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Mbaga DS, Kenmoe S, Njiki Bikoï J, Takuissu GR, Amougou-Atsama M, Atenguena Okobalemba E, Ebogo-Belobo JT, Bowo-Ngandji A, Oyono MG, Magoudjou-Pekam JN, Kame-Ngasse GI, Nka AD, Feudjio AF, Zemnou-Tepap C, Adamou Velhima E, Ndzie Ondigui JL, Nayang-Mundo RA, Touangnou-Chamda SA, Kamtchueng Takeu Y, Taya-Fokou JB, Mbongue Mikangue CA, Kenfack-Momo R, Kengne-Ndé C, Sake CS, Esemu SN, Njouom R, Ndip L, Riwom Essama SH. Global prevalence of occult hepatitis C virus: A systematic review and meta-analysis. World J Methodol 2022; 12:179-190. [PMID: 35721241 PMCID: PMC9157636 DOI: 10.5662/wjm.v12.i3.179] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/03/2022] [Accepted: 04/30/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Occult hepatitis C infection (OCI) is characterized by the presence of hepatitis C virus (HCV) RNA in the liver, peripheral blood mononuclear cells (PBMC) and/or ultracentrifuged serum in the absence of detectable HCV-RNA in serum. OCI has been described in several categories of populations including hemodialysis patients, patients with a sustained virological response, immunocompromised individuals, patients with abnormal hepatic function, and apparently healthy subjects.
AIM To highlight the global prevalence of OCI.
METHODS We performed a systematic and comprehensive literature search in the following 4 electronic databases PubMed, EMBASE, Global Index Medicus, and Web of Science up to 6th May 2021 to retrieve relevant studies published in the field. Included studies were unrestricted population categories with known RNA status in serum, PBMC, liver tissue and/or ultracentrifuged serum. Data were extracted independently by each author and the Hoy et al tool was used to assess the quality of the included studies. We used the random-effect meta-analysis model to estimate the proportions of OCI and their 95% confidence intervals (95%CI). The Cochran's Q-test and the I2 test statistics were used to assess heterogeneity between studies. Funnel plot and Egger test were used to examine publication bias. R software version 4.1.0 was used for all analyses.
RESULTS The electronic search resulted in 3950 articles. We obtained 102 prevalence data from 85 included studies. The pooled prevalence of seronegative OCI was estimated to be 9.61% (95%CI: 6.84-12.73) with substantial heterogeneity [I² = 94.7% (95%CI: 93.8%-95.4%), P < 0.0001]. Seropositive OCI prevalence was estimated to be 13.39% (95%CI: 7.85-19.99) with substantial heterogeneity [I2 = 93.0% (90.8%-94.7%)]. Higher seronegative OCI prevalence was found in Southern Europe and Northern Africa, and in patients with abnormal liver function, hematological disorders, and kidney diseases. Higher seropositive OCI prevalence was found in Southern Europe, Northern America, and Northern Africa.
CONCLUSION In conclusion, in the present study, it appears that the burden of OCI is high and variable across the different regions and population categories. Further studies on OCI are needed to assess the transmissibility, clinical significance, long-term outcome, and need for treatment.
