirrhosis due to
HCV infection who were treated with Peginterferon alfa and ribavirin (RBV) combination during this duration (2012-
2013) was collected from patient medical records and analyzed. In the year 2012, eligible patients who were offered
antiviral treatment paid for treatment themselves, while in 2013, ‘Sambhav’ program was launched and this provided
interest free financing by non-banking financial company (NBFC) for the treatment of HCV in addition to free counselor
services for disease management. The treatment initiation and compliance rates were compared between the patients (n
= 585) enrolled in 2013 who were offered ‘Sambhav’ assistance and those enrolled in 2012 (n = 628) when ‘Sambhav’
was not available.
Results: Introduction of Sambhav program improved the rates of treatment initiation (59% in 2013 vs. 51% in 2012,
P=.004). Of the 585 eligible patients offered ‘Sambhav’ assistance in 2013, 233 patients (39.8%) applied but 106/233
(45.4%) received assistance. Antiviral therapy was started in 93/106 (87.7%) of these patients, while only 52 (42.5%) of
127 patients whose applications were rejected underwent treatment. Compliance to antiviral therapy also improved with
the introduction of ‘Sambhav’ program (87.7% vs. 74.1%, P=.001).
Conclusion: ‘Sambhav’ program had significant impact on the initiation of antiviral therapy by overcoming the financial
hurdles. The free counselor services helped to mitigate social taboos and imparted adequate awareness about the disease
to the patients. Initiatives like ‘Sambhav’ can be utilized for improving healthcare services in developing countries,
especially for chronic diseases.
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Affiliation(s)
- Ajit Sood
- Department of Gastroentrology, Dayanand Medical College and Hospital (DMCH), Ludhiana, India
| | - Vandana Midha
- Department of Internal Medicine, Dayanand Medical College and Hospital (DMCH), Ludhiana, India
| | | | - Vikram Narang
- Department of Pathology, Dayanand Medical College & Hospital (DMCH), Ludhiana, India
| | - Ramit Mahajan
- Department of Gastroentrology, Dayanand Medical College and Hospital (DMCH), Ludhiana, India
| | - Varun Mehta
- Department of Gastroentrology, Dayanand Medical College and Hospital (DMCH), Ludhiana, India
| | - Kirandeep Kaur
- Department of Pharmacology, Dayanand Medical College and Hospital, Ludhiana, India
| | | | | | - Dharmatma Singh
- Department of Gastroentrology, Dayanand Medical College and Hospital (DMCH), Ludhiana, India
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12
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Prevalence of hepatitis B and hepatitis C infection from a population-based study in Southern India. Eur J Gastroenterol Hepatol 2018; 30:1344-1351. [PMID: 29889684 DOI: 10.1097/meg.0000000000001180] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES This study aims to estimate the prevalence of hepatitis B (HBV) and C (HCV) in the population through field-screening camps conducted by Chennai Liver Foundation, in the southern state of Tamil Nadu, India. This is the largest population-based study from Tamil Nadu. PATIENTS AND METHODS A total of 75 camps were conducted across 14 districts of Tamil Nadu (2014-2017). Screening was done by rapid point-of-care assays (SD-bioline tests) and confirmed by enzyme-linked immunosorbent assay (Monolisa tests). Those tested negative were offered first dose of HBV vaccine. Positive patients with HBV count of more than 2000 IU/ml or HCV-RNA positive on quantitative analysis were treated. RESULTS A total of 18 589 people were screened, with HBV infection detected in 303 (prevalence 1.63%) and HCV infection in 56 (prevalence 0.3%), with significant variation among districts. Males contributed to about three-fourths of detected HBV [233/303 (77%)] or HCV [41/56 (73%)] infection. Screening detected a higher overall HBV/HCV infection rate in rural [203 (2.52%) infections in 8047 people] than in urban [156 (1.47%) infections in 10 542 people] areas (P<0.0001). Slum areas had a HBV prevalence of 5%. In a dialysis unit, all patients were found to have either HBV/HCV infection. A total of 162/303 (54%) people with HBV and 27/56 (48%) with HCV infection were treated, and 7704 people received the first dose of HBV vaccine. CONCLUSION The prevalence of HBV was 1.63% and HCV was 0.30% in Tamil Nadu. Three-fourths of HBV/HCV infected people were males. Prevalence of HBV/HCV was higher in rural areas. Slum area and dialysis unit had high HBV and HCV prevalence.
