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Ebranati E, Mancon A, Airoldi M, Renica S, Shkjezi R, Dragusha P, Della Ventura C, Ciccaglione AR, Ciccozzi M, Bino S, Tanzi E, Micheli V, Riva E, Galli M, Zehender G. Time and Mode of Epidemic HCV-2 Subtypes Spreading in Europe: Phylodynamics in Italy and Albania. Diagnostics (Basel) 2021; 11:diagnostics11020327. [PMID: 33671355 PMCID: PMC7922790 DOI: 10.3390/diagnostics11020327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/12/2021] [Accepted: 02/14/2021] [Indexed: 01/21/2023] Open
Abstract
Hepatitis C virus (HCV) genotype 2 causes about 10% of global infections and has the most variable circulation profile in Europe. The history of “endemic” HCV-2 subtypes has been satisfactorily reconstructed, instead there is little information about the recent spread of the “epidemic” subtypes, including HCV-2c. To investigate the origin and dispersion pathways of HCV-2c, 245 newly characterized Italian and Albanian HCV-2 NS5B sequences were aligned with 247 publicly available sequences and included in phylogeographic and phylodynamic analyses using the Bayesian framework. Our findings show that HCV-2c was the most prevalent subtype in Italy and Albania. The phylogeographic analysis suggested an African origin of HCV-2c before it reached Italy about in the 1940s. Phylodynamic analysis revealed an exponential increase in the effective number of infections and Re in Italy between the 1940s and 1960s, and in Albania between the 1990s and the early 2000s. It seems very likely that HCV-2c reached Italy from Africa at the time of the second Italian colonization but did not reach Albania until the period of dramatic migration to Italy in the 1990s. This study contributes to reconstructing the history of the spread of epidemic HCV-2 subtypes to Europe.
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Affiliation(s)
- Erika Ebranati
- Department of Biomedical and Clinical Sciences “L. Sacco”, University of Milan, 20157 Milan, Italy; (E.E.); (M.A.); (S.R.); (C.D.V.); (M.G.)
- CRC-Coordinated Research Center “EpiSoMI”, University of Milan, 20122 Milan, Italy
| | - Alessandro Mancon
- Unit of Microbiology, Hospital Sacco of Milan, 20157 Milan, Italy; (A.M.); (V.M.)
| | - Martina Airoldi
- Department of Biomedical and Clinical Sciences “L. Sacco”, University of Milan, 20157 Milan, Italy; (E.E.); (M.A.); (S.R.); (C.D.V.); (M.G.)
| | - Silvia Renica
- Department of Biomedical and Clinical Sciences “L. Sacco”, University of Milan, 20157 Milan, Italy; (E.E.); (M.A.); (S.R.); (C.D.V.); (M.G.)
| | - Renata Shkjezi
- Faculty of Medicine and Surgery, Catholic University “Our Lady of the Good Counsel”, 1001 Tirana, Albania; (R.S.); (P.D.)
| | - Pranvera Dragusha
- Faculty of Medicine and Surgery, Catholic University “Our Lady of the Good Counsel”, 1001 Tirana, Albania; (R.S.); (P.D.)
| | - Carla Della Ventura
- Department of Biomedical and Clinical Sciences “L. Sacco”, University of Milan, 20157 Milan, Italy; (E.E.); (M.A.); (S.R.); (C.D.V.); (M.G.)
| | - Anna Rita Ciccaglione
- Viral Hepatitis Unit, Department of Infectious, Parasitic and Immune-Mediated Diseases, Istituto Superiore di Sanità, 00161 Rome, Italy;
| | - Massimo Ciccozzi
- Unit of Medical Statistics and Molecular Epidemiology, University Campus Bio-Medico of Rome, 00128 Roma, Italy;
| | - Silvia Bino
- National Institute of Health, 1001 Tirana, Albania;
| | - Elisabetta Tanzi
- Department of Biomedical Sciences for the Health, University of Milan, 20133 Milan, Italy;
| | - Valeria Micheli
- Unit of Microbiology, Hospital Sacco of Milan, 20157 Milan, Italy; (A.M.); (V.M.)
| | - Elisabetta Riva
- Laboratory of Virology, Campus Bio-Medico University, 00128 Rome, Italy;
| | - Massimo Galli
- Department of Biomedical and Clinical Sciences “L. Sacco”, University of Milan, 20157 Milan, Italy; (E.E.); (M.A.); (S.R.); (C.D.V.); (M.G.)
- CRC-Coordinated Research Center “EpiSoMI”, University of Milan, 20122 Milan, Italy
| | - Gianguglielmo Zehender
- Department of Biomedical and Clinical Sciences “L. Sacco”, University of Milan, 20157 Milan, Italy; (E.E.); (M.A.); (S.R.); (C.D.V.); (M.G.)
- CRC-Coordinated Research Center “EpiSoMI”, University of Milan, 20122 Milan, Italy
- Correspondence: ; Tel.: +39-02-503-19770
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Quaranta MG, Ferrigno L, Monti M, Filomia R, Biliotti E, Iannone A, Migliorino G, Coco B, Morisco F, Vinci M, D'Ambrosio R, Chemello L, Massari M, Ieluzzi D, Russo FP, Blanc P, Verucchi G, Puoti M, Rumi MG, Barbaro F, Santantonio TA, Federico A, Chessa L, Gentile I, Zuin M, Parruti G, Morsica G, Kondili LA. Advanced liver disease outcomes after hepatitis C eradication by human immunodeficiency virus infection in PITER cohort. Hepatol Int 2020; 14:362-372. [PMID: 32279177 PMCID: PMC7220859 DOI: 10.1007/s12072-020-10034-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 03/18/2020] [Indexed: 02/06/2023]
Abstract
Background Liver disease progression after Hepatitis C Virus (HCV) eradication following direct-acting antiviral (DAA) treatment in the real-life setting according to Human Immunodeficiency Virus (HIV) coinfection was evaluated. Methods Patients consecutively enrolled in PITER between April 2014 and June 2019 and with at least 12-weeks follow-up following treatment were analysed. Cox regression analysis were used to evaluate HIV coinfection and factors independently associated with liver disease outcomes following viral eradication in DAA treated patients with pre-treatment liver cirrhosis. Results 93 HIV/HCV coinfected and 1109 HCV monoinfected patients were evaluated during a median follow-up of 26.7 (range 6–44.6) and 24.6 (range 6.8–47.3) months, respectively. No difference in the cumulative HCC incidence and hepatic decompensation was observed between coinfected and monoinfected patients. Age (Hazard Ratio [HR] = 1.08; 95% CI 1.04–1.13), male sex (HR = 2.76; 95% CI 1.28–5.96), lower albumin levels (HR = 3.94; 95% CI 1.81–8.58), genotype 3 (HR = 5.05; 95% CI 1.75–14.57) and serum anti-HBc positivity (HR = 1.99, 95% CI 1.01–3.95) were independently associated with HCC incidence. Older age (HR = 1.03; 95% CI 1.00–1.07), male sex (HR = 2.13; 95% CI 1.06–4.26) and lower albumin levels (HR = 3.75; 95% CI 1.89–7.46) were independently associated with the appearance of a decompensating event after viral eradication. Conclusion Different demographic, clinical and genotype distribution between HIV coinfected vs those monoinfected, was observed in a representative cohort of HCV infected patients in Italy. Once liver cirrhosis is established the disease progression is decreased, but still persists regardless of viral eradication in both coinfected and monoinfected patients. In patients with cirrhosis, HIV coinfection was not associated with a higher probability of liver complications, after viral eradication.
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Affiliation(s)
| | - Luigina Ferrigno
- Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Monica Monti
- Center for Systemic Manifestations of Hepatitis Viruses (MaSVE), Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Roberto Filomia
- Division of Clinical and Molecular Hepatology, University Hospital of Messina, Messina, Italy
| | - Elisa Biliotti
- Department of Clinical Medicine, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Andrea Iannone
- Department of Emergency and Organ Transplantation, Gastroenterology Unit, University of Bari, Bari, Italy
| | | | - Barbara Coco
- Hepatology and Liver Physiopathology Laboratory and Internal Medicine, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Filomena Morisco
- Gastroenterology and Hepatology Unit, Federico II University Hospital, Naples, Italy
| | - Maria Vinci
- Department of Hepatology and Gastroenterology, Niguarda Hospital, Milan, Italy
| | - Roberta D'Ambrosio
- Gastroenterology and Hepatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Liliana Chemello
- Department of Medicine, University Hospital of Padua, Padua, Italy
| | - Marco Massari
- Infectious Diseases, Azienda Unità Sanitaria Locale, IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Francesco Paolo Russo
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Pierluigi Blanc
- Infectious Disease Unit, Santa Maria Annunziata Hospital, Florence, Italy
| | - Gabriella Verucchi
- Department of Medical and Surgical Sciences, Infectious Disease Unit, University Hospital S.Orsola-Malpighi, Bologna, Italy
| | - Massimo Puoti
- Department of Infectious Disease, Niguarda Hospital, Milan, Italy
| | - Maria Grazia Rumi
- Hepatology Unit, San Giuseppe Hospital, University of Milan, Milan, Italy
| | - Francesco Barbaro
- Infectious and Tropical Diseases Unit, Azienda Ospedaliera di Padova, Padua, Italy
| | | | - Alessandro Federico
- Department of Hepato-Gastroenterology, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Luchino Chessa
- Liver Unit, University Hospital, Monserrato, Cagliari, Italy
| | - Ivan Gentile
- Infectious Disease Unit, Federico II University Hospital, Naples, Italy
| | - Massimo Zuin
- Gastroenterology and Hepatology Unit, San Paolo Hospital, University of Milan, Milan, Italy
| | - Giustino Parruti
- Infectious Disease Unit, Spirito Santo General Hospital, Pescara, Italy
| | - Giulia Morsica
- Department of Infectious Diseases, San Raffaele Hospital, Milan, Italy
| | - Loreta A Kondili
- Center for Global Health, Istituto Superiore di Sanità, Rome, Italy.