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Affiliation(s)
- Donatien Serge Mbaga
- Department of Microbiology, The University of Yaounde I, Yaounde 00237, Cameroon
| | - Sebastien Kenmoe
- Department of Microbiology and Parasitology, University of Buea, Buea 00237, Cameroon
- Department of Virology, Centre Pasteur of Cameroon, Yaounde 00237, Cameroon
| | - Jacky Njiki Bikoï
- Department of Microbiology, The University of Yaounde I, Yaounde 00237, Cameroon
| | - Guy Roussel Takuissu
- Centre of Research in Food, Food Security and Nutrition, Institute of Medical Research and Medicinal Plants Studies, Yaounde 00237, Cameroon
| | - Marie Amougou-Atsama
- Centre de Recherche sur les Maladies Emergentes et Re-Emergentes, Institute of Medical Research and Medicinal Plants Studies, Yaounde 00237, Cameroon
| | | | - Jean Thierry Ebogo-Belobo
- Medical Research Centre, Institute of Medical Research and Medicinal Plants Studies, Yaounde 00237, Cameroon
| | - Arnol Bowo-Ngandji
- Department of Microbiology, The University of Yaounde I, Yaounde 00237, Cameroon
| | - Martin Gael Oyono
- Laboratory of Parasitology and Ecology, The University of Yaounde I, Yaounde 00237, Cameroon
| | | | - Ginette Irma Kame-Ngasse
- Medical Research Centre, Institute of Medical Research and Medicinal Plants Studies, Yaounde 00237, Cameroon
| | - Alex Durand Nka
- Virology Laboratory, Chantal Biya International Reference Center for Research on HIV/AIDS Prevention and Management, Yaounde 00237, Cameroon
| | | | - Cromwel Zemnou-Tepap
- Department of Biochemistry, The University of Yaounde I, Yaounde 00237, Cameroon
| | - Elie Adamou Velhima
- Medical Research Centre, Institute of Medical Research and Medicinal Plants Studies, Yaounde 00237, Cameroon
| | | | | | | | - Yrene Kamtchueng Takeu
- Medical Research Centre, Institute of Medical Research and Medicinal Plants Studies, Yaounde 00237, Cameroon
| | | | | | - Raoul Kenfack-Momo
- Department of Biochemistry, The University of Yaounde I, Yaounde 00237, Cameroon
| | - Cyprien Kengne-Ndé
- Epidemiological Surveillance, Evaluation and Research Unit, National Aids Control Committee, Douala 00237, Cameroon
| | | | - Seraphine Nkie Esemu
- Department of Microbiology and Parasitology, University of Buea, Buea 00237, Cameroon
| | - Richard Njouom
- Department of Virology, Centre Pasteur of Cameroon, Yaounde 00237, Cameroon
| | - Lucy Ndip
- Department of Microbiology and Parasitology, University of Buea, Buea 00237, Cameroon
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Hedayati-Moghaddam MR, Soltanian H, Ahmadi-Ghezeldasht S. Occult hepatitis C virus infection in the Middle East and Eastern Mediterranean countries: A systematic review and meta-analysis. World J Hepatol 2021; 13:242-260. [PMID: 33708353 PMCID: PMC7934012 DOI: 10.4254/wjh.v13.i2.242] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/25/2020] [Accepted: 12/08/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The presence of hepatitis C virus (HCV) RNA in liver tissue or peripheral blood mononuclear cells with no identified virus genome in the serum has been reported worldwide among patients with either normal or elevated serum liver enzymes. The characterization of occult HCV infection (OCI) epidemiology in the Middle East and Eastern Mediterranean (M and E) countries, a region with the highest incidence and prevalence rates of HCV infection in the world, would be effective for more appropriate control of the infection.
AIM To estimate the pooled prevalence of OCI in M and E countries using a systematic review and meta-analysis.
METHODS A systematic literature search was performed using international, regional and local electronic databases. Some conference proceedings and references from bibliographies were also reviewed manually. The search was carried out during May and June 2020. Original observational surveys were considered if they assessed the prevalence of OCI among the population of M and E countries by examination of HCV nucleic acid in peripheral blood mononuclear cells in at least 30 cases selected by random or non-random sampling methods. The meta-analysis was performed using Comprehensive Meta-analysis software based on heterogeneity assessed by Cochran’s Q test and I-square statistics. Data were considered statistically significant at a P value < 0.05.