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13
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Sood A, Suryaprasad A, Trickey A, Kanchi S, Midha V, Foster MA, Bennett E, Kamili S, Alvarez-Bognar F, Shadaker S, Surlikar V, Garg R, Mittal P, Sharma S, May MT, Vickerman P, Averhoff F. The burden of hepatitis C virus infection in Punjab, India: A population-based serosurvey. PLoS One 2018; 13:e0200461. [PMID: 30048454 PMCID: PMC6061991 DOI: 10.1371/journal.pone.0200461] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 06/27/2018] [Indexed: 12/15/2022] Open
Abstract
Introduction Hepatitis C virus (HCV) infection prevalence is believed to be elevated in Punjab, India; however, state-wide prevalence data are not available. An understanding of HCV prevalence, risk factors and genotype distribution can be used to plan control measures in Punjab. Methods A cross-sectional, state-wide, population-based serosurvey using a multi-stage stratified cluster sampling design was conducted October 2013 to April 2014. Children aged ≥5 years and adults were eligible to participate. Demographic and risk behavior data were collected, and serologic specimens were obtained and tested for anti-HCV antibody, HCV Ribonucleic acid (RNA) on anti-HCV positive samples, and HCV genotype. Prevalence estimates and adjusted odds ratios for risk factors were calculated from weighted data and stratified by urban/rural residence. Results 5,543 individuals participated in the study with an overall weighted anti-HCV prevalence of 3.6% (95% Confidence Interval [CI]: 3.0%–4.2%) and chronic infection (HCV Ribonucleic acid test positive) of 2.6% (95% CI: 2.0%–3.1%). Anti-HCV was associated with being male (adjusted odds ratio 1.52; 95% CI: 1.08–2.14), living in a rural area (adjusted odds ratio 2.53; 95% CI: 1.62–3.95) and was most strongly associated with those aged 40–49 (adjusted odds ratio 40–49 vs. 19–29-year-olds 3.41; 95% CI: 1.90–6.11). Anti-HCV prevalence increased with each blood transfusion received (adjusted odds ratio 1.36; 95% CI: 1.10–1.68) and decreased with increasing education, (adjusted odds ratio 0.37 for graduate-level vs. primary school/no education; 95% CI: 0.16–0.82). Genotype 3 (58%) was most common among infected individuals. Discussion The study findings, including the overall prevalence of chronic HCV infection, associated risk factors and demographic characteristics, and genotype distribution can guide prevention and control efforts, including treatment provision. In addition to high-risk populations, efforts targeting rural areas and adults aged ≥40 would be the most effective for identifying infected individuals.
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Affiliation(s)
- Ajit Sood
- Dayanand Medical College, Ludhiana, Punjab, India
| | - A. Suryaprasad
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - A. Trickey
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
- * E-mail:
| | | | - V. Midha
- Dayanand Medical College, Ludhiana, Punjab, India
| | - M. A. Foster
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - E. Bennett
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - S. Kamili
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | | | - S. Shadaker
- CDC Foundation, Atlanta, GA, United States of America
| | | | - R. Garg
- Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - P. Mittal
- Mittal Liver and Gastroenterology Centre, Patiala, Punjab, India
| | - S. Sharma
- College of Nursing, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - M. T. May
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - P. Vickerman
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - F. Averhoff
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
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14
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Rewri P, Sharma M, Vats DP, Singhal A. Seroprevalence, risk associations, and cost analysis of screening for viral infections among patients of cataract surgery. Indian J Ophthalmol 2018; 66:394-399. [PMID: 29480249 PMCID: PMC5859593 DOI: 10.4103/ijo.ijo_726_17] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Purpose The purpose of this study was to estimate the prevalence of blood-borne viral infections (triple H: HBV-hepatitis B virus, HCV-hepatitis C virus, and HIV-human immunodeficiency virus) among cataract patients, sought possible risk associations and discuss feasibility of universal preoperative screening. Methods This prospective, cross-sectional study enrolled consecutive patients of senile cataract. They were screened by immunoassay-based rapid diagnostic card tests for blood-borne viral infections. Positive cases were confirmed with confirmatory ELISA tests. Seropositive patients were enquired about the exposure to possible risk associations for acquiring these infections. Cost of card test per patient was calculated. Results The prevalence of seropositivity for triple H viral infections (HBV, HCV, and HIV) among patients of senile cataract was 5.9% (95% confidence interval [CI]: 5.3-6.6), and HCV was most common viral infection. The dental extraction was most common (54%; 95% CI:48-60) possible risk association. The total cost of primary screening per patient for triple H infections(HBV, HCV, and HIV) was $0.93. Conclusion The prevalence of blood-borne viral infection among cataract patients is high in this area. Awareness of the prevalence of blood-borne viral infections in service area, along with knowledge of rate of accidental exposure and risk of transmission would help to understand cost-effectiveness of universal preoperative screening before cataract surgery.
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Affiliation(s)
- Parveen Rewri
- Department of Ophthalmology, Maharaja Agrasen Medical College, Agroha, Hisar, Haryana, India
| | - Madhavi Sharma
- Department of Ophthalmology, Maharaja Agrasen Medical College, Agroha, Hisar, Haryana, India
| | - D P Vats
- Department of Ophthalmology, Maharaja Agrasen Medical College, Agroha, Hisar, Haryana, India
| | - Aparna Singhal
- Department of Ophthalmology, Maharaja Agrasen Medical College, Agroha, Hisar, Haryana, India
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15
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Mahajan R, Midha V, Goyal O, Mehta V, Narang V, Kaur K, Singh A, Singh D, Bhanot R, Sood A. Clinical profile of hepatitis C virus infection in a developing country: India. J Gastroenterol Hepatol 2018; 33:926-933. [PMID: 28921677 DOI: 10.1111/jgh.13995] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 08/20/2017] [Accepted: 09/11/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIM The epidemiology and clinical profile of hepatitis C virus (HCV) varies worldwide, and data from developing countries are sparse. The aim of the present study was to assess the clinical profile of HCV infection in a developing country in South-East Asia (India). METHODS This observational study assessed patient demographics, viral characteristics, risk factors for virus acquisition, and disease characteristics in HCV patients diagnosed between January 2004 and December 2015. RESULTS Of 8035 patients who were diagnosed with HCV infection, a majority were men (68.3%), middle aged (52.2%), and from low (34%) to middle (46%) socioeconomic status and rural population (69.8%). Eighty-two percent had identifiable risk factors, the most common being history of dental treatment (52%) and therapeutic injections with reusable syringes/needles (45%). Household contacts of index patients had high prevalence of HCV (15.3%). Common genotypes were genotype 3 (70.4%) and genotype 1 (19.3%). Although a majority of patients were either asymptomatic (54.8%) or had non-specific symptoms (6.7%) at presentation, a significant proportion (9.3%) had advanced liver disease. Presentation with cirrhosis (38.8%) was associated with male gender, higher age at time of virus detection, rural residence, alcohol or opium intake, and coinfections with hepatitis B virus or human immunodeficiency virus. CONCLUSIONS Hepatitis C virus infection in northern India is seen more commonly in men, the middle aged and people from rural background and low to middle socioeconomic status. The common possible risk factors are dental treatment and exposure to reused syringes and needles. Although the most common presentation is incidental detection, a large number of patients present with advanced liver disease.