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Petruzziello A, Sabatino R, Loquercio G, Guzzo A, Di Capua L, Labonia F, Cozzolino A, Azzaro R, Botti G. Nine-year distribution pattern of hepatitis C virus (HCV) genotypes in Southern Italy. PLoS One 2019; 14:e0212033. [PMID: 30785909 PMCID: PMC6382136 DOI: 10.1371/journal.pone.0212033] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 01/26/2019] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION It has been greatly described that different hepatitis C virus (HCV) genotypes are strictly correlated to various evolution, prognosis and response to therapy during the chronic liver disease. Aim of this study was to outline the changes in the epidemiology of Hepatitis C genotypes in Southern Italy regions from 2006 to 2014. MATERIAL/METHODS Prevalence of HCV genotypes was analyzed in 535 HCV-RNA positive patients with chronic Hepatitis C infection, selected during the period 2012-2014, and compared with our previous data, referred to periods 2006-2008 and 2009-2011. RESULTS In all the three periods analyzed, genotype 1b is predominant (51.8% in 2006-08, 48.3% in 2009-11 and 54.4% in 2012-14) while genotype 2 showed an increase in prevalence (27.9% in 2006-08, 31.7% in 2009-11 and 35.2% in 2012-14) and genotypes 3a and 1a a decrease during the same period (6.8% in 2006-08, 4.7% in 2009-11 and 3.2% in 2012-14 and 7.9% in 2006-08, 4.7% in 2009-11 and 2.6% in 2012-14, respectively). Subtype 1b seems to be equally distributed between males and females (52.7% vs 56.6%) and the prevalence in the age range 31-40 years is significantly higher in the 2012-14 period than in both previous periods (53.8% vs. 16.6% in 2009-11, p< 0.001 and 13.4% in 2006-08, p < 0.001). CONCLUSIONS Genotype 1b is still the most prevalent, even if shows a significantly increase in the under 40 years old population. Instead, genotype 3a seems to have a moderate increase among young people. Overall, the alarming finding is the "returning" role of the iatrogenic transmission as risk factor for the diffusion of Hepatitis C infection.
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Affiliation(s)
- Arnolfo Petruzziello
- SSD Virology and Molecular Biology, Department of Diagnostic Area, Istituto Nazionale Tumori, Fondazione “G. Pascale”, IRCCS Italia, Naples, Italy
- * E-mail:
| | - Rocco Sabatino
- SSD Virology and Molecular Biology, Department of Diagnostic Area, Istituto Nazionale Tumori, Fondazione “G. Pascale”, IRCCS Italia, Naples, Italy
| | - Giovanna Loquercio
- SSD Virology and Molecular Biology, Department of Diagnostic Area, Istituto Nazionale Tumori, Fondazione “G. Pascale”, IRCCS Italia, Naples, Italy
| | - Annunziata Guzzo
- SSD Virology and Molecular Biology, Department of Diagnostic Area, Istituto Nazionale Tumori, Fondazione “G. Pascale”, IRCCS Italia, Naples, Italy
| | - Lucia Di Capua
- SSD Virology and Molecular Biology, Department of Diagnostic Area, Istituto Nazionale Tumori, Fondazione “G. Pascale”, IRCCS Italia, Naples, Italy
| | - Francesco Labonia
- SSD Virology and Molecular Biology, Department of Diagnostic Area, Istituto Nazionale Tumori, Fondazione “G. Pascale”, IRCCS Italia, Naples, Italy
| | - Anna Cozzolino
- SSD Virology and Molecular Biology, Department of Diagnostic Area, Istituto Nazionale Tumori, Fondazione “G. Pascale”, IRCCS Italia, Naples, Italy
| | - Rosa Azzaro
- Transfusion Service, Department of Hemathology, Istituto Nazionale Tumori—Fondazione “G. Pascale”, IRCCS Italia, Naples, Italy
| | - Gerardo Botti
- SSD Virology and Molecular Biology, Department of Diagnostic Area, Istituto Nazionale Tumori, Fondazione “G. Pascale”, IRCCS Italia, Naples, Italy
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Petruzziello A, Marigliano S, Loquercio G, Cacciapuoti C. Hepatitis C virus (HCV) genotypes distribution: an epidemiological up-date in Europe. Infect Agent Cancer 2016; 11:53. [PMID: 27752280 PMCID: PMC5062817 DOI: 10.1186/s13027-016-0099-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 09/02/2016] [Indexed: 02/07/2023] Open
Abstract
Hepatitis C virus (HCV) infection is a major public health burden in Europe, causing an increasing level of liver-related morbidity and mortality, characterized by several regional variations in the genotypes distribution. A comprehensive review of the literature from 2000 to 2015 was used to gather country-specific data on prevalence and genotype distribution of HCV infection in 33 European countries (about 80 % of the European population), grouped in three geographical areas (Western, Eastern and Central Europe), as defined by the Global Burden of Diseases project (GBD). The estimated prevalence of HCV in Europe is 1.7 % showing a decrease than previously reported (− 0.6 %) and accounting over 13 million of estimated cases. The lowest prevalence (0.9 %) is reported from Western Europe (except for some rural areas of Southern Italy and Greece) and the highest (3.1 %) from Central Europe, especially Romania and Russia. The average HCV viraemic rate is 72.4 %, with a population of almost 10 million of HCV RNA positive patients. Genotype distribution does not show high variability among the three macro-areas studied, ranging between 70.0 % (Central Europe), 68.1 % (Eastern Europe) and 55.1 % (Western Europe) for genotype 1, 29.0 % (Western Europe), 26.6 % (Eastern Europe) and 21.0 % (Central Europe) for genotype 3. Genotype 2 seems, instead, to have a major prevalence in the Western Europe (8.9 %), if compared to Eastern (4.3 %) or Central (3.2 %), whereas genotype 4 is present especially in Central and Western area (4.9 % and 5.8 %, respectively). Despite the eradication of transmission by blood products, HCV infection continues to be one of the leading blood-borne infections in Europe. The aim of this review is, therefore, to provide an update on the epidemiology of HCV infection across Europe, and to foster the discussion about eventual potential strategies to eradicate it.
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Affiliation(s)
- Arnolfo Petruzziello
- Virology and Molecular Biology Unit "V. Tridente", Istituto Nazionale Tumori - Fondazione "G. Pascale", IRCCS Italia, Via Mariano Semmola, 80131 Naples, Italy
| | - Samantha Marigliano
- Virology and Molecular Biology Unit "V. Tridente", Istituto Nazionale Tumori - Fondazione "G. Pascale", IRCCS Italia, Via Mariano Semmola, 80131 Naples, Italy
| | - Giovanna Loquercio
- Virology and Molecular Biology Unit "V. Tridente", Istituto Nazionale Tumori - Fondazione "G. Pascale", IRCCS Italia, Via Mariano Semmola, 80131 Naples, Italy
| | - Carmela Cacciapuoti
- Virology and Molecular Biology Unit "V. Tridente", Istituto Nazionale Tumori - Fondazione "G. Pascale", IRCCS Italia, Via Mariano Semmola, 80131 Naples, Italy
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Kartashev V, Döring M, Nieto L, Coletta E, Kaiser R, Sierra S, Guerrero A, Stoiber H, Paar C, Vandamme A, Nevens F, Ranst MV, Cuypers L, Braun P, Ehret R, Obermeier M, Schneeweiss S, Scholten S, Römer K, Isernhagen K, Qurashi N, Heger E, Knops E, Neumann-Fraune M, Timm J, Walker A, Lübke N, Wedemeyer H, Wiesch JSZ, Lütgehetmann M, Polywka S, Däumer M, Hoffmann D, Protzer U, Marascio N, Foca A, Liberto M, Barreca G, Galati L, Torti C, Pisani V, Perno C, Ceccherini-Silberstein F, Cento V, Ciotti M, Zazzi M, Rossetti B, Luca A, Caudai C, Mor O, Devaux C, Staub T, Araujo F, Gomes P, Cabanas J, Markin N, Khomenko I, Govorukhina M, Lugovskaya G, Dontsov D, Mas A, Martró E, Saludes V, Rodríguez-Frías F, García F, Casas P, Iglesia ADL, Alados J, Pena-López M, Rodríguez M, Galán J, Suárez A, Cardeñoso L, Guerrero M, Vegas-Dominguez C, Blas-Espada J, García R, García-Bujalance S, Benítez-Gutiérrez L, Mendoza CD, Montiel N, Santos J, Viciana I, Delgado A, Martínez-Sanchez P, Fernández-Alonso M, Reina G, Trigo M, Echeverría M, Aguilera A, Navarro D, Bernal S, Lozano M, Fernández-Cuenca F, Orduña A, Eiros J, Lejarazu ROD, Martínez-Sapiña A, García-Díaz A, Haque T. New findings in HCV genotype distribution in selected West European, Russian and Israeli regions. J Clin Virol 2016; 81:82-9. [DOI: 10.1016/j.jcv.2016.05.010] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 05/17/2016] [Accepted: 05/19/2016] [Indexed: 02/06/2023]
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Cheng CH, Chen HL, Lin IT, Wu CH, Lee YK, Wong MW, Bair MJ. The genotype distribution of hepatitis C in southeastern Taiwan: Clinical characteristics, racial difference, and therapeutic response. Kaohsiung J Med Sci 2015; 31:597-602. [PMID: 26678941 DOI: 10.1016/j.kjms.2015.09.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 09/04/2015] [Accepted: 09/14/2015] [Indexed: 02/07/2023] Open
Abstract
The genotypes of hepatitis C virus (HCV) are associated with the therapeutic response. The racial diversity of Taitung, Taiwan is heterogeneous and a distinguishing feature; how such racial differences influence the genotype distribution and treatment outcome has not been well studied. The objective of this study is to elucidate the HCV genotype distribution in southeastern Taiwan and to analyze the racial differences influencing genotypes and clinical implications. In this retrospective cohort study, we included 343 patients who had been treated with peginterferon-alpha plus ribavirin. The predominant HCV genotype in the southeastern area was type 1 (43.7%), followed by type 2 (37.0%). The proportion of patients mixed with genotype 1 was lower in indigenous vis-à-vis nonindigenous groups (46.1% and 60.2%, p = 0.02). The prevalence of genotype 6 (5.2%) seems higher than in the general population of Taiwan and showed no difference between indigenous and nonindigenous people. The sustained virological response rate was higher in patients without genotype 1, low baseline HCV RNA (≤ 400,000 IU/mL), and in patients who achieved rapid virological response. Racial differences did not influence the therapeutic response. In this retrospective study, the proportion of HCV genotype 6 appeared slightly higher in southeastern areas than in the general population in Taiwan. The prevalence of genotype 1 in indigenous people was statistically lower than in nonindigenous people. Sustained virological response rate did not show any significant difference between indigenous and nonindigenous people in the current study.
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Affiliation(s)
- Chun-Han Cheng
- Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, Taitung, Taiwan
| | - Huan-Lin Chen
- Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, Taitung, Taiwan
| | - I-Tsung Lin
- Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, Taitung, Taiwan
| | - Chia-Hsien Wu
- Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, Taitung, Taiwan
| | - Yuan-Kai Lee
- Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, Taitung, Taiwan
| | - Ming-Wun Wong
- Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, Taitung, Taiwan
| | - Ming-Jong Bair
- Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, Taitung, Taiwan; Department of Medicine, Mackay Medical College, New Taipei, Taiwan.