RESULTS A total of 116 non-duplicated citations were found in electronic sources and grey literature. A total of 51 non-overlapping original surveys were appraised, of which 37 met the inclusion criteria and were included in the analysis. Data were available from 5 of 26 countries including Egypt, Iran, Pakistan, Saudi Arabia, and Turkey. The overall prevalence rate of OCI was estimated at 10.04% (95%CI: 7.66%-13.05%). The lowest OCI rate was observed among healthy subjects (4.79%, 95%CI: 2.86%-7.93%). The higher rates were estimated for patients suffering from chronic liver diseases (12.04%, 95%CI: 5.87%-23.10%), and multi-transfused patients (8.71%, 95%CI: 6.05%-12.39%). Subgroup analysis indicated that the OCI rates were probably not associated with the studied subpopulations, country, year of study, the detection method of HCV RNA, sample size, patients’ HCV serostatus, and sex (all P > 0.05). Meta-regression analyses showed no significant time trends in OCI rates among different groups.
CONCLUSION This review estimated high rates of OCI prevalence in M and E countries, especially among multi-transfused patients as well as patients with chronic liver diseases.
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Affiliation(s)
- Mohammad Reza Hedayati-Moghaddam
- Blood Borne Infections Research Center, Academic Center for Education, Culture and Research (ACECR), Razavi Khorasan Branch, Mashhad 91779-49367, Iran
| | - Hossein Soltanian
- Blood Borne Infections Research Center, Academic Center for Education, Culture and Research (ACECR), Razavi Khorasan Branch, Mashhad 91779-49367, Iran
| | - Sanaz Ahmadi-Ghezeldasht
- Blood Borne Infections Research Center, Academic Center for Education, Culture and Research (ACECR), Razavi Khorasan Branch, Mashhad 91779-49367, Iran
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Timofte D, Dragos D, Balcangiu-Stroescu AE, Tanasescu MD, Gabriela Balan D, Avino A, Tulin A, Stiru O, Ionescu D. Infection with hepatitis C virus in hemodialysis patients: An overview of the diagnosis and prevention rules within a hemodialysis center (Review). Exp Ther Med 2020; 20:109-116. [PMID: 32509002 PMCID: PMC7271692 DOI: 10.3892/etm.2020.8606] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 03/03/2020] [Indexed: 12/20/2022] Open
Abstract
Increase in the number of patients with chronic kidney disease (CKD) calls for improved management of these patients. In stage 5 CKD, when the initiation of renal replacement therapy (RRT) becomes necessary, there is an increase in the infection risk of the patients and immunological tests for hepatitis C virus (HCV) detection turn positive at an alarmingly higher rate compared to general population. With the introduction into clinical practice of diagnostic tests, the increased prevalence of HCV among CKD patients has been known since the 1990s. Also, the negative impacts of HCV infection on CKD evolution as well as the unfavorable evolution of grafts received by HCV infected patients are known. Chronic hemodialysis patients are a category of patients whose risk of HCV infection is substantial. Currently, in the hemodialysis centers, at the base of the transmission of HCV infection there are a multitude of factors. Infection with HCV has a different impact on patient with end-stage renal disease (ESRD). Comorbidities in this case have significant sources of mortality and morbidity. It was proven that the post transplantations problems were prevented and mortality was reduced for patients who were diagnosed with HCV and in whom the infection was treated before the kidney transplant (KT). Consequently, early detection of the infection and the application of specific treatment has a considerable impact on the outcome of the patients. Another important component of the management of HCV infection in the chronic hemodialysis patients is the prevention of the infection transmission by applying specific methods.