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Affiliation(s)
- Ramit Mahajan
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Vandana Midha
- Department of Internal Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Omesh Goyal
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Varun Mehta
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Vikram Narang
- Department of Pathology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Kirandeep Kaur
- Department of Pharmacology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Arshdeep Singh
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Dharmatma Singh
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Rishu Bhanot
- Department of Internal Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Ajit Sood
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
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16
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Nayak S, Kataria A, Sharma MK, Rastogi A, Gupta E, Singh A, Tiwari SC. Hepatitis C Virus-associated Membranoproliferative Glomerulonephritis Treated with Directly Acting Antiviral Therapy. Indian J Nephrol 2018; 28:462-464. [PMID: 30647501 PMCID: PMC6309397 DOI: 10.4103/ijn.ijn_235_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Hepatitis C virus (HCV) infection has been shown to affect kidneys with various histopathological pattern on the kidney biopsy. These commonly include a membranoproliferative glomerulonephritis (MPGN) pattern with mixed cryoglobulinemia (CG), thrombotic microangiopathy, membranous nephropathy, and vasculitis affecting medium and small vessels of the kidneys causing polyarteritis nodosa. It has been rarely associated with MPGN without detectable CG. We present one such patient who presented to us with HCV-associated MPGN without detectable CG, who recovered completely with directly acting antiviral therapy without any immunosuppression.
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Affiliation(s)
- S Nayak
- Department of Nephrology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - A Kataria
- Department of Nephrology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - M K Sharma
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - A Rastogi
- Department of Pathology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - E Gupta
- Department of Virology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - A Singh
- Department of Nephrology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - S C Tiwari
- Department of Nephrology, Institute of Liver and Biliary Sciences, New Delhi, India
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Trickey A, May MT, Davies C, Qureshi H, Hamid S, Mahmood H, Saeed Q, Hickman M, Glass N, Averhoff F, Vickerman P. Importance and Contribution of Community, Social, and Healthcare Risk Factors for Hepatitis C Infection in Pakistan. Am J Trop Med Hyg 2017; 97:1920-1928. [PMID: 29141707 DOI: 10.4269/ajtmh.17-0019] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Pakistan has a high prevalence of hepatitis C virus (HCV) infection, estimated at 4.9% (2,290/46,843) in the 2007 national HCV seroprevalence survey. We used data from this survey to assess the importance of risk factor associations with HCV prevalence in Pakistan. Exposures were grouped as community (going to the barbers, sharing smoking equipment, having an ear/nose piercing, tattoo, or acupuncture), healthcare (ever having hemodialysis, blood transfusion, or ≥ 5 injections in the last year), demographic (marital status and age), and socio-economic (illiterate or laborer). We used mutually adjusted multivariable regression analysis, stratified by sex, to determine associations with HCV infection, their population attributable fraction, and how risk of infection accumulates with multiple exposures. Strength of associations was assessed using adjusted odds ratios (aOR). Community [aOR females 1.5 (95% confidence interval [CI]: 1.2, 1.8); males 1.2 (1.1, 1.4)] and healthcare [females 1.4 (1.2, 1.6); males 1.2 (1.1, 1.4)] exposures, low socio-economic status [females 1.6 (1.3, 1.80); males 1.3 (1.2, 1.5)], and marriage [females 1.5 (1.2, 1.9); males 1.4 (1.1, 1.8)] were associated with increased HCV infection. Among married women, the number of children was associated with an increase in HCV infection; linear trend aOR per child 1.06 (1.01, 1.11). Fewer infections could be attributed to healthcare exposures (females 13%; males 6%) than to community exposures (females 25%; males 9%). Prevalence increased from 3% to 10% when cumulative exposures increased from 1 to ≥ 4 [aOR per additional exposure for females 1.5 (1.4, 1.6); males 1.2 (1.2, 1.3)]. A combination of community, healthcare, and other factors appear to drive the Pakistan HCV epidemic, highlighting the need for a comprehensive array of prevention strategies.