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Rao H, Wei L, Li H, Yang R, Zhang H, Shang J, Chen H, Li J, Xie Q, Gao Z, Wang L, Wei J, Jiang J, Sun Y. Prevalence of abnormal glycometabolism in treatment-naive patients with hepatitis C virus infection in a Chinese Han population. J Gastroenterol Hepatol 2015; 30:1049-56. [PMID: 25611567 DOI: 10.1111/jgh.12901] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/12/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIM The hepatitis C virus (HCV) may promote pancreatic β-cell apoptosis-like cell death through a caspase 3-dependent pathway, initiating the onset of type 2 diabetes mellitus (T2DM); however, the risk factors for development of T2DM and other abnormal glycometabolic factors in HCV patients of the Chinese Han ethnicity have been poorly explored. METHODS A total of 947 patients Chinese Han patients with confirmed HCV infection were enrolled in a multicenter study in order to examine the genetic and physiological parameters associated with the onset of abnormal glycometabolic conditions, including T2DM and prediabetes. RESULTS HCV genotype 1b and host interleukin-28B CC genotype were most commonly observed. A total of 145 (15.3%) patients were diagnosed with T2DM and prediabetes. Elevated age, waist circumference, smoking duration, and systolic and diastolic blood pressure were shown to increase risks for abnormal glycometabolism. Liver dysfunction was shown to have positive correlations with abnormal glycometabolism in HCV patients. Genome-wide association studies indicated that certain genetic encoding inosine triphosphatase polymorphs (rs6051702) were associated with elevated risks for abnormal glycometabolism. Coupled with previous research data, it is likely that abnormal glycometabolism may be a useful predictor of risk for poor response to antiviral therapies and treatment-induced complications, such as anemia, in treatment naïve patients. CONCLUSIONS Abnormal glycometabolism and other such complications of HCV and HCV treatment may share critical metabolic and genetic pathways, providing potentially novel targets for future antiviral therapies for treatment resistant HCV genotypes.
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Affiliation(s)
- Huiying Rao
- Peking University People's Hospital, Beijing Key Laboratory for Hepatitis C and Immunotherapy for Liver Disease, Peking University Hepatology Institute, Beijing, China
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Fernández Rodriguez CM, Gutierrez Garcia ML. [Impact of antiviral therapy on the natural history of hepatitis C virus]. GASTROENTEROLOGIA Y HEPATOLOGIA 2014; 37:583-92. [PMID: 25066318 DOI: 10.1016/j.gastrohep.2014.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 05/28/2014] [Indexed: 02/08/2023]
Abstract
Chronic hepatitis C virus infection affects around 150 million persons, and 350,000 persons worldwide die of this disease each year. Although the data on its natural history are incomplete, after the acute infection, most patients develop chronic forms of hepatitis C with variable stages of fibrosis. In these patients, continual inflammatory activity can cause significant fibrosis, cirrhosis, decompensation of the liver disease, or hepatocarcinoma. In the next few years, it is expected that hepatitis C virus infection and its complications will significantly increase, as will the incidence of hepatocarcinoma in Spain. This review presents the data on the natural history of hepatitis C virus infection and discusses the potential impact of antiviral therapy on the distinct stages of the disease.
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Hu GR, Zheng BX, Liu ZF. Association between TGFB1 915G/C polymorphism and susceptibility to chronic hepatitis C virus infection: A meta-analysis. Biomed Rep 2014; 2:239-244. [PMID: 24649103 DOI: 10.3892/br.2014.230] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 01/20/2014] [Indexed: 12/09/2022] Open
Abstract
The human transforming growth factor-β1 (TGF-β1) gene, namely TGFB1, contains several single-nucleotide polymorphisms (SNPs) and some of the polymorphic variants were shown to affect the TGF-β1 protein levels. A number of studies reported the association between 915G/C polymorphism and susceptibility to chronic hepatitis C virus (HCV) infection. However, the results were inconsistent. This meta-analysis was conducted to assess the association of TGFB1 915G/C polymorphism with susceptibility to chronic HCV infection. PubMed, ISI Web of Knowledge, ScienceDirect and Google Scholar databases were systematically searched up to August, 2013 to identify relevant studies. The pooled odds ratios (ORs) with their corresponding 95% confidence intervals (95% CIs) were calculated in 5 genetic comparison models (C vs. G, CC vs. GG, GC vs. GG, CC vs. GG+GC and CC+GC vs. GG). The Galbraith plot and subgroup analyses based on ethnicity, genotyping methods, sample size and fibrosis were performed to investigate possible sources of heterogeneity. A sensitivity analysis and assessment of publication bias were also conducted. Finally, 8 eligible case-control studies on TGFB1 915G/C polymorphism, including a total of 910 cases and 632 controls, were included in this meta-analysis. Overall, there was no evidence of any gene-disease association obtained from the subgroup analyses. Therefore, this meta-analysis demonstrated that there is no association between TGFB1 915G/C polymorphisms and susceptibility to chronic HCV infection.
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Affiliation(s)
- Guo-Rui Hu
- Medical College of Nanjing University, Nanjing, Jiangsu 210093, P.R. China ; Department of Digestive Disease, Nanjing Children's Hospital, Nanjing Medical University, Nanjing, Jiangsu 210008, P.R. China
| | - Bi-Xia Zheng
- Department of Digestive Disease, Nanjing Children's Hospital, Nanjing Medical University, Nanjing, Jiangsu 210008, P.R. China
| | - Zhi-Feng Liu
- Medical College of Nanjing University, Nanjing, Jiangsu 210093, P.R. China ; Department of Digestive Disease, Nanjing Children's Hospital, Nanjing Medical University, Nanjing, Jiangsu 210008, P.R. China
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Petruzziello A, Coppola N, Diodato AM, Iervolino V, Azzaro R, Di Costanzo G, Di Macchia CA, Di Meo T, Loquercio G, Pasquale G, Cacciapuoti C. Age and gender distribution of hepatitis C virus genotypes in the metropolitan area of Naples. Intervirology 2013; 56:206-12. [PMID: 23594735 DOI: 10.1159/000348506] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Accepted: 01/22/2013] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To assess any time-related variations in the distribution of hepatitis C virus (HCV) genotypes in the metropolitan area of Naples, Italy. METHODS HCV genotypes were analysed in 255 HCV RNA-positive patients with chronic HCV infection, observed from 2009 to 2011, and compared with data pertaining to a sample of 176 HCV RNA-positive patients observed from 2006 to 2008. RESULTS In both periods of analysis, genotype 1b was predominant (51.8 and 48.3%, respectively), followed by genotype 2 (27.9 and 31.7%, respectively). These HCV genotypes were particularly prevalent in older patients, whereas genotypes 3a and 1a were observed more frequently in the younger population. Genotype 1b was particularly common in females compared to males in both study periods (39.3% of 89 males vs. 64.3% of 87 females in the 3-year period 2006-2008, p < 0.001; 41.5% of 118 males vs. 54.0% of 137 females in the period 2009-2011, p < 0.05). The prevalence of patients with genotype 1b in the age range 51-60 years was higher in the 2006-2008 period than in 2009-2011 (76.9 vs. 37.7%; p < 0.0005) and lower in the over 60 year olds (55.1 vs. 59.6%; p = 0.5). CONCLUSION Genotype 1b, historically the most prevalent in Italy, is still predominant; however, when comparing the two time periods, a cohort effect evidencing the increasing prevalence of genotype 1b among elderly patients was revealed.
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Affiliation(s)
- Arnolfo Petruzziello
- Laboratory of Virology and Molecular Biology 'V. Tridente', Transfusion Service, Department of Haematology, Istituto Nazionale Tumori, Fondazione G. Pascale, Naples, Italy.
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Keyvani H, Fazlalipour M, Monavari SHR, Mollaie HR. Hepatitis C Virus - Proteins, Diagnosis, Treatment and New Approaches for Vaccine Development. Asian Pac J Cancer Prev 2012. [DOI: 10.7314/apjcp.2012.13.12.5917] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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12
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Pellicelli AM, Romano M, Guarascio P, Vignally P. Which is the real efficacy of pegylated interferon alpha 2a or 2b plus ribavirin in HCV infected patients with advanced fibrosis? J Hepatol 2012; 57:704-5. [PMID: 22510262 DOI: 10.1016/j.jhep.2012.03.008] [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: 03/01/2012] [Accepted: 03/14/2012] [Indexed: 12/04/2022]
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13
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Persico M, Bruno S, Costantino A, Mazza M, Almasio PL. The impact of antiviral therapy and the influence of metabolic cofactors on the outcome of chronic HCV infection. Int J Hepatol 2011; 2011:314301. [PMID: 22164334 PMCID: PMC3230116 DOI: 10.4061/2011/314301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Revised: 08/09/2011] [Accepted: 08/18/2011] [Indexed: 12/20/2022] Open
Abstract
NATURAL HISTORY OF HCV RELATED CHRONIC HEPATITIS IS INFLUENCED AND MODIFIED BY MANY FACTORS: virus features, coinfections and host characteristics. In particular, a peculiar genetic background of the host by conditioning the occurrence of intracellular metabolic derangements (i.e., insulin resistance) might contribute to accelerate the rate of progression to cirrhosis and eventually the occurrence of hepatocellular carcinoma (HCC) and death. Likely, direct interplays between virus genotype and host genetic background might be hypothesized at this level. Morbidity and mortality in cirrhosis is primarily associated with complications of liver cirrhosis (ascites, hepatic encephalopathy, jaundice, and gastroesophageal bleeding) and HCC occurrence. Therefore the main goal of therapy is to clear viral infection and decrease liver necro-inflammation that directly relates to development of cirrhosis and HCC. Among patients treated with Interferon-based therapy, those with sustained viral response showed a significant reduction of progression to cirrhosis and development of HCC. However, a residual risk of hepatocellular carcinoma still remains indicating the need for careful follow-up using ultrasonography every six months in cirrhotic patients, even in those showing persistently normal ALT and undetectable HCV RNA levels after antiviral therapy.
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Affiliation(s)
- Marcello Persico
- Internal Medicine and Hepatology Division, Second University of Naples, Via Del Parco Carelli 36, 80123 Naples, Italy
| | - Savino Bruno
- Department of Internal Medicine, AO Fatebenefratelli e Oftalmico, Corso di Porta Nuova 23, 20121 Milano, Italy
| | - Andrea Costantino
- Gastroenterology & Hepatology Unit, Di.Bi.M.I.S., University of Palermo, Piazza delle Cliniche, 2, 90127 Palermo, Italy
| | - Marta Mazza
- Gastroenterology & Hepatology Unit, Di.Bi.M.I.S., University of Palermo, Piazza delle Cliniche, 2, 90127 Palermo, Italy
| | - Piero Luigi Almasio
- Gastroenterology & Hepatology Unit, Di.Bi.M.I.S., University of Palermo, Piazza delle Cliniche, 2, 90127 Palermo, Italy
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Cariani E, Villa E, Rota C, Critelli R, Trenti T. Translating pharmacogenetics into clinical practice: interleukin (IL)28B and inosine triphosphatase (ITPA) polymophisms in hepatitis C virus (HCV) infection. Clin Chem Lab Med 2011; 49:1247-1256. [PMID: 21612542 DOI: 10.1515/cclm.2011.618] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Hepatitis C virus (HCV) infection is frequently characterized by evolution to chronicity and by a variable clinical course of the disease. The clinical heterogeneities of HCV infection and the imperfect predictability of the response to interferon (IFN) have suggested the need to search for a genetic basis of clinical features. This led to the discovery of genetic polymorphisms playing a major role in the evolution of infection, as well as on treatment response and adverse effects. This review will cover recent reports on the subject, focusing on the potential use of the new genetic markers in the diagnostic algorithm for the stratification of patients for personalized antiviral regimens.