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Affiliation(s)
- Delia Timofte
- Department of Dialysis, Emergency University Hospital, 050098 Bucharest, Romania
| | - Dorin Dragos
- Discipline of Internal Medicine I and Nephrology, Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Nephrology, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
| | - Andra-Elena Balcangiu-Stroescu
- Department of Dialysis, Emergency University Hospital, 050098 Bucharest, Romania.,Discipline of Physiology, Faculty of Dental Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Maria-Daniela Tanasescu
- Discipline of Internal Medicine I and Nephrology, Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Nephrology, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
| | - Daniela Gabriela Balan
- Discipline of Physiology, Faculty of Dental Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Adelaida Avino
- Department of Plastic and Reconstructive Surgery, Clinical Emergency Hospital 'Prof. Dr. Agrippa Ionescu', 011356 Bucharest, Romania
| | - Adrian Tulin
- Department of General Surgery, Clinical Emergency Hospital 'Prof. Dr. Agrippa Ionescu', 011356 Bucharest, Romania.,Anatomy and Cardiovascular Surgery, Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Ovidiu Stiru
- Department of Cardiovascular Surgery, Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Cardiovascular Surgery, 'Prof. Dr. C.C. Iliescu' Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania
| | - Dorin Ionescu
- Discipline of Internal Medicine I and Nephrology, Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Nephrology, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
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KDIGO 2018 Clinical Practice Guideline for the Prevention, Diagnosis, Evaluation, and Treatment of Hepatitis C in Chronic Kidney Disease. Kidney Int Suppl (2011) 2018; 8:91-165. [PMID: 30675443 PMCID: PMC6336217 DOI: 10.1016/j.kisu.2018.06.001] [Citation(s) in RCA: 114] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Lin MS, Chen TH, Lin WY, Liu CH, Hsieh YY, Chiu WN, Chang CH, Chen MY, Chung CM, Lin YS. Add-on neurological benefits of antiviral therapy in HCV patients with chronic kidney disease - a nationwide cohort study. BMC Gastroenterol 2017; 17:99. [PMID: 28814273 PMCID: PMC5559858 DOI: 10.1186/s12876-017-0653-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 07/31/2017] [Indexed: 12/18/2022] Open
Abstract
Background Hepatitis C virus (HCV)-infected patients with chronic kidney disease (CKD) have rarely been studied because they rarely accept interferon-based therapy (IBT) and have been difficult to follow up. We investigated long-term outcomes of IBT on the population. Methods This population-based cohort study used the Taiwan National Health Insurance Research Database as its data source. HCV patients diagnosed with CKD between Jan. 1, 2003, and Dec. 31, 2013, were selected. They were then divided into two groups based on whether they had undergone IBT. All-cause mortality, acute myocardial infarction (AMI), ischemic stroke (IS), hemorrhagic stroke, and new-onset dialysis were evaluated using a Cox proportional hazard regression analysis after propensity score matching. Results We enrolled 9872 HCV patients with CKD: 1684 patients in the treated cohort and 8188 patients in the untreated cohort. The annual incidence of all-cause mortality (19.00 vs. 42.89 events per 1000 person-years; p < 0.001) and the incidences of hemorrhagic stroke (1.21 vs. 4.19 events per 1000 person-years; p = 0.006) were lower in the treated cohort. New-onset dialysis was also lower in the treated cohort (aHR: 0.31; 95% CI: 0.20–0.48; p < 0.001). Conclusion Antiviral therapy might provide protective benefits on all-cause mortality, hemorrhagic stroke, and new-onset dialysis in HCV-infected patients with CKD. Electronic supplementary material The online version of this article (doi:10.1186/s12876-017-0653-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ming-Shyan Lin
- Department of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Yunlin, Taiwan
| | - Tien-Hsing Chen
- Department of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Keelung, Taiwan
| | - Wey-Yil Lin
- Stroke Center and Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chi-Hung Liu
- Stroke Center and Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yung-Yu Hsieh
- Department of Hepato-Gastroenterology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Wen-Nan Chiu
- Department of Hepato-Gastroenterology, Chang Gung Memorial Hospital, Yunlin, Taiwan
| | - Chih-Hsiang Chang
- Department of Nephrology, Kidney research center, Chang Gung Memorial Hospital, Chang Gung University, College of medicine, Taoyuan, Taiwan
| | - Mei-Yen Chen
- College of Nursing, Chang Gung University of Science and Technology (CGUST), Taoyuan, Taiwan.,Department of Nursing, Chang Gung University, Taoyuan, Taiwan
| | - Chang-Min Chung
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan County, Taiwan. .,Department of Cardiology, Chiayi Chang Gung Memorial Hospital, 6, Sec. West Chai-Pu Road, Pu-TZ City, Chai Yi Hsien, 61363, Taiwan.
| | - Yu-Sheng Lin
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan County, Taiwan. .,Department of Cardiology, Chiayi Chang Gung Memorial Hospital, 6, Sec. West Chai-Pu Road, Pu-TZ City, Chai Yi Hsien, 61363, Taiwan.