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Affiliation(s)
- Adam Trickey
- Bristol Medical School, University of Bristol, Bristol, United Kingdom.,National Institute of Health Research (NIHR) Health Protection Research Unit (HPRU) in Evaluation of Interventions, Bristol, United Kingdom
| | - Margaret T May
- National Institute of Health Research (NIHR) Health Protection Research Unit (HPRU) in Evaluation of Interventions, Bristol, United Kingdom.,Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Charlotte Davies
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Huma Qureshi
- Pakistan Medical Research Council (PMRC), Islamabad, Pakistan
| | - Saeed Hamid
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Hassan Mahmood
- Pakistan Medical Research Council (PMRC), Islamabad, Pakistan
| | - Quaid Saeed
- National AIDS Control Programme, Islamabad, Pakistan
| | - Matthew Hickman
- National Institute of Health Research (NIHR) Health Protection Research Unit (HPRU) in Evaluation of Interventions, Bristol, United Kingdom.,Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Nancy Glass
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Peter Vickerman
- National Institute of Health Research (NIHR) Health Protection Research Unit (HPRU) in Evaluation of Interventions, Bristol, United Kingdom.,Bristol Medical School, University of Bristol, Bristol, United Kingdom
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18
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Dhiman RK, Satsangi S, Grover GS, Puri P. Tackling the Hepatitis C Disease Burden in Punjab, India. J Clin Exp Hepatol 2016; 6:224-232. [PMID: 27746619 PMCID: PMC5052426 DOI: 10.1016/j.jceh.2016.09.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 09/01/2016] [Indexed: 12/12/2022] Open
Abstract
Hepatitis C virus (HCV) is a globally prevalent pathogen and is a major cause of healthcare burden in India. HCV poses a significant problem in the state of Punjab, India owing to the higher prevalence of risk factors like unsafe medical practices (including unsafe injections and dental procedures) and intravenous drug use. The reported prevalence of HCV in this part of the country was 5.2% in 2012, while a recent study has shown the prevalence to be 3.2% in 2016. Similar to the other geographic belts in India, genotype 3 predominates in the state of Punjab. Control of HCV infection in Punjab requires focusing on several strategies. There is a need to formulate a health educational curriculum targeting not only the high-risk population but also the general population regarding the transmission of HCV. Training of family physicians who form the first link to patients in the community is imperative in the success of healthcare programmes. Adopting the dual approach of treating the old cases (decreasing the reservoir pool of HCV) and decreasing the incidence of new ones would help curtail the disease and decrease liver related mortality. A commendable initiative has been launched by the Punjab state government to eliminate HCV from Punjab. However, besides the initiative by the government, a concerted effort by all other stakeholders in managing the HCV burden in India, namely the doctors, the drug companies and the non-government organizations is required for control of HCV.
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Key Words
- BPL, below poverty line
- DNDi, drugs for neglected diseases initiative
- ECHO, Extension for Community Healthcare Outcomes
- HBV, hepatitis B virus
- HCC, hepatocellular carcinoma
- HCV, hepatitis C virus
- HCW, health care worker
- HD, hemodialysis
- INASL, Indian National Association for study of the Liver
- IVDU, intravenous drug user
- MMPHCRF, Mukh Mantri Punjab Hepatitis-C Relief Fund
- NAT, nucleic acid testing
- NGO, non-government organization
- PSACS, Punjab State AIDS Control Society
- Punjab
- control
- hepatitis C
- prevalence
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Affiliation(s)
- Radha K. Dhiman
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India,Address for correspondence: Radha K. Dhiman, Professor, Department of Hepatology, PGIMER, Chandigarh 160012, India.Professor, Department of Hepatology, PGIMERChandigarh160012India
| | - Sandeep Satsangi
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | | | - Pankaj Puri
- Department of Internal Medicine, Armed Forces Medical College, Pune 411040, India
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19
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Viral hepatitis: Indian scenario. Med J Armed Forces India 2016; 72:204-10. [PMID: 27546957 DOI: 10.1016/j.mjafi.2016.06.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 06/27/2016] [Indexed: 02/07/2023] Open
Abstract
Viral hepatitis is a cause for major health care burden in India and is now equated as a threat comparable to the "big three" communicable diseases - HIV/AIDS, malaria and tuberculosis. Hepatitis A virus and Hepatitis E virus are predominantly enterically transmitted pathogens and are responsible to cause both sporadic infections and epidemics of acute viral hepatitis. Hepatitis B virus and Hepatitis C virus are predominantly spread via parenteral route and are notorious to cause chronic hepatitis which can lead to grave complications including cirrhosis of liver and hepatocellular carcinoma. Around 400 million people all over the world suffer from chronic hepatitis and the Asia-Pacific region constitutes the epicentre of this epidemic. The present article would aim to cover the basic virologic aspects of these viruses and highlight the present scenario of viral hepatitis in India.
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20
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Moezzi M, Imani R, Karimi A, Pourheidar B. Hepatitis C Seroprevalence and Risk Factors in Adult Population of Chaharmahal and Bakhtiari Province of Iran in 2013. J Clin Diagn Res 2015; 9:LC13-7. [PMID: 26557546 DOI: 10.7860/jcdr/2015/14986.6694] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 07/11/2015] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Hepatitis C is the second leading viral infectious disease worldwide. In Iran, hepatitis C is the most important and prevalent reason for chronic hepatitis and liver cirrhosis in the multi transfused population. AIM This study was conducted to determine seroprevalence and burden of hepatitis C in Chaharmahal and Bakhtiari province and to plan for controlling it. MATERIALS AND METHODS For this analytical, population-based study, 3000 samples were older than 15 years old and were enrolled from urban and rural areas of Chaharmahal and Bakhtiari province, southwest Iran per cluster sampling. Written informed consent was obtained from the participants and the demographic data, transmission route and risk factors were collected after blood sample taking. Hepatitis C virus antibody (HCV Ab) and western blotting were consecutively run. STATISTICAL ANALYSIS Data analysis was done by SPSS 19 using descriptive statistics, and chi-square test, Fisher's exact test, and logistic regression Ap value of 0.05 was considered as the level of significance. RESULTS The prevalence of HCV Ab was obtained 1.4% (95% CI, 0.95-1.7) and that of positive hepatitis C by western blotting 0.9% (95% CI, 0.65-1.3). The prevalence in men (1.2%) was obtained two times higher than women. The highest prevalence was obtained in 35 to 44-year-old population (2%). The prevalence was higher in married individuals and less in higher educated. History of hospital stay, first degree relatives infected with HCV, jaundice, history of blood transfusion, tattoo, outpatient surgery, imprisonment, contact with the infected, intravenous (IV) drug abuse, and smoking had significant association with disease prevalence (p<0.05). The highest odds ratio was obtained for history of IV drug abuse (OR=38.2, 95% CI, 14.06-103.9) followed by imprisonment (OR=8.9, 95% CI, 2.97-26.6). However, by logistic regression only history of IV drug abuse was obtained as significant (p<0.05). CONCLUSION Hepatitis C is growing and emerging as the most prevalent chronic, viral hepatic disease, so further consideration of risk factors and routes of transmission is crucial for appropriate planning for, and preventing, treating, and controlling hepatitis C. IV drug abusers as the most important group need special consideration and surveillance in order to cut infection chain and decrease the disease incidence.
