Epidemiological characteristics and medical follow-up of 61 patients with acute hepatitis C identified through the hepatitis C surveillance system in France

Characteristics of Adults With Hepatitis C Virus: Evidence From the National Health and Nutrition Examination Survey 2011-2012

Hepatitis C virus (HCV) infects more than 3 million people in the United States (U.S.). Long-term complications of hepatitis C infection result in increased liver disease and financial burden for the nation. The purpose of this study was to identify characteristics of adults with HCV in the U.S. This secondary, descriptive study analyzed data from the 2011-2012 National Health and Nutrition Examination Survey. The weighted sample included 2,075,749 adults diagnosed with HCV. Descriptive statistics were calculated. The findings revealed that most adults in the U.S. with HCV were insured non-Hispanic, white males, aged 45 to 64 years. Almost half of adults with HCV denied a liver condition. Several participants either were co-infected or had previous infection (82%) with other hepatitis. Substance use (53.5%), alcohol use (96%), and cigarette use (88.6%) among adults with HCV were higher than previously reported. A majority of adults were noncompliant with hepatitis A and B vaccination series completion (67% and 65.1%, respectively). Medication adherence was higher than other reported cases. Adults with HCV have increased mental health symptoms (67.1%) and do not routinely visit a mental health professional (90.2%). HCV-infected adults are likely to use alcohol, cigarettes, and/or other substances. Adults with HCV have significant mental health issues, but rarely access care. Medication adherence was higher than expected for this cohort. The findings provide information for nurses to develop individualized plans of care and identify at-risk individuals for treatment noncompliance.

Current knowledge and future perspectives on acute hepatitis C infection

Acute hepatitis C virus (HCV) infections are frequently seen worldwide in certain risk groups, with an annual incidence rate varying between 0.08% and 66%. Although this incidence is substantial, a delayed diagnosis during chronic infection is most often made in the absence of clinical symptoms in the acute phase of the infection. Currently used methods to diagnose acute HCV infection are IgG antibody seroconversion and repeated HCV RNA measurements, although no definitive diagnostic test is currently available. Progress in the field of adaptive and innate immune responses has aided both advances in the field of HCV vaccine development and a more basic understanding of viral persistence. The rapid changes in the treatment of chronic HCV infection will affect therapeutic regimens for acute HCV infection in the coming years, leading to shorter treatment courses and pegylated interferon-free modalities. This review gives an overview of the current knowledge and uncertainties, together with some future perspectives on acute hepatitis C epidemiology, virology, immunology, and treatment.

How did chronic hepatitis C impact costs related to hospital health care in France in 2009?

AIMS

To evaluate the health care burden of chronic hepatitis C (CHC) in French hospitals.

METHODS

All hospital stays with CHC ICD-10 code were extracted from the 2009 French hospital discharge database and classified in five groups: non-complicated CHC, liver cirrhosis (CIR), hepatocarcinoma (HCC), liver transplantation (LT) and unclassified. Hospital costs were calculated according to the French official prices and expressed in 2010 euro. The economic analysis was carried out from the Social Security point of view.

RESULTS

Twenty-seven thousand two hundred and fifty-eight of the 68,683 hospital stays with CHC ICD-10 code corresponding to 15,482 patients were considered as directly related to HCV: 52% for non-complicated CHC, 33% for CIR, 11% for HCC, 2% for LT and 2% unclassified. The total cost of hospital stays for CHC and its complications was estimated at 65,956,938 €. Almost half (47%) of total costs were attributable to CIR while HCC and LT contributed to 18% and 19%, respectively.

CONCLUSION

This first analysis of the French hospital discharge database focused on CHC brings new and essential information. It shows that 84% of HCV-related hospital costs are attributable to advanced liver diseases. Together with more efficient therapies, enhancing screening and access to treatment policies could substantially relieve the hospital burden of CHC.

Case definitions for acute hepatitis C virus infection: a systematic review

BACKGROUND & AIMS

Case definitions for recent hepatitis C virus (HCV) infection vary considerably between studies. The aim of this systematic review was to characterize case definitions for recent HCV and explore the heterogeneity in studies performed to date.