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Affiliation(s)
- Elisabetta Cariani
- Clinical Pathology-Toxicology, Ospedale Civile S. Agostino-Estense, Modena, Italy
| | - Erica Villa
- Department of Gastroenterology, Azienda Ospedaliera-Universitaria, University of Modena and Reggio Emilia, Modena, Italy
| | - Cristina Rota
- Clinical Pathology-Toxicology, Ospedale Civile S. Agostino-Estense, Modena, Italy
| | - Rosina Critelli
- Department of Gastroenterology, Azienda Ospedaliera-Universitaria, University of Modena and Reggio Emilia, Modena, Italy
| | - Tommaso Trenti
- Clinical Pathology-Toxicology, Ospedale Civile S. Agostino-Estense, Modena, Italy
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Calvaruso V, Craxì A. Fibrosis in chronic viral hepatitis. Best Pract Res Clin Gastroenterol 2011; 25:219-30. [PMID: 21497740 DOI: 10.1016/j.bpg.2011.02.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Revised: 02/21/2011] [Accepted: 02/23/2011] [Indexed: 01/31/2023]
Abstract
In the last years, several studies have been performed with the aim to evaluate the real impact of antiviral treatments on fibrosis progression in patients with chronic viral hepatitis. The main goal of therapy in patients with chronic hepatitis B is viral suppression. This outcome leads to an important improvement in both hepatic inflammation and fibrosis and reduces the HCC occurrence. An histological improvement has been largely demonstrated in patient treated with oral nucleoside and nucleotide analogs achieving the rate of 72% with entecavir and tenofovir. Similarly, in patients with chronic hepatitis C, sustained virologic response to interferon therapy is associated with regression of fibrosis and lower liver decompensation and HCC occurrence. In the next future further studies will assess the real impact of the new directly anti-viral agents on liver necroinflammation and fibrosis in chronic hepatitis C.
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Affiliation(s)
- Vincenza Calvaruso
- Sezione di Gastroenterologia ed Epatologia, Di.Bi.M.I.S., University of Palermo, Piazza delle Cliniche n.2, 90127 Palermo, Italy.
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Brant LJ, Ramsay ME, Tweed E, Hale A, Hurrelle M, Klapper P, Ngui SL. Planning for the healthcare burden of hepatitis C infection: Hepatitis C genotypes identified in England, 2002–2007. J Clin Virol 2010; 48:115-9. [DOI: 10.1016/j.jcv.2010.03.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Revised: 03/17/2010] [Accepted: 03/19/2010] [Indexed: 11/24/2022]
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17
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Cozzolongo R, Osella AR, Elba S, Petruzzi J, Buongiorno G, Giannuzzi V, Leone G, Bonfiglio C, Lanzilotta E, Manghisi OG, Leandro G, Donnaloia R, Fanelli V, Mirizzi F, Parziale L, Crupi G, Detomaso P, Labbate A, Zizzari S, Depalma M, Polignano A, Lopinto D, Daprile G. Epidemiology of HCV infection in the general population: a survey in a southern Italian town. Am J Gastroenterol 2009; 104:2740-6. [PMID: 19638964 DOI: 10.1038/ajg.2009.428] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The objective of this study was to estimate the seroprevalence of hepatitis C virus (HCV) in the general population older than 18 years of age in a southern Italian town. METHODS The survey was conducted from July 2005 through January 2007 in Putignano, Bari, Apulia. A random 1:5 sampling from the list of records maintained by general practitioners was used. Serology for HCV, hepatitis B surface antigen (HBsAg), antibodies to hepatitis B core antigen (anti-HBc), and genotyping for HCV were performed. RESULTS Of a total of 2,195 serum samples tested, 58 (2.6%) were positive for anti-HCV antibodies. The prevalence increased from 1% in subjects aged <30 years to 7.7% in those aged 70 years and was similar in both males and females (3.1 vs. 2.4%, P=0.4). Approximately one-third of 58 positive subjects also showed alanine transaminase levels and 53.5% tested positive for HCV RNA by TaqMan PCR. Genotypes 2a and 1b were represented in 21 and 10 subjects, respectively. In a multivariate logistic regression analysis, age (adjusted odds ratio (OR) 1.05; 95% confidence interval (CI): 1.03-1.07), blood transfusion (adjusted OR 3.3; 95% CI: 1.7-6.3), and household contact with HCV-infected individuals (adjusted OR 4.8; 95% CI: 1.8-13.1) were the independent variables predictive of HCV infection. The overall HBsAg and anti-HBc prevalence rates were 0.5 and 12%, respectively. CONCLUSIONS This survey confirms that HCV infection is clearly also declining in southern Italy, especially among the elderly. HCV genotype 2a predominates, reflecting the current epidemiology of HCV in Italy. Age, blood transfusion, and household contact with HCV-infected individuals may have had a role in the spread of HCV infection.
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Affiliation(s)
- Raffaele Cozzolongo
- Division of Gastroenterology 1, National Institute of Gastroenterology S. de Bellis, Castellana Grotte, Bari, Italy.
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18
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Pizzillo P, Almasio PL, Ferraro D, Craxì A, Di Stefano R. HCV genotypes in Sicily: Is there any evidence of a shift? J Med Virol 2009; 81:1040-6. [DOI: 10.1002/jmv.21498] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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19
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Seme K, Vrhovac M, Mocilnik T, Maticic M, Lesnicar G, Baklan Z, Volkar JM, Rajter M, Stepec S, Lunar M, Poljak M. Hepatitis C virus genotypes in 1,504 patients in Slovenia, 1993-2007. J Med Virol 2009; 81:634-9. [PMID: 19235845 DOI: 10.1002/jmv.21427] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
In order to identify the main routes of hepatitis C (HCV) transmission and to determine the HCV genotype distribution and its dynamics during a 15-year period in Slovenia, HCV genotypes were detected using the INNO-LiPA HCV II (Innogenetics) test for serum samples obtained from 1,504 patients representing 72.6% of all patients with chronic hepatitis C diagnosed from 1993 to 2007. HCV genotype 1 was predominant (56%), followed by genotypes 3, 2, and 4, with a prevalence of 37.8%, 5%, and 1.2%, respectively. HCV genotypes 5 and 6 were not detected in any patient. Patients infected with HCV genotype 3 were significantly younger (mean age 28.9 +/- 8.5 years) than those infected with genotype 1 (mean age 38.9 +/- 14.8 years; P < 0.0001) and those infected with HCV genotype 2 (mean age 50.3 +/- 18.2 years; P < 0.0001). Intravenous drug use was identified as the most frequent possible HCV transmission route (34.3%), followed by medical-related transmission such as transfusion of HCV-contaminated blood or blood products, and hemodialysis (12.5%). Being an intravenous drug user was found to be strongly associated with HCV genotype 3 (OR, 3.71 [95% CI, 2.97-4.65]; P < 0.0001) and reporting infection by transfusion of blood or blood products was found to be strongly associated with HCV genotype 1 (OR, 3.28 [95% CI, 2.18-4.95]; P < 0.0001). During the 15-year period, the proportion of genotype 3 increased substantially, reflecting the fact that the HCV epidemic in Slovenia is driven mostly by intravenous drug use.
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Affiliation(s)
- Katja Seme
- Faculty of Medicine, Institute of Microbiology and Immunology, University of Ljubljana, Ljubljana, Slovenia
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Abstract
Hepatitis C is of concern both to industrialized and developing countries. Preliminary unpublished estimates of the global burden of disease (GBD) attributable to HCV-related chronic liver disease seem to be substantial. Therefore, the reduction of global mortality and morbidity related to chronic hepatitis C should be a concern to public health authorities, and primary, secondary and tertiary prevention activities should be implemented and monitored in each country, with precise targets set to be reached. In order to decide on national health policies, there is a need to estimate the burden of disease, globally, regionally and nationally. To evaluate the GBD, three components have to be assessed: 1) The global, regional and national burden of morbidity and mortality associated with HCV infection, based on prevalence, incidence, transmission and economics; 2) The natural history of HCV infection, including 'healthy individuals'; and 3) The areas for which more research is needed. A working group was created to assist the World Health organization (WHO) in estimating the GBD associated with HCV infection.
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21
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PATEL H, HEATHCOTE EJ. When to treat and the benefits of treating hepatitis C in patients with haemophilia. Haemophilia 2009; 15:20-32. [DOI: 10.1111/j.1365-2516.2008.01917.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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22
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Koletzki D, Dumont S, Vermeiren H, Peixe P, Nina J, Camacho RJ, Stuyver LJ. Full genome sequence of three isolates of hepatitis C virus subtype 4b from Portugal. Arch Virol 2008; 154:127-32. [PMID: 19050819 DOI: 10.1007/s00705-008-0270-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2008] [Accepted: 11/09/2008] [Indexed: 02/05/2023]
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23
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Borroni G, Andreoletti M, Casiraghi MA, Ceriani R, Guerzoni P, Omazzi B, Terreni N, Salerno F. Effectiveness of pegylated interferon/ribavirin combination in 'real world' patients with chronic hepatitis C virus infection. Aliment Pharmacol Ther 2008; 27:790-7. [PMID: 18298638 DOI: 10.1111/j.1365-2036.2008.03657.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Clinical trials have shown that the combination of pegylated interferon/ribavirin induces a sustained virological response in 54-63% of patients with chronic hepatitis C virus infection, but its effectiveness in day-to-day clinical practice is less clear. AIM To verify if the efficacy of pegylated interferon/ribavirin combination in 'real world' patients is comparable to that observed in trials. Methods The medical records of 397 consecutive naïve patients with chronic hepatitis C virus infection treated with pegylated interferon/ribavirin combination in nontertiary hospital settings were reviewed in order to assess the response to anti-viral treatment. RESULTS The sustained virological response rate achieved in this population was similar to that recorded in registration trials (total population: 64%; genotype 1: 46%; genotypes 2-3: 84%). Also, the premature discontinuation rate (15%) was similar to that observed in registration trials, but there were fewer dose reductions in one or both medications (26%). We confirmed the association between adherence and sustained virological response among the patients infected with hepatitis C virus genotype 1 who were treated for > or =80% of the planned duration of treatment. CONCLUSION The effectiveness of pegylated interferon/ribavirin therapy and factors predicting an sustained virological response in everyday clinical practice mirror those reported in randomized-controlled studies.