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Affiliation(s)
- Masoumeh Moezzi
- Faculty, Department of Community Medicine, Shahrekord University of Medical Sciences , Shahrekord, IR Iran
| | - Reza Imani
- Faculty, Department of Infectious Diseases, Shahrekord University of Medical Sciences , Shahrekord, IR Iran
| | - Ali Karimi
- Faculty, Department of Microbiology, Shahrekord University of Medical Sciences , Shahrekord, IR Iran
| | - Behrouz Pourheidar
- Central Disease Control Unit, Shahrekord University of Medical Sciences , Shahrekord, IR Iran
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Gupta V, Kumar A, Sharma P, Bansal N, Singla V, Arora A. Most Patients of Hepatitis C Virus Infection in India Present Late for Interferon-Based Antiviral Treatment: An Epidemiological Study of 777 Patients from a North Indian Tertiary Care Center. J Clin Exp Hepatol 2015; 5:134-41. [PMID: 26155041 PMCID: PMC4491643 DOI: 10.1016/j.jceh.2015.05.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Accepted: 05/11/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Interferon-based antiviral therapy is offered only to those HCV patients who have either chronic hepatitis or early cirrhosis. Advanced cirrhotics do not tolerate interferon-based therapy. Since HCV is asymptomatic in early stages and usually presents late, the eligibility for interferon-based therapy is thus limited. There are scarce studies from India, which looked specifically the eligibility of interferon-based therapy in HCV patients. AIM To study the spectrum of presentation of HCV infection, determine their eligibility for interferon-based therapy, and follow for SVR. METHODS The records of all consecutive patients of HCV, >14 years age, who presented to our department between 2008 and 2014, were analyzed for categorization into chronic hepatitis, cirrhosis and hepatocellular carcinoma. Patients with detectable HCV RNA who have chronic hepatitis or Child A cirrhosis were considered eligible for Peg-interferon and ribavirin. Patients who received treatment were followed for SVR. RESULTS 777 patients (median age 49 [range 15-95] years, males 69%) were included. Cirrhosis was the most common presentation (56%, 439/777) followed by chronic hepatitis (37%, 287/777) and HCC (7%, 51/777). Of patients who had cirrhosis (including those with HCC), 36% (174/490) were Child A; 51% (250/490) were Child B and 14% (66/490) were Child C. Only 347/777 (45%) were eligible for Peg-interferon-alpha and Ribavirin. Among the remaining 430 patients, in 326 (76%) the disease was far too advanced. Of eligible patients only 54% actually received Peg-interferon-alpha and Ribavirin and 81% patients could complete the course. Of them only 70% could achieve SVR. CONCLUSIONS Most HCV patients in India present late and only about 45% are eligible for Interferon-based antiviral treatment. At presentation 56% patients already have cirrhosis and 7% have HCC. Since HCV is usually asymptomatic in early stages, awareness about screening should be increased so that more patients are diagnosed early before they develop cirrhosis or HCC.
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Key Words
- AFP, Alphafetoprotein
- ALT, Alanine aminotransferase
- ANA, Antinuclear antibody
- BCLC, Barcelona Clinic Liver Cancer
- DAA, Directly acting agents
- FNAC, Fine needle aspiration cytology
- HBV, Hepatitis B virus
- HCC, Hepatocellular carcinoma
- HCV, Hepatitis C virus
- HIV, Human immunodeficiency virus
- PCR, Polymerase chain reaction
- PEG-IFN, Pegylated Interferon
- RBV, Ribavirin
- RNA, Ribonucleic acid
- SMA, Smooth Muscle Antibody
- SVR, Sustained virological response
- WHO, World health organization
- chronic liver disease
- cirrhosis
- epidemiology
- hepatitis C
- hepatocellular carcinoma
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Affiliation(s)
| | | | | | | | | | - Anil Arora
- Address for correspondence. Anil Arora, Chairman, Department of Gastroenterology & Hepatology, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110 060, India. Tel.: +91 9311638779.