METHODS

A systematic literature search of MEDLINE, SCOPUS, and ISI Web of Knowledge was performed covering all studies of recent HCV infection cited between January 2000 and June 2011. The criteria used by each study to define cases of recent HCV infection were extracted, structured, and analyzed.

RESULTS

Overall, 195 articles were included, with 87% (n=169) providing a clear case definition for recent HCV infection. The most frequently used individual criteria for defining a case included HCV antibody seroconversion (77%), alanine aminotransferase (ALT) elevation (68%), and HCV RNA detection (63%). In studies using HCV antibody seroconversion, the window period between the last negative and the first positive antibody test varied widely across studies (4 weeks to 4 years). Considerable diversity was also observed with respect to the ALT threshold used to characterize ALT elevations, ranging from 2 to 20 times the upper limit of normal. HCV antibody seroconversion was used as a single criterion in 41% of the studies, while all other studies used at least two criteria (range: 2-9). Epidemiology/surveillance studies mostly used a more sensitive case definition, whereas treatment studies, natural history studies, and diagnosis studies used more specific case definitions.

CONCLUSIONS

Marked heterogeneity in case definitions for recent HCV infection was observed. Although a single case definition for recent HCV is not warranted, a degree of standardization within specific study categories would enable improved cross-study comparison and more uniform evaluation of HCV prevention and management strategies.

[Current status of acute hepatitis C]

Acute hepatitis C (AHC) is an increasing health issue. Despite the decline of blood-to-blood transmission of hepatitis C virus (HCV) through donor screening programs and a decline in intravenous drug use, the incidence of sexual transmission has now increased, particularly in HIV-infected homosexual patients. The presentation is almost always asymptomatic, which complicates diagnosis. Spontaneous clearance of the virus occurs in 25% of cases and usually, within the first three months after onset of symptoms and in symptomatic patients. If serum HCV-RNA remains detectable after this period, antiviral treatment should be started without delay, since sustained viral response rate in the acute phase is higher than that achieved with chronic liver disease. The optimal treatment regimen (interferon alone or combined with ribavirin) and its duration are not clearly established at the present time.

Acute hepatitis C: analysis of a 126-case prospective, multicenter cohort

OBJECTIVES

To analyze the data (epidemiology, mode of transmission, course, and outcome) of a large series of patients with acute hepatitis C (AHC) in France.

METHODS

Prospective multicenter register, observational study.

RESULTS

A cohort of 126 patients with AHC was prospectively enrolled between 1999 and 2007. Fifteen (12%) were HIV coinfected. Suspected modes of hepatitis C virus transmission were drug use (38%), sexual contact (21%), nosocomial transmission (18%), and occupational exposure (12%). For 40% of the patients, AHC was revealed by jaundice. Spontaneous viral clearance occurred in 40% of the 72 patients observed for 3 months without treatment. Only jaundice and nosocomial/occupational transmission were predictive of spontaneous viral clearance. Ninety patients were treated with standard or pegylated interferon-alpha alone (58%) or in combination with ribavirin (42%), for 24 weeks or less in 90%. In intention-to-treat, a sustained viral response was obtained in 58 of 78 (74%) hepatitis C virus monoinfected patients [19 of 22 (86%) with 24 weeks of pegylated interferon-alpha alone], but only six of 12 (50%) of HIV coinfected patients.

CONCLUSION

AHC remains rare, and drug and sexual transmission are predominant. A 3-month follow-up after diagnosis avoids treatment for four out of 10 patients. Antiviral treatment is highly effective, 24 weeks of pegylated interferon-alpha alone being a good option.

Treatment of acute hepatitis C: the success of monotherapy with (pegylated) interferon alpha

Early control in the acute phase of hepatitis C infection is an attractive therapeutic goal in order to shorten disease duration and infectivity, to prevent chronicity and progression to advanced liver disease and to avoid eventual therapeutic non-response in the later stages of chronic hepatitis C. Over the past decade, different interferon-based treatment options have been developed, which lead to sustained virological response rates of up to 98%. The present article summarizes the successful invention of immediate and delayed strategies in acute hepatitis C monoinfection, critically discusses potential limitations and illustrates the therapeutic challenges of the near future.