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Affiliation(s)
- G Borroni
- Unità Organizzativa Alcoldipendenze, ASL Provincia di Milano 1, Abbiategrasso, Milan, Italy.
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Abstract
UNLABELLED Hepatitis C virus genotype 4 (HCV-4) is the most common variant of the hepatitis C virus (HCV) in the Middle East and Africa, particularly Egypt. This region has the highest prevelance of HCV worldwide, with more than 90% of infections due to genotype 4. HCV-4 has recently spread in several Western countries, particularly in Europe, due to variations in population structure, immigration, and routes of transmission. The features of HCV-4 infection and the appropriate therapeutic regimen have not been well characterized. This review discusses the virology, epidemiology, natural history, histology, clinical data, and treatment options for patients with HCV-4 infections. Early reports on the treatment of patients with chronic HCV-4 with conventional interferon (IFN)-alpha monotherapy indicated poor rates of sustained viral response (SVR), which improved slightly when combined with ribavirin. Pegylated IFN and ribavirin combination therapy has dramatically improved the response rates, with recent clinical trials showing rates that exceed 60%. These data can now be used as a platform for further research to define optimal treatment duration and predictors of SVR in patients with HCV-4 infection. CONCLUSION HCV-4 infection is spreading beyond its strongholds in Africa and the Middle East. Recent clinical trials show that HCV-4 is not difficult to treat, as the response to treatment may be at an intermediate level compared with genotype 1 and genotypes 2 or 3. Tailored treatment options that are comparable to the treatment approaches for genotype 1, 2, and 3 patients to optimize treatment for each patient are now being developed.
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Affiliation(s)
- Sanaa M Kamal
- Department of Gastroenterology and Liver Disease, Ain Shams Faculty of Medicine, Cairo, Egypt.
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25
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Esteban JI, Sauleda S, Quer J. The changing epidemiology of hepatitis C virus infection in Europe. J Hepatol 2008; 48:148-62. [PMID: 18022726 DOI: 10.1016/j.jhep.2007.07.033] [Citation(s) in RCA: 334] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2007] [Accepted: 07/30/2007] [Indexed: 02/07/2023]
Abstract
The epidemic of hepatitis C virus (HCV) infection in Europe is continuously evolving and epidemiological parameters (prevalence, incidence, disease transmission patterns and genotype distribution) have changed substantially during the last 15 years. Four main factors contribute to such changes: increased blood transfusion safety, improvement of healthcare conditions, continuous expansion of intravenous drug use and immigration to Europe from endemic areas. As a result, intravenous drug use has become the main risk factor for HCV transmission, prevalent infections have increased and genotype distribution has changed and diversified. Hence, prevalence data from studies conducted a decade ago may not be useful to estimate the current and future burden of HCV infection and additional epidemiological studies should be conducted, as well as new preventive strategies implemented to control the silent epidemic. This review summarizes recently published data on the epidemiology of HCV infection in Europe focusing on the factors currently shaping the epidemic.
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Affiliation(s)
- Juan I Esteban
- Liver Unit, Department of Medicine, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain.
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Abstract
The natural history of chronic Hepatitis C Virus (HCV) infection is still poorly understood. The main reason is the asymptomatic onset and course in the majority of infected subjects. Moreover, in the presence of the very effective therapies now available it is impossible to follow people untreated in order to analyse the events and their timing and type of evolution. For these reasons, most studies are mainly retrospective, although studies on post-transfusion hepatitis could help in understanding the natural course of the infection. Another important phenomenon that makes this issue problematic is that chronic HCV infection is not linear in time, probably because many co-factors can change the speed of development of fibrosis, cirrhosis and hepatocellular carcinoma. Data now available show that this disease can persist for about two decades with limited morbidity and mortality; problems may arise between the third and fourth decade after infection. Alcohol consumption is a very important factor of additional risk of progression, but there are several other factors (iron, steatosis, metabolic problems, etc.) that must be better analysed. In conclusion, only in a small group (no more than 15%) of all HCV-infected patients does the disease reduce quality and/or quantity of life.
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Samimi-Rad K, Shahbaz B. Hepatitis C virus genotypes among patients with thalassemia and inherited bleeding disorders in Markazi province, Iran. Haemophilia 2007; 13:156-63. [PMID: 17286768 DOI: 10.1111/j.1365-2516.2006.01415.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Hepatitis C virus (HCV) genotypes, multiple genotypes infection and HCV seroprevalence were investigated among 98 thalassemia patients and 76 haemophiliacs in Markazi province, Iran. HCV antibody was detected in 5 (5.1%) of the first group and 33 (43.4%) of the latter. Risk factors associated with anti-HCV antibody were also determined. Anti-HCV positivity in thalassemiacs were related to the number of blood transfusion units, splenectomy and duration of thalassemia. Analysis of risk factors in haemophiliacs revealed that seropositivity was significantly associated with duration of transfusion (P =0.009) and severity of disease (P = 0.000). The prevalence of HCV antibody in thalassemia subjects dropped from 8.1% to 0% after implementation of anti-HCV screening (1996). It was found that higher prevalence of HCV antibody in haemophiliacs (43.4%) compared with thalassemia patients (5.1%) correlated with clotting factor concentrates. Of the 34 seropositive haemophilia patients, HCV RNA was detected in 23 (67.7%). HCV genotype distribution was one in 50%, three in 18.2%, two in 4.54% and mixed in 27.3% (1 + 2 in 9.1%, 1 + 3 in 4.54%, 1 + 4 in 9.2% and 2 + 3a in 4.54%) cases. Among the five anti-HCV-positive thalassemiacs, two (40%) were positive for HCV RNA and one sample was found to be subtype 3a. This study confirms that multitransfused patients in Markazi province had similar genotype distribution as those previously reported form some other regions of Iran. Considering the possibilities of HCV mixed genotype among patients with haemophilia and thalassemia, accuracy and precision should be highly concerned in the detection of genotypes and their subsequent treatment.
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Affiliation(s)
- K Samimi-Rad
- Department of Virology, School of Public Health and Institute of Public Health Researches, Tehran University of Medical Sciences, Tehran, Iran.
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28
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Harris HE, Eldridge KP, Harbour S, Alexander G, Teo CG, Ramsay ME. Does the clinical outcome of hepatitis C infection vary with the infecting hepatitis C virus type? J Viral Hepat 2007; 14:213-20. [PMID: 17305887 DOI: 10.1111/j.1365-2893.2006.00795.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Whether differences in the natural history of hepatitis C virus (HCV) can be explained by differences in the infecting HCV type is unknown. The aim of this study was to investigate whether the HCV type might influence the clinical outcome of infection. Study serum samples were assembled from 749 individuals enrolled into the UK HCV National Register from which data on clinical outcomes were extracted. HCV-RNA-positive specimens were genotyped and HCV-RNA-negative specimens serotyped. Logistic regression analysis was used to investigate the independent effect of HCV type on viral clearance by comparing patients who were HCV RNA negative (n = 86) with those who were HCV RNA positive (n = 508). The same method was used to investigate whether HCV type was associated with histological stage of liver disease. The prevalence of HCV type 1 among those who cleared infection was 69% and among those who remained HCV RNA positive was 51%: Type 1 infections were more likely to be HCV RNA negative than non-1 types (OR 0.47, 95% CI 0.29-0.78, P = 0.003). Type 1 infections were also more likely to be associated with histological stage scores above the median when compared with non-1 types (OR 2.03, 95% CI 1.07-3.83, P = 0.03). In conclusion, HCV type 1 infection was more often HCV RNA negative, suggesting that spontaneous clearance may occur more commonly with this type. Among the RNA-positive infections, type 1 infection may be more aggressive than types 2/3.
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Affiliation(s)
- H E Harris
- Immunisation Department, Centre for Infections, Health Protection Agency, London, UK.
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Lee CM, Lu SN, Hung CH, Tung WC, Wang JH, Tung HD, Chen CH, Hu TH, Changchien CS, Chen WJ. Hepatitis C virus genotypes in southern Taiwan: prevalence and clinical implications. Trans R Soc Trop Med Hyg 2006; 100:767-74. [PMID: 16443243 DOI: 10.1016/j.trstmh.2005.10.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2005] [Revised: 10/20/2005] [Accepted: 10/21/2005] [Indexed: 12/20/2022] Open
Abstract
The role of hepatitis C virus (HCV) genotypes in the development of hepatocellular carcinoma (HCC) is still controversial. To determine the distribution and clinical implications of HCV genotypes in southern Taiwan, we analysed 418 patients with chronic HCV infections. HCV genotypes were determined using an HCV Line Probe Assay. The predominant HCV genotype was 1b (45.5%), followed by 2a/2c (30.9%) and 2b (6.9%). The prevalence of genotype 1b in HCC patients (60.3%) was significantly higher than in those with liver cirrhosis (38.7%) and chronic hepatitis (38.7%) (P=0.003 and P<0.001, respectively). Patients with chronic HCV 2a/2c infection had higher alanine aminotransferase (ALT) levels than those with chronic HCV 1b infection (P<0.001). Univariate analysis revealed that disease severity was significantly correlated with older age, genotype 1b, lower ALT levels and lower viral load. Based on multiple logistic regression analysis, after adjusting for age and serum HCV RNA levels, HCV 1b infection was still a significant risk factor for HCC. In conclusion, the predominant genotypes in southern Taiwan were 1b and 2a/2c, and disease severity was associated with genotype 1b.
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Affiliation(s)
- Chuan-Mo Lee
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, 123 Ta Pei Road, Kaohsiung, Taiwan.
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Massard J, Ratziu V, Thabut D, Moussalli J, Lebray P, Benhamou Y, Poynard T. Natural history and predictors of disease severity in chronic hepatitis C. J Hepatol 2006; 44:S19-24. [PMID: 16356583 DOI: 10.1016/j.jhep.2005.11.009] [Citation(s) in RCA: 153] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Cirrhosis is the end-stage consequence of fibrosis progression in patients with chronic hepatitis C. The median time from infection to cirrhosis is 30 years, with a high inter-individual variability, which is now better understood. Several factors have been clearly shown to be associated with fibrosis progression rate: duration of infection, age, male gender, alcohol consumption, HIV co-infection and low CD4 count. Metabolic conditions such as steatosis, being overweight and diabetes are emerging as independent co-factors of fibrogenesis. The recent validation of non-invasive biomarkers should facilitate the study of fibrosis progression in large populations.