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Kumar AS, Sibia RS. Predictors of in-hospital mortality among patients presenting with variceal gastrointestinal bleeding. Saudi J Gastroenterol 2015; 21:43-6. [PMID: 25672238 PMCID: PMC4355862 DOI: 10.4103/1319-3767.151226] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND/AIM The recent years have witnessed an increase in number of people harboring chronic liver diseases. Gastroesophageal variceal bleeding occurs in 30% of patients with cirrhosis, and accounts for 80%-90% of bleeding episodes. We aimed to assess the in-hospital mortality rate among subjects presenting with variceal gastrointestinal bleeding and (2) to investigate the predictors of mortality rate among subjects presenting with variceal gastrointestinal bleeding. PATIENTS AND METHODS This retrospective study was conducted from treatment records of 317 subjects who presented with variceal upper gastrointestinal bleeding to Government Medical College, Patiala, between June 1, 2010, and May 30, 2014. The data thus obtained was compiled using a preset proforma, and the details analyzed using SPSSv20. RESULTS Cirrhosis accounted for 308 (97.16%) subjects with bleeding varices, with extrahepatic portal vein obstruction 9 (2.84%) completing the tally. Sixty-three (19.87%) subjects succumbed to death during hospital stay. Linear logistic regression revealed independent predictors for in-hospital mortality, including higher age (P = 0.000), Child-Pugh Class (P = 0.002), altered sensorium (P = 0.037), rebleeding within 24 h of admission (P = 0.000), low hemoglobin level (P = 0.023), and serum bilirubin (P = 0.002). CONCLUSION Higher age, low hemoglobin, higher Child-Pugh Class, rebleeding within 24 h of admission, higher serum bilirubin, and lower systolic blood pressure are the independent predictors of in-hospital mortality among subjects presenting with variceal gastrointestinal bleeding.
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Affiliation(s)
- Amith S. Kumar
- Department of Internal Medicine, Rajindra Hospital/Government Medical College, Patiala, Punjab, India
| | - Raminderpal S. Sibia
- Department of Internal Medicine, Rajindra Hospital/Government Medical College, Patiala, Punjab, India,Address for correspondence: Asst. Prof. Raminderpal Singh Sibia, Department of Internal Medicine, Rajindra Hospital/Government Medical College, Patiala - 147 001, Punjab, India. E-mail:
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Saraswat V, Norris S, de Knegt RJ, Sanchez Avila JF, Sonderup M, Zuckerman E, Arkkila P, Stedman C, Acharya S, Aho I, Anand AC, Andersson MI, Arendt V, Baatarkhuu O, Barclay K, Ben-Ari Z, Bergin C, Bessone F, Blach S, Blokhina N, Brunton CR, Choudhuri G, Chulanov V, Cisneros L, Croes EA, Dahgwahdorj YA, Dalgard O, Daruich JR, Dashdorj NR, Davaadorj D, de Vree M, Estes C, Flisiak R, Gadano AC, Gane E, Halota W, Hatzakis A, Henderson C, Hoffmann P, Hornell J, Houlihan D, Hrusovsky S, Jarčuška P, Kershenobich D, Kostrzewska K, Kristian P, Leshno M, Lurie Y, Mahomed A, Mamonova N, Mendez-Sanchez N, Mossong J, Nurmukhametova E, Nymadawa P, Oltman M, Oyunbileg J, Oyunsuren T, Papatheodoridis G, Pimenov N, Prabdial-Sing N, Prins M, Puri P, Radke S, Rakhmanova A, Razavi H, Razavi-Shearer K, Reesink HW, Ridruejo E, Safadi R, Sagalova O, Sanduijav R, Schréter I, Seguin-Devaux C, Shah SR, Shestakova I, Shevaldin A, Shibolet O, Sokolov S, Souliotis K, Spearman CW, Staub T, Strebkova EA, Struck D, Tomasiewicz K, Undram L, van der Meer AJ, van Santen D, Veldhuijzen I, Villamil FG, Willemse S, Zuure FR, Silva MO, Sypsa V, Gower E. Historical epidemiology of hepatitis C virus (HCV) in select countries - volume 2. J Viral Hepat 2015; 22 Suppl 1:6-25. [PMID: 25560839 DOI: 10.1111/jvh.12350] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Chronic hepatitis C virus (HCV) infection is a leading cause of liver related morbidity and mortality. In many countries, there is a lack of comprehensive epidemiological data that are crucial in implementing disease control measures as new treatment options become available. Published literature, unpublished data and expert consensus were used to determine key parameters, including prevalence, viremia, genotype and the number of patients diagnosed and treated. In this study of 15 countries, viremic prevalence ranged from 0.13% in the Netherlands to 2.91% in Russia. The largest viremic populations were in India (8 666 000 cases) and Russia (4 162 000 cases). In most countries, males had a higher rate of infections, likely due to higher rates of injection drug use (IDU). Estimates characterizing the infected population are critical to focus screening and treatment efforts as new therapeutic options become available.
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Affiliation(s)
- V Saraswat
- Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
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Garg R, Kaur S, Aseri R, Aggarwal S, Singh JP, Mann S, Kumar S, Kaur S. Hepatitis B & C among farmers - a seroprevalence study. J Clin Diagn Res 2014; 8:MC07-9. [PMID: 25584254 DOI: 10.7860/jcdr/2014/9514.5185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 08/29/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Hepatitis B & C are the two major causes of chronic liver disease, having the similar parenteral route of transmission, thereby responsible for significant morbidity and mortality. OBJECTIVE Agriculture being the backbone of this part of country, the present study was undertaken to assess the seroprevalence of these diseases among the farmers which form the major occupation class in the Malwa belt of Punjab, India. MATERIALS AND METHODS Screening camp was organized at Kisan Mela at the regional station of Punjab Agriculture University at Faridkot, Punjab. Blood samples were collected, and tested for HBsAg and anti-HCV. RESULTS Total of 1219 subjects, 63% being in the age group of 30-50 years, were screened of which the seroprevalence of HCV & HBV was 5% and 0.32% respectively, and 72% of HCV positive cases were between 30-50 years of age. CONCLUSION The study stresses on the need of safe injection practices especially in villages and control on addiction, a more effective vaccination program for HBV, strict check on commercial blood banks, and community education regarding tattooing and sexual behaviour.