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Kargar Kheirabad A, Bahri F, Kargar M, Ghasemzadeh I. Hepatitis C and G Virus Infection Prevalence Among Hemodialysis Patients and Associated Risk Factors in the Hormozgan Province of Southern Iran. HEPATITIS MONTHLY 2016; 16:e40375. [PMID: 27882069 PMCID: PMC5111419 DOI: 10.5812/hepatmon.40375] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Revised: 07/27/2016] [Accepted: 08/03/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Infection with blood-borne viruses including hepatitis C (HCV) and hepatitis G (HGV) viruses is a substantial health problem. Varying prevalences of these infections in different studies reflect the role of predisposing risk factors in different countries or even different regions of a country. OBJECTIVES The objective of the present survey was to assess the prevalences of HCV and HGV virus infections among hemodialysis (HD) patients in Bandar Abbas, Hormozgan, Iran, 2015. METHODS A total of 149 subjects with chronic renal failure undergoing HD at Shahid Mohammadi hospital in the Hormozgan province of southern Iran from January 1, 2015 to March 31, 2015 were evaluated for anti-HCV and antibodies against HGV E2 glycoprotein by census sampling method. Thereafter, all of the specimens were evaluated for molecular assays using polymerase chain reaction (PCR) and other techniques. Investigated data were recorded for each participant in a pre-designed data collection sheet. All statistical analyses were conducted using the Statistical Package for the Social Sciences (SPSS) version 19 for Windows by t-test and chi-square test (χ2). RESULTS The mean age of patients was 56.23 ± 12.35 years (minimum age 18, maximum age 85). Both kinds of assays determined that five (3.36%) patients were HCV positive, whereas no HGV positives were diagnosed. The prevalence of HCV is associated with longer duration of HD (P value = 0.008), history of blood transfusion (P value = 0.037) and drug addiction (P value = 0.035). CONCLUSIONS History of drug addiction and/or blood transfusion and longer duration of HD treatment were the main risk factors determining the prevalence of HCV infection in the Hormozgan province of southern Iran in 2015. However, the values observed in the present investigation reflect the effective management techniques imposed by healthcare authorities and relevant organizations in recent years.
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Affiliation(s)
- Ali Kargar Kheirabad
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Fahime Bahri
- Department of Microbiology, Islamic Azad University, Jahrom Branch, Jahrom, IR Iran
| | - Mohammad Kargar
- Department of Microbiology, Islamic Azad University, Jahrom Branch, Jahrom, IR Iran
| | - Iman Ghasemzadeh
- Infectious and Tropical Disease Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, IR Iran
- Corresponding Author: Iman Ghasemzadeh, Infectious and Tropical Disease Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, IR Iran. Tel: +98-9122900572, E-mail:
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Hasanjani Roushan MR, Farokhtabar S, Bayani M, Siadati S. Epidemiological Aspects of Hepatitis B and C and Human Immunodeficiency Viruses Among Hemodialysis Patients in Mazandaran Province, Iran. Nephrourol Mon 2016; 8:e37878. [PMID: 27570757 PMCID: PMC4983454 DOI: 10.5812/numonthly.37878] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 04/08/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Hemodialysis patients are potentially susceptible to infection with blood-borne viral agents, especially hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV). OBJECTIVES The aim of this study was to evaluate the prevalence and incidence of HBV, HCV, and HIV infections in hemodialysis patients. PATIENTS AND METHODS This study was carried out in 482 hemodialysis patients who had been referred to eight dialysis centers in the Mazandaran province in Iran from 2012 - 2014. HBs Ag, HCV Ab, HBs Ab and HIV Ab were assessed every three months for two years. The patients' demographic characteristics, including age, gender, area of residence, and