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Affiliation(s)
- Julien Massard
- Service d'Hépato-Gastroentérologie, Groupe Hospitalier Pitié-Salpêtrière, 47 Boulevard de l'Hôpital, 75651 Paris Cedex 13, France
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31
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Savvas SP, Koskinas J, Sinani C, Hadziyannis A, Spanou F, Hadziyannis SJ. Changes in epidemiological patterns of HCV infection and their impact on liver disease over the last 20 years in Greece. J Viral Hepat 2005; 12:551-7. [PMID: 16108773 DOI: 10.1111/j.1365-2893.2005.00614.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The aim of this study was to investigate the relative frequency of hepatitis C virus (HCV) genotypes in Greek patients with chronic infection as well as possible secular changes in their distribution in relation to modes of transmission, age and time at acquisition of the infection and other variables. We evaluated 434 unselected patients, 241 males and 193 females with a median age of 46.2 years (18-75), with chronic HCV infection presenting during the period 1996-2000. HCV infection was confirmed by the detection of HCV-RNA by polymerase chain reaction (PCR), while HCV genotyping was performed by the Inno-LiPA assay. Liver biopsies were evaluated according to Ishak's scoring system. Of 434 patients, 167 had a history of blood transfusion [post-transfusion hepatitis (PTH)], 80 were i.v. drug users and in 187 the route of infection remained unknown. The overall distribution of HCV genotypes 1, 2, 3 and 4 was 47, 8.3, 27 and 15.2%, respectively. Genotype 3 was common in younger adults and i.v. drug users, whereas genotype 1 predominated in older people and PTH patients (P < 0.001 for both). Infection acquired before 1981 (group A) was related to transfusion and genotype 1, while after 1981 (group B) with i.v. drug use and genotype 3 (P < 0.01). Biopsy was available in 369 (85%) patients, of whom 22.5% had cirrhosis; 29.8% in group A and 9.9% in group B. In a multivariate analysis, cirrhosis was strongly associated with the duration of infection (P = 0.013). Our study revealed a change of HCV genotype distribution in the last 20 years among Greek patients with chronic HCV infection as a result of epidemiological changes in HCV transmission. The presence of cirrhosis was associated only with the duration of infection. These observations have impact both on prevention and treatment.
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Affiliation(s)
- S P Savvas
- Second Department of Medicine, Athens University, Athens, Greece
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Rubio Caballero M, Rubio Rivas C, Egido García R, Nogués Biau A. [Chronic hepatitis C in HIV co-infected patients. Study of 55 cases with liver biopsy]. Med Clin (Barc) 2004; 123:441-4. [PMID: 15498438 DOI: 10.1016/s0025-7753(04)74551-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND AND OBJECTIVE To study the evolution of chronic hepatitis in HIV-HCV co-infected patients and the factors conditioning this evolution. PATIENTS AND METHOD 55 intravenous drug users with HIV-HCV co-infection were studied. We performed a clinical and laboratory study determining the age at the time of HCV infection and the date of liver biopsy, HIV stage, CD4 cell count, viral load, and time under antiretroviral treatment. Moreover, we analyzed the HCV genotype, HCV viral load, ALT plasmatic level, and liver biopsy. Univariate and multivariate analyses were made. RESULTS 55 patients with HIV-HCV co-infection were evaluated. In the multivariate analysis, gender (p = 0.034; 95% confidence interval [CI], 1.306-1082.625), lowest level of CD4+ lymphocytes (p = 0.021; 95% CI, 1,693-653,484) and highest viral load value (p = 0.022; 95% CI, 1366-53,817) were significantly correlated with liver disease progression. CONCLUSIONS Both a male sex and a poor immune system situation are associated with a worse evolution of chronic hepatitis C.
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Fontana RJ, Everson GT, Tuteja S, Vargas HE, Shiffman ML. Controversies in the management of hepatitis C patients with advanced fibrosis and cirrhosis. Clin Gastroenterol Hepatol 2004; 2:183-97. [PMID: 15017601 DOI: 10.1016/s1542-3565(04)00002-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Robert J Fontana
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.
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Di Tommaso L, Macchia S, Morandi L, Leoncini S, Pession A, Dal Monte PR, Foschini MP. Correlation between histologic staging, hepatitis C virus genotypes and clinical features in HCV chronic hepatitis: evidence of a new pattern. Int J Surg Pathol 2003; 11:197-204. [PMID: 12894351 DOI: 10.1177/106689690301100306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Genome heterogeneity may be related to the wide variability of clinical and pathological features in hepatitis C virus (HCV)-related chronic liver disease. This paper addresses the possible association between HCV subtypes and clinical and histological features of chronically infected patients. Sixty-eight consecutive liver biopsies of chronic hepatitis constituted the basis of the study. HCV genotyping was performed on frozen tissue. Grading of necroinflammatory activity and staging of fibrosis were histologically assessed. Serologic HCV-RNA and liver function were assessed at the same time. All information was compared with clinical data including age, sex, HCV serology, and probable data and route of infection. Two cases were excluded as inadequate tissue was available. Five cases were negative to HCV-RNA in both serum and tissue. In 61 cases HCV RNA was present at the same time in serum and liver tissue. Forty-four patients were men (72%) and 17 (28%) were women. Two peaks of age were observed: 1 in the 4th decade of life, the 2nd in the 7th. The 2 groups had different HCV genotypes. Patients with genotypes 1b (mean age 50.7 years), 2c (mean age 61.3 years), and a subgroup of coinfections (mean age 60 years) were older than patients with genotypes 1a (mean age 35.5 years), 3 (mean age 36 years), and a subgroup of coinfections (mean age 33 years). Patients with genotypes 1b, 2, or 2c and a subgroup of coinfections more frequently had a history of blood transfusion and or surgical intervention dating up to 49 years previously. Patients with HCV 1a, 3, and a subgroup of coinfections frequently admitted a period of intravenous drug abuse. Patients with advanced liver disease, i.e., severe fibrosis and cirrhosis, showed the same 2 peaks of incidence: in the 4th and 7th decades of life, the first group mainly comprising patients with HCV types 1a and 3, the second, patients with HCV types 1b and 2c. Both these groups shared a clinical history of a long-standing infection. Two profiles of patients emerged. The largest group was composed of elderly patients, infected by HCV genotypes 1b or 2c, with a history of blood transfusion and/or surgery, presenting an advanced stage of liver disease (namely, severe fibrosis or cirrhosis). The second group was composed of younger patients, mainly in the 4th decade of life, infected by HCV types 3 or 1a, often presenting with chronic hepatitis in the stage of severe fibrosis or cirrhosis. The latter could be the profile of HCV infection in the near future.
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Affiliation(s)
- L Di Tommaso
- Department of Oncology, Section of Anatomic Pathology Marcello Malpighi, University of Bologna, Italy
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35
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Abstract
Much controversy surrounds the issue of the natural history of hepatitis C virus (HCV) infection. Many authorities view the disease as inexorably progressive with a high probability of advancing over time to cirrhosis and occasionally hepatocellular carcinoma (HCC) and, therefore, likely to be responsible for causing death. Others regard chronic hepatitis C as having a variable outcome, the majority of infected persons not dying from the disease, but more likely from the comorbid conditions that so often accompany infection by this agent, or from more common medical conditions. Disagreements probably derive from the manner of conduct of the study and the populations studied. Efforts to determine natural history are handicapped by the primary characteristics of the disease, namely that its onset rarely is recognized and its course is prolonged exceedingly. Thus, different outcomes have come from retrospective rather than from prospective studies, but both have concluded that at least 20% of chronically infected adults develop cirrhosis within 20 years. More recent studies that used a retrospective/prospective approach, focusing largely on young infected individuals, have produced different results. Among these young people, particularly young women, spontaneous resolution of the viral infection is more common than previously thought and cirrhosis has been identified in 5% or fewer of them. The major failing for all groups studied, young and old, is that natural history studies have rarely exceeded the first 2 decades, so that outcome beyond this time is not known, other than through modeling. Several host-related and extraneous factors probably affect the natural history.
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Affiliation(s)
- Leonard B Seeff
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of Health, Bethesda, MD, USA.
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36
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Dal Molin G, Ansaldi F, Biagi C, D'Agaro P, Comar M, Crocè L, Tiribelli C, Campello C. Changing molecular epidemiology of hepatitis C virus infection in Northeast Italy. J Med Virol 2002; 68:352-6. [PMID: 12226821 DOI: 10.1002/jmv.10210] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
To assess HCV genotype distribution and its determinants, 318 consecutive HCV RNA positive patients were examined. Subtype 1b infection was the most prevalent (35.5%), followed by subtype 1a (22%), 3a (21.4%) and 2 genotype (21.3%). Subtypes 1a, 1b and 3a had a comparable prevalence (30-35%) in the 0-15-, 16-30- and 31-45-year age groups. In subjects older than 45 years, genotype 2 prevalence increased, whereas subtype 1a and 3a infections decreased markedly. In this age group types 1b and 2 accounted for a prevalence of more than 90% in a comparable proportion. Genotype prevalence rates according to different risk factors were different statistically (P < 0.001): subtype 1a and 3a infections were predominant in injection drug users (42.9% and 37.7%, respectively), whereas community acquired infections and infections in patients with a history of transfusion were caused mainly by subtype 1b (38.5% and 66.6%, respectively). Logistic regression showed that age and injection drug use are independent determinants of genotype distribution.
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Affiliation(s)
- Gianna Dal Molin
- Department of Public Medicine Sciences, UCO Hygiene and Preventive Medicine, University of Trieste, and IRCCS Burlo Garofolo, Trieste, Italy
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37
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Abstract
Much controversy surrounds the issue of the natural history of hepatitis C virus (HCV) infection. Many authorities view the disease as inexorably progressive with a high probability of advancing over time to cirrhosis and occasionally hepatocellular carcinoma (HCC) and, therefore, likely to be responsible for causing death. Others regard chronic hepatitis C as having a variable outcome, the majority of infected persons not dying from the disease, but more likely from the comorbid conditions that so often accompany infection by this agent, or from more common medical conditions. Disagreements probably derive from the manner of conduct of the study and the populations studied. Efforts to determine natural history are handicapped by the primary characteristics of the disease, namely that its onset rarely is recognized and its course is prolonged exceedingly. Thus, different outcomes have come from retrospective rather than from prospective studies, but both have concluded that at least 20% of chronically infected adults develop cirrhosis within 20 years. More recent studies that used a retrospective/prospective approach, focusing largely on young infected individuals, have produced different results. Among these young people, particularly young women, spontaneous resolution of the viral infection is more common than previously thought and cirrhosis has been identified in 5% or fewer of them. The major failing for all groups studied, young and old, is that natural history studies have rarely exceeded the first 2 decades, so that outcome beyond this time is not known, other than through modeling. Several host-related and extraneous factors probably affect the natural history.
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Affiliation(s)
- Leonard B Seeff
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of Health, Bethesda, MD, USA.