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Affiliation(s)
- Ravinder Garg
- Associate Professor, Department of Medicine, GGS Medical College & Hospital , Faridkot, Punjab, India
| | - Shaminder Kaur
- Assistant Professor, Department of Medicine, GGS Medical College & Hospital , Faridkot, Punjab, India
| | - Rakesh Aseri
- PG Resident, Department of Medicine, GGS Medical College & Hospital , Faridkot, Punjab, India
| | - Simmi Aggarwal
- Professor & Head, Department of Radio- Diagnosis, GGS Medical College & Hospital , Faridkot, Punjab, India
| | | | - Simarpreet Mann
- Consultant Physician, Apex hospital , RampuraPhul, Bathinda, India
| | - Sumit Kumar
- Senior Resident, Department of Medicine, GGS Medical College & Hospital , Faridkot, Punjab, India
| | - Sarabjot Kaur
- PG Resident, Department of Medicine, GGS Medical College & Hospital , Faridkot, Punjab, India
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Gower E, Estes C, Blach S, Razavi-Shearer K, Razavi H. Global epidemiology and genotype distribution of the hepatitis C virus infection. J Hepatol 2014; 61:S45-57. [PMID: 25086286 DOI: 10.1016/j.jhep.2014.07.027] [Citation(s) in RCA: 1329] [Impact Index Per Article: 132.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 07/14/2014] [Accepted: 07/19/2014] [Indexed: 02/08/2023]
Abstract
The treatment of chronic hepatitis C virus (HCV) infection has the potential to change significantly over the next few years as therapeutic regimens are rapidly evolving. However, the burden of chronic infection has not been quantified at the global level using the most recent data. Updated estimates of HCV prevalence, viremia and genotypes are critical for developing strategies to manage or eliminate HCV infection. To achieve this, a comprehensive literature search was conducted for anti-HCV prevalence, viraemic prevalence and genotypes for all countries. Studies were included based on how well they could be extrapolated to the general population, sample size and the age of the study. Available country estimates were used to develop regional and global estimates. Eighty-seven countries reported anti-HCV prevalence, while HCV viraemic rates were available for fifty-four countries. Total global viraemic HCV infections were estimated at 80 (64-103) million infections. Genotype distribution was available for ninety-eight countries. Globally, genotype 1 (G1) was the most common (46%), followed by G3 (22%), G2 (13%), and G4 (13%). In conclusion, the total number of HCV infections reported here are lower than previous estimates. The exclusion of data from earlier studies conducted at the peak of the HCV epidemic, along with adjustments for reduced prevalence among children, are likely contributors. The results highlight the need for more robust surveillance studies to quantify the HCV disease burden more accurately.
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Affiliation(s)
- Erin Gower
- Center for Disease Analysis, Louisville, CO, USA
| | - Chris Estes
- Center for Disease Analysis, Louisville, CO, USA
| | - Sarah Blach
- Center for Disease Analysis, Louisville, CO, USA
| | | | - Homie Razavi
- Center for Disease Analysis, Louisville, CO, USA.
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Identification of Indian sub-continent as hotspot for HCV genotype 3a origin by Bayesian evolutionary reconstruction. INFECTION GENETICS AND EVOLUTION 2014; 28:87-94. [PMID: 25224661 DOI: 10.1016/j.meegid.2014.09.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 09/04/2014] [Accepted: 09/06/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND Recent emphasis in Hepatitis C virus (HCV) evolutionary biology has focused on analysis using Core, E1/E2 and/or NS5b regions, with limited appreciation of full length genome. While HCV genotypes have been described as endemic in the Indian subcontinent, there has been no confirmation at the molecular evolutionary level of these genotypes. We have attempted here to determine the status of Indian HCV genotype 3a sequences in relation to similar genotypes from other parts of the world. METHODS Cloning, sequencing and molecular characterization was performed on 9 Indian sequences and comparative analyses were performed with 46 sequences from other countries. Evolutionary-rate and molecular-clock hypothesis testing was addressed by Bayesian MCMC. RESULTS Genetic analysis of full length genome revealed two hypervariable regions (HVR) in E2 region - HVR496 and HVR576, with a variable 5-8 amino-acid insertion sequence and a putative N-glycosylation site. Phylogenetic analysis revealed a divergence resulting in 2 distinct clades: clade-1 represented by HCV 3a subtype and clade-2 represented by other 3 subtype genomes. Clade-2 shows earlier divergence than clade-1. Analysis revealed that genotype 3a genomes from India roots out first (∼99 years ago) in clade1. Bayesian skyline plot analysis revealed an increase in effective number of infections from 1940s to 1990s, followed by a gradual decrease after 2000. CONCLUSIONS Genotype 3a sequences appear to have originated in India and later dispersed to United Kingdom around mid 1940s, most likely around the time of Indian independence and World War II.
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Choudhary MC, Gupta E, Pandey P, Natarajan V, Sharma S, Vashishtha C, Sharma MK, Kazim SN, Sarin SK. Identification and full-length molecular characterization of rare hepatitis C virus genotype 5a from India. Arch Virol 2014; 160:329-33. [PMID: 25193070 DOI: 10.1007/s00705-014-2220-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 08/28/2014] [Indexed: 12/13/2022]
Abstract
This report presents a molecular characterization of the complete genome of a rare hepatitis C virus (HCV) genotype (GT5a) from India. Sequence homology of full genome revealed that the strain belonged to HCV GT5a. To trace the origin of this virus and to understand its evolutionary pattern, a phylogenetic reconstruction was carried out on full HCV genome sequences using Bayesian coalescent methods. The phylogenetic tree reconstruction revealed genotypic divergence, with formation of distinct clades. This analysis revealed that HCV genotype 5 might have originated from HCV genotype 3, as they have a recent common ancestor.