duration of dialysis, were noted. The prevalence of each virus was also determined. RESULTS From a total of 482 patients, 253 (52.5%) males and 229 (47.5%) females were evaluated. The mean age of all patients was 54.96 ± 16.1 years, and all participants were HIV negative. One subject had both HBV and HCV infections. HBs Ag and anti-HCV were detected in 10 (2.1%) and 40 (8.27%) patients, respectively. The mean age of HCV-positive patients was 55.4 ± 16.4, while HCV-negative patients were an average of 51.6 ± 10.7 years old (P = 0.002). The incidence of HCV was higher in people from 40-59 years of age (P < 0.001). No patients had HBV, and incidence of HCV was 0.5% in the first year and 0.75 in the second year. No cases of HIV were identified. CONCLUSIONS The results show that the prevalence rates of HBV and HCV in hemodialysis patients were moderate to low in the Mazandaran province. Based upon the obtained levels of these viruses, these incidence rates are therefore reasonable.
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Affiliation(s)
| | | | - Masomeh Bayani
- Infectious Diseases and Tropical Medicine Research Center, Babol University of Medical Sciences, Babol, IR Iran
- Corresponding author: Masomeh Bayani, Infectious Diseases and Tropical Medicine Research Center, Babol University of Medical Sciences, Babol, IR Iran, E-mail:
| | - Sepideh Siadati
- Department of Pathology, Shahid Beheshti Hospital, Babol University of Medical Sciences, Babol, IR Iran
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Ha S, Totten S, Pogany L, Wu J, Gale-Rowe M. Hepatitis C in Canada and the importance of risk-based screening. CANADA COMMUNICABLE DISEASE REPORT = RELEVE DES MALADIES TRANSMISSIBLES AU CANADA 2016; 42:57-62. [PMID: 29770005 PMCID: PMC5864411 DOI: 10.14745/ccdr.v42i03a02] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Chronic hepatitis C (CHC) remains a public health issue affecting an estimated 220,000 individuals in Canada. In 2011, approximately 44% of those with CHC were unaware of their infection. Hepatitis C is infectious in origin, and if left untreated, can lead to significant morbidity and mortality in its chronic form, including liver cirrhosis, hepatocellular carcinoma and liver failure. These health outcomes are associated with comorbidities, adding a burden to the Canadian health care system. Recent advancements in the treatment of hepatitis C have changed the clinical landscape. In Canada, the prevalence of incident cases is higher in specific population groups. Injection drug use (IDU) currently accounts for the highest proportion of new hepatitis C virus (HCV) infection. It is unclear to what extent HCV infection through health care or personal services use contributed to current prevalent cases of CHC. The Canadian Task Force on Preventive Health Care (CTFPHC) is currently reviewing the evidence for different approaches to HCV screening and the benefits and harms of screening. Risk-based screening remains critical to detecting hepatitis C as knowing one's status has been linked to the cascade of care and improved population health outcomes. This article intends to highlight risk factors associated with the acquisition of HCV so that health care providers can screen, where appropriate, and detect CHC.
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Affiliation(s)
- S Ha
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON
| | - S Totten
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON
| | - L Pogany
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON
| | - J Wu
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON
| | - M Gale-Rowe
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON
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Kao HH, Chen KS, Lin CL, Chang JJ, Lee CH. Utilization of Signal-to-Cutoff Ratio of Hepatitis C Virus Antibody Assay in Predicting HCV Viremia among Hemodialysis Patients. Nephron Clin Pract 2015; 130:127-33. [PMID: 26065912 DOI: 10.1159/000430988] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 04/28/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) infection is a common cause of acute