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38
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Matera G, Lamberti A, Quirino A, Focà D, Giancotti A, Barreca GS, Guadagnino V, Liberto MC. Changes in the prevalence of hepatitis C virus (HCV) genotype 4 in Calabria, Southern Italy. Diagn Microbiol Infect Dis 2002; 42:169-73. [PMID: 11929687 DOI: 10.1016/s0732-8893(01)00350-9] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The aim of this study was to assess changes in the prevalence of hepatitis C virus (HCV) genotypes, focusing on genotype 4, by surveying population of chronic hepatitis C patients within an area of Southern Italy. HCV-RNA was detected in serum using two commercial hepatitis C RNA PCR assays (Amplicor Roche Diagnostic System, and AmpliSensor HCV, Nuclear Laser Medicine). PCR products were analyzed for genotyping using a reverse hybridization of the amplified product by a line probe assay (INNO LIPA, Innogenetics). In our Institution we have previously observed, in a period of 18 months (January 1997-May 1998) an initial increase of the genotype 4 which appeared in 3.3% of HCV patients versus a percentage of 1.3%, during 1996. Later data obtained from 702 HCV-RNA positive patients, collected from June 1998 until December 1999 indicated a 3.7% of genotype 4. This percentage increased until to 4.7% in the most recent period studied (January 2000-February 2001). Drug addiction, blood transfusion and sporadically acquired infections represented the most frequent risk factors. In the Calabria region, genotype 1b, the most prevalent isolate (53.3%) and genotype 2a/2c (26.2%) were associated with older age, confirming our previous study. Genotype 4 was the fifth most prevalent genotype observed, just after 3a and 1a subtypes. Spread of genotype 4 in Calabria region is mostly associated to older age when compared to genotype 3a and 1a, but is statistically associated with a younger group of patients when compared with genotype 1b. In conclusion we demonstrated a fourfold increased prevalence of HCV genotype 4 during the last 5 years.
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Affiliation(s)
- Giovanni Matera
- Department of Medical Sciences, Institute of Microbiology, University of Catanzaro, Italy.
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39
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Bourlière M, Barberin JM, Rotily M, Guagliardo V, Portal I, Lecomte L, Benali S, Boustière C, Perrier H, Jullien M, Lambot G, Loyer R, LeBars O, Daniel R, Khiri H, Halfon P. Epidemiological changes in hepatitis C virus genotypes in France: evidence in intravenous drug users. J Viral Hepat 2002; 9:62-70. [PMID: 11851904 DOI: 10.1046/j.1365-2893.2002.00319.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Hepatitis C virus (HCV) genotypes are distributed differently depending on geography and route of infection. We characterized the distribution of genotypes in a large cohort of patients with chronic hepatitis C in the South-east of France and evaluated the relative prevalence according to time of acquisition. One thousand, one hundred-and-eighty-three patients who were anti-HCV-positive were studied. HCV genotype distribution has changed significantly from the 1960s to 2000. The prevalence of genotype 1b decreased from 47% before 1978 to 18.8% in the 1990s while the prevalence of genotype 1a and 3a increased during the same period from 18% and 15.3% to 28.8% and 26.3%, respectively. The logistic regression model showed that genotype 1a was significantly more common in patients infected through intravenous drug injection odds ratio ((OR): 2.08, P < 0.01) and after 1990 (OR: 1.98, P < 0.05). Genotype 1b was significantly less frequent in patients infected through intravenous drug injection (OR: 0.17, P < 0.001) and has decreased since 1978 (OR: 0.27, P < 0.001). Genotype 3a was independently associated with intravenous drug injection (OR: 6.1, P < 0.001) and tattooing (OR: 8.01, P < 0.001) and was more frequent in the 1979-90 period (OR: 2.05 and 1.74, P < 0.001 and P < 0.05). Our results show a modification of HCV genotypes distribution over the last four decades due to an increase of intravenous drug use (IVDU) contamination and an evolution of HCV genotypes distribution only in IVDU population characterized by a decrease of genotype 1b, an increase of genotype 3a from 1970 to 1990 and a higher increase of genotype 1a which is currently the predominant genotype in our population.
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Affiliation(s)
- M Bourlière
- Department of Gastroenterology and Liver Unit, Hôpital Saint Joseph, France.
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40
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Yu ML, Chuang WL, Chen SC, Dai CY, Hou C, Wang JH, Lu SN, Huang JF, Lin ZY, Hsieh MY, Tsai JF, Wang LY, Chang WY. Changing prevalence of hepatitis C virus genotypes: molecular epidemiology and clinical implications in the hepatitis C virus hyperendemic areas and a tertiary referral center in Taiwan. J Med Virol 2001. [PMID: 11505444 DOI: 10.1002/jmv.2001] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
To determine the hepatitis C virus (HCV) genotype distribution in Taiwan and to clarify the relationship between genotype and the pathogenesis of HCV infection, 1,164 subjects positive for serum HCV antibodies and HCV RNA from three HCV hyperendemic areas (Masago, Tzukuan, and Taoyuan) and a tertiary referral center in Taiwan were studied during 1995-1997. HCV genotypes and viral loads were determined using Okamoto's method and branched DNA assay, respectively. Genotype 1b was the most prevalent in Tzukuan (61.9%), Taoyuan (76.9%), and the referral center (47.0%). By contrast, genotype 2a was the major HCV type in Masago (63.5%). Prevalence of genotype 1b positively and that of genotype 2a negatively correlated to age, regardless of study populations (P < 0.01). Based on multivariate analysis, the significant factors associated with the presence of cirrhosis, with or without hepatocellular carcinoma, in chronic hepatitis C patients were genotype 1b and age. In conclusion, these results underline that independent HCV outbreaks continue in HCV hyperendemic areas in Taiwan, concomitant with a changing relative prevalence of HCV genotypes in relation to age. Both the correlation of genotype 1b with age (cohort effect) and intrinsic properties of HCV genotypes are probably responsible for the association between genotype and the pathogenesis of HCV infection.
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Affiliation(s)
- M L Yu
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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41
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Franchini M, Rossetti G, Tagliaferri A, Capra F, de Maria E, Pattacini C, Lippi G, Lo Cascio G, de Gironcoli M, Gandini G. The natural history of chronic hepatitis C in a cohort of HIV-negative Italian patients with hereditary bleeding disorders. Blood 2001; 98:1836-41. [PMID: 11535518 DOI: 10.1182/blood.v98.6.1836] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
This study looked at 102 anti-hepatitis C virus (HCV)-positive, hepatitis B virus (HBV)-negative, and HIV-negative patients (median age, 45.1 years; range, 15-71) affected by hereditary bleeding disorders who have been infected with HCV for 15 to 34 years (median, 25.1). All these patients were infected before the mid 1980s because of non-virally inactivated pooled blood products. Fourteen patients (13.7%) were HCV-RNA negative with no signs of liver disease and were considered to have cleared the virus. Eighty-eight patients (86.3%) were HCV-RNA positive. The HCV genotype distribution was 1a in 20.5%, 1b in 36.4%, 2 in 17.0%, 3 in 15.9%, 4 in 3.4%, and mixed in 6.8% of cases. Twenty-four patients (23.5%) had serum cryoglobulins, symptomatic in 4 cases, and associated with liver disease and with genotype 1. Among the 88 HCV-RNA-positive patients, 15 (17.0%) had normal alanine aminotransferase levels and abdominal ultrasound, 61 (69.3%) had nonprogressive chronic hepatitis, and 12 (13.7%) had severe liver disease (6 [6.9%] liver cirrhosis, 4 [4.5%] hepatic decompensation, and 2 [2.3%] hepatocellular carcinoma) after a follow-up period of 25 years. There were 3 (3.4%) liver-related deaths. HCV genotype 1, patient's age at evaluation, duration of infection, and severity of congenital bleeding disorder were associated with more advanced liver disease. The results confirm the slow progression of HCV infection in HIV-negative hemophiliacs.
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Affiliation(s)
- M Franchini
- Servizio di Immunoematologia e Trasfusione, Centro Emofilia, Azienda Ospedaliera di Verona, Verona, Italy.
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42
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Fontaine H, Nalpas B, Poulet B, Carnot F, Zylberberg H, Brechot C, Pol S. Hepatitis activity index is a key factor in determining the natural history of chronic hepatitis C. Hum Pathol 2001; 32:904-9. [PMID: 11567218 DOI: 10.1053/hupa.2001.28228] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
To analyze the spontaneous pathologic progression of chronic hepatitis C, we analyzed the histopathologic semiquantitative scores (Metavir and Knodell) of sequential liver biopsies performed in untreated hepatitis C virus (HCV)-infected patients. Subjects included 35 men and 41 women, with a mean age of 41 +/- 12 years, a duration of HCV infection of 11 +/- 5 years, and an interval between liver biopsies of 3.7 +/- 2.5 years. Results obtained using the Knodell score and the Metavir score were similar. At the first biopsy, 78.9% of patients had a low activity score (A0-A1) and 82.9% had a low fibrosis score (F0-F2). At the second biopsy, the activity decreased in 9.2%, was unchanged in 72.4%, and increased in 18.5%. An increase in activity was more frequently observed in patients infected with genotype 1 (28.9%) than with others (7.7%; P =.04); the yearly progression of activity was significantly higher in patients with a low rather than high initial activity score (0.11 v -0.02; P <.01). An increase in fibrosis was noted in 13.3% of those with a low and 43.8% of those with a high initial activity score (P <.01), with a highest rate of yearly fibrosis progression (0.12 U). In multivariate analysis, only a high activity score was significantly associated with an increased risk of fibrosis progression (relative risk, 25.5; 95% confidence interval, 2.7 to 238; P =.004). Spontaneous chronic hepatitis C evolution is worsening in only 20% of patients. Fibrosis progression is significantly associated with the necroinflammatory activity suggesting that this factor should be regarded as a major clue for deciding therapy.
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Affiliation(s)
- H Fontaine
- Unité d'Hépatologie and INSERM U370, Hôpital Necker, Paris, France
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43
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Osella AR, Misciagna G, Guerra V, Elba S, Buongiorno G, Cavallini A, Di Leo A, Sonzogni L, Mondelli MU, Silini EM. Hepatitis C virus genotypes and risk of cirrhosis in southern Italy. Clin Infect Dis 2001; 33:70-5. [PMID: 11389497 DOI: 10.1086/320887] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2000] [Revised: 11/14/2000] [Indexed: 12/16/2022] Open
Abstract
Because hepatitis C virus (HCV) genotypes have raised considerable interest as variables that influence chronic hepatitis C progression, a case-control study was conducted to estimate their effects on patients with cirrhosis. Case patients (n = 46) had tested positive for anti-HCV antibody and HCV RNA and were residents of the study area who had cirrhosis recently diagnosed. Controls (n = 138) were drawn randomly from a residents' cohort from the same area. Demographic and other information were recorded. Presence of HCV infection, presence of HCV RNA, and HCV genotypes were assessed. Crude, stratified, and logistic regression analyses were performed. HCV genotype 2a/c occurred in 84 controls (60.9%) and 9 case patients (19.6%); HCV genotype 1b was found in 45 controls (32.6%) and 34 case patients (73.9%). HCV 1b genotype showed an independent effect on the risk of cirrhosis (odds ratio, 7.49; 95% confidence interval, 3.15--17.81). No significant effects related to other variables were observed. These results indicate that the genetic diversity of HCV phylogenetic variants may explain differences in biological behaviors.
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Affiliation(s)
- A R Osella
- Laboratory of Epidemiology and Biostatistics, Istituto di Ricovero e Cura a Carattere Scientifico Saverio De Bellis, Castellana, Italy.
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44
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Hervé S, Savoye G, Riachi G, Hellot MF, Goria O, Lerebours E, Colin R, Ducrotte P. Chronic hepatitis C with normal or abnormal aminotransferase levels: is it the same entity? Eur J Gastroenterol Hepatol 2001; 13:495-500. [PMID: 11396527 DOI: 10.1097/00042737-200105000-00006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE The features of hepatitis C virus (HCV) infection with persistently normal serum alanine aminotransferase (ALT) activity levels are not well defined. This study evaluated the characteristics of HCV infection according to the presence or absence of elevated ALT. METHODS Demographic data, liver histology and HCV genotype were studied in a group of 80 HCV-RNA-positive subjects with persistently normal ALT (PNALT) (group 1), and compared with a second group of 455 HCV-RNA-positive patients with elevated ALT (group 2). The annual progression of liver fibrosis was also calculated. RESULTS A higher proportion of women was found in group 1:64% vs 42% in group 2 (P< 0.0002). The HCV genotype 1 was less frequent in group 1:49% vs 60% in group 2 and genotype 2 was more frequent: 16% in group 1 vs 4% in group 2 (P< 0.002). Cirrhosis was less frequent in group 1 (4% vs 13% in group 2 (P< 0.0001)). Normal liver was more frequent in group 1:9% vs 1% in group 2 (P< 0.0001). The Knodell score was significantly different between the two groups: 3.2 +/- 0.27 vs 7.15 +/- 0.22 (P< 0.0001). The progression of liver fibrosis was lower in group 1: 0.053 +/- 0.14 units/year vs 0.13 +/- 0.24 in group 2 (P < 0.007). CONCLUSION HCV infection with PNALT is associated with less severe histological liver disease and a lower fibrosis progression rate. This suggests that the natural history of HCV infection in these patients is different from that in patients with abnormal ALT.
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Affiliation(s)
- S Hervé
- Digestive Tract Research Group, Rouen University Hospital, France.
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45
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Riestra S, Fernández E, Leiva P, García S, Ocio G, Rodrigo L. Prevalence of hepatitis C virus infection in the general population of northern Spain. Eur J Gastroenterol Hepatol 2001; 13:477-81. [PMID: 11396524 DOI: 10.1097/00042737-200105000-00003] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES To estimate the prevalence of hepatitis C in a population of northern Spain and describe (i) the risk factors associated with infection and (ii) the distribution of genotypes. DESIGN Randomized cross-sectional study. METHODS A random sample of 1,170 people participated in the study. Sociodemographic data were obtained. Antibodies against hepatitis C virus (anti-HCV) and hepatitis C virus (HCV) genotypes were determined. RESULTS Nineteen of 1,170 (1.6%) subjects were anti-HCV positive (95% CI 1.0-2.6%). In 12 cases (63%), viraemia was present, and the predominant genotype was 1 b (80%). Anti-HCV positive subjects were older than anti-HCV negative subjects (55.8 +/- 15.3 v. 44.8 +/- 20.9; P = 0.02). Two peaks of maximum frequency were found (in the fourth decade and in those over 60 years). Parenteral drug addiction predominates among those of the fourth decade, while transfusion and surgery predominate in people over 60 years. Three (16%) subjects knew they were carriers of HCV. Only three variables remained significant in the multivariate model (illegal drug use, P< 0.0001; previous hepatitis, P< 0.0001; and age, P< 0.02). CONCLUSIONS Our study emphasizes the need to develop health policies that can cope with the foreseeable increases in the problems associated with HCV infection in the near future.
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Affiliation(s)
- S Riestra
- Digestive Section, Hospital Valle del Nalón, Spain.
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46
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Roffi L, Redaelli A, Colloredo G, Minola E, Donada C, Picciotto A, Riboli P, Del Poggio P, Rinaldi G, Paris B, Fornaciari G, Giusti M, Marin R, Morales R, Sangiovanni A, Belloni G, Pozzi M, Poli G, Mascoli N, Corradi C, Pioltelli P, Scalori A, Mancia G. Outcome of liver disease in a large cohort of histologically proven chronic hepatitis C: influence of HCV genotype. Eur J Gastroenterol Hepatol 2001; 13:501-6. [PMID: 11396528 DOI: 10.1097/00042737-200105000-00007] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To assess the influence of hepatitis C virus (HCV) genotypes on the clinical outcome of liver disease, we analysed 2,307 patients. RESULTS The most frequently represented genotypes were 1b (40%) and 2 (28.1%). Patients with these genotypes had a median age higher than patients with other genotypes (P< 0.01). The overall survival of subjects with genotype 1b was poorer than the survival of patients with other genotypes (P< 0.01). Liver cirrhosis was found in 280 patients (12.1%), and type 1b was the most represented isolate among them (P< 0.01). Sixty-two patients (22%) developed hepatocellular carcinoma (HCC) during a follow-up of 1481.8 cumulative years (estimated crude incidence rate, 4.1 cases per 100 person-years for all cirrhotics; 5.9 cases for genotype 1a; 4.5 cases for genotype 1b; and 2.8 cases for genotypes non-1). Considering the whole population of 2,307 patients, only genotype 1b was associated significantly with both cirrhosis and the development of HCC. One hundred and nineteen cirrhotic patients underwent treatment with interferon in uncontrolled studies. Interferon therapy was associated with both better survival (P< 0.01) and a lower cumulative hazard for HCC (P< 0.01). CONCLUSIONS Genotype 1b was associated with a poorer prognosis, probably because it leads to cirrhosis and consequently to HCC development. However, our data did not confirm genotype 1b as an independent risk factor for HCC in liver cirrhosis, which plays a major role in carcinogenesis. Interferon should be considered as a useful strategy in cirrhosis for improvement of survival and reduction of HCC risk.
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Affiliation(s)
- L Roffi
- Department of Internal Medicine, Sondrio Hospital, Italy.
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47
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Poynard T, Ratziu V, Charlotte F, Goodman Z, McHutchison J, Albrecht J. Rates and risk factors of liver fibrosis progression in patients with chronic hepatitis c. J Hepatol 2001; 34:730-9. [PMID: 11434620 DOI: 10.1016/s0168-8278(00)00097-0] [Citation(s) in RCA: 476] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AIMS In hepatitis C there is controversy over the linearity of the rate of progression and the significance of gender, mode of infection and viral factors. METHODS 2313 untreated patients with a reliable estimated duration of infection and liver fibrosis were included. Fibrosis progression was calculated using the Kaplan-Meier method and the rate of fibrosis progression using the hazard function. Seven risk factors were assessed: age at biopsy, gender, alcohol consumption, mode of infection, activity grade, hepatitis C virus genotype and RNA level. RESULTS The percentage of patients without cirrhosis was 91% after 20 years of infection (95% CI:90-92%) and 56% after 40 years (95% CI:48-64%). Three independent factors were associated (P < 0.001) with a faster progression rate: age at infection, alcohol consumption of 50 g or more per day, and male gender. The mode of infection, histologic activity, genotype and viral load were not independently associated with fibrosis. Fibrosis progression was mainly dependent on age and the duration of infection and can be divided into four successive periods with very slow, slow, intermediate and rapid progression rates. CONCLUSION In patients infected with hepatitis C, the majority of fibrosis progression occurred in those aged fifty years or older.
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Affiliation(s)
- T Poynard
- Service d'Hépato-gastroentérologie, Groupe Hospitalier Pitié-Salpêtriére, Paris, France.
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48
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Abstract
The widespread incidence of hepatitis C (HCV) infection throughout the community is of concern. Although many of those infected will not suffer significantly from their infection, up to one-third will have liver disease, fatigue and oral health problems. General dental practitioners need to be aware of the precautions necessary in treating people with severe liver disease. This paper discusses the issues associated with treating patients who have HCV infection including the importance of preventive programs to reduce dental pathology and maximise oral health.
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Affiliation(s)
- E A Coates
- South Australian Dental Service, Adelaide Dental Hospital
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49
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Elghouzzi MH, Bouchardeau F, Pillonel J, Boiret E, Tirtaine C, Barlet V, Moncharmont P, Maisonneuve P, du Puy-Montbrun MC, Lyon-Caen D, Couroucé AM. Hepatitis C virus: routes of infection and genotypes in a cohort of anti-HCV-positive French blood donors. Vox Sang 2001. [PMID: 11111231 DOI: 10.1046/j.1423-0410.2000.7930138.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND We evaluated and analysed risk factors of HCV-infected blood donors according to HCV genotypes in order to improve the transfusion policy and safety of blood supply. MATERIALS AND METHODS HCV-RNA was analysed in sera from 518 anti-HCV-positive blood donors, who were invited to medical consultation and interview as to risk factors by means of an extensive questionnaire. HCV genotyping was done on all samples positive for HCV-RNA. RESULTS Of the 518 sera, 399 (77%) were HCV-RNA positive, and 394 of 399 HCV genotypes were identified. Major genotypes were 1b (34.3%), 3a (24%), 1a (19.5%) and 2 (11.4%). Of the donors, 289 (55.8%) were interviewed regarding their risk behaviour: 27% were former intravenous drug users (IVDUs), 26% had been transfused, 8% had a history of invasive diagnostic procedures, and 13% a history of surgery. Among the 224 interviewed donors, genotypes 1a and 3a were mainly associated with IVDU (51 and 45% respectively) and genotype 1b, with transfusion and nosocomial infections (40 and 25%, respectively). CONCLUSION In this population of anti-HCV-positive blood donors, nosocomial infection may be a route of HCV spread, but the main risk factor remains IVDU, particularly in young men. The transfusion policy will improve if predonation interviews of such young men are done with a specific and sensitive questionnaire.
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Affiliation(s)
- M H Elghouzzi
- Etablissement de Transfusion Sanguine de l'Ouest Francilien, Rungis, France
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50
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Bellentani S, Miglioli L, Masutti F, Saccoccio G, Tiribelli C. Epidemiology of hepatitis C virus infection in Italy: the slowly unraveling mystery. Microbes Infect 2000; 2:1757-63. [PMID: 11137048 DOI: 10.1016/s1286-4579(00)01332-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
In spite of the large diffusion of hepatitis C virus (HCV) infection and its high association with liver disease, the epidemiology of HCV in Italy is still unclear. This review collects all the data available on the prevalence and incidence of HCV infection in Italy and compares them with those reported in other countries.
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Affiliation(s)
- S Bellentani
- Fondo per lo Studio delle Malattie del Fegato- Sezione di Modena - Via R.Wagner, 12 - 41100, Modena, Italy.
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