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Affiliation(s)
- Manish Chandra Choudhary
- Department of Research, Institute of Liver and Biliary Sciences (ILBS), Vasant Kunj, New Delhi, 110070, India
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Singh P, Kaur R, Kaur A. Frequency distribution of Hepatitis C virus in different geographical regions of Punjab: Retrospective study from a tertiary care centre in North India. J Nat Sci Biol Med 2014; 5:56-8. [PMID: 24678198 PMCID: PMC3961953 DOI: 10.4103/0976-9668.127288] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND AIM There is a scarcity of published information on epidemiology of Hepatitis C infection in India particularly in Punjab. We conducted a retrospective study to assess the frequency distribution, including demographic and geographical data of patients with Hepatitis C in different regions of Punjab. MATERIALS AND METHODS We retrospectively collected the clinical, demographic and geographical data of 516 patients with Hepatitis C admitted in our hospital from January 2010 to December 2010. Punjabi patients with positive anti-Hepatitis C virus (HCV)-enzyme linked immune sorbent assay test for the detection of anti-HCV antibodies were included. RESULTS There was predominantly rural distribution (67.3%) of patients with maximum cases from Ludhiana district (30.04%). Highest frequency of Hepatitis C infection was found in the middle aged (41-60 years) patients with male predominance. High proportions (44.8%) of the patients included in our study were incidentally detected with Hepatitis C infection on routine screening. Various associations of HCV infection with other diseases were also identified. CONCLUSIONS Hepatitis C is an emerging disease in Punjab with a sizeable cluster of HCV infected asymptomatic persons who can act as a pool for its continuous transmission. The study helps us to predict the probable risk factors for Hepatitis C infection in Punjab. The need of the hour is to increase awareness about HCV among the public and practicing physicians.
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Affiliation(s)
- Paramdeep Singh
- Department of Radiodiagnosis, Guru Gobind Singh Medical College and Hospital, Baba Farid University of Health Sciences, Faridkot, Punjab, India
| | - Rupinderjeet Kaur
- Department of Medicine, Guru Gobind Singh Medical College and Hospital, Baba Farid University of Health Sciences, Faridkot, Punjab, India
| | - Amarpreet Kaur
- Department of Pediatrics, Guru Gobind Singh Medical College and Hospital, Baba Farid University of Health Sciences, Faridkot, Punjab, India
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Daw MA, El-Bouzedi A. Prevalence of hepatitis B and hepatitis C infection in Libya: results from a national population based survey. BMC Infect Dis 2014; 14:17. [PMID: 24405790 PMCID: PMC3893419 DOI: 10.1186/1471-2334-14-17] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 01/02/2014] [Indexed: 12/14/2022] Open
Abstract
Background Libya is one of the largest countries in Africa and has the longest coast in the Mediterranean basin facing southern Europe. High rates of prevalence of viral hepatitis have been observed in various regions in Africa, but the prevalence in Libya is not well documented. We report on a large-scale nationwide study that evaluated the epidemiology of hepatitis B and hepatitis C in Libya and assessed the risk factors involved. Methods A cross-sectional study was carried out in 2008 on 65,761 individuals all over Libya. The country was divided into 12 regions according to the population density and sampling within each region was carried out under the supervision of the National Centre for Prevention of Infectious Diseases. Serum samples were collected from both males and females of all ages in both urban and rural areas and tested for HBsAg for hepatitis B and anti-HCV antibody for hepatitis C. Prevalence rates were determined in regions and in different groups and correlated with different demographic and risk factors involved in the spread of these viruses. Results The prevalence of hepatitis B and hepatitis C viruses varied regionally across the country. The overall prevalence of hepatitis B was 2.2% (95% CI 2.1%-2.3%) and was higher among males than females (1.4:1.0). Hepatitis C virus (HCV) prevalence was 1.2% (95% CI 1.1-1.3) and it increased gradually after the age of 30 years (0.7-0.9% for < 30 years; 3.6% for ≥ 60 years). Prevalence of HBsAg was 0.8-0.9% below the age of 10 years, and higher but similar in older age groups (2.3-2.7%). There was an association between literacy and prevalence of hepatitis, particularly for HCV. Hospital admission, surgical operation, blood transfusion, and intravenous drug use were the main risk factors, and they were associated independently with a higher prevalence rate of viral hepatitis. Conclusions Libya may be considered an area of low-intermediate endemicity for hepatitis B virus infection, with lower rates in young age groups, and an area of low endemicity for hepatitis C. The prevalence of hepatitis B and C across Libya is not homogeneous, with indications of the effect of the higher rates in some neighbouring countries. Libya should adopt full coverage national plans and guidelines to face the future consequences of viral hepatitis, particularly hepatitis C virus.
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Affiliation(s)
- Mohamed A Daw
- Department of Medical Microbiology, Faculty of Medicine, Tripoli, Libya.
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Ahammed SM, Chowdhury A. Hepatitis C in Punjab--peeping into Pandora's box! Indian J Gastroenterol 2012; 31:223-5. [PMID: 23086403 DOI: 10.1007/s12664-012-0262-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 09/19/2012] [Indexed: 02/04/2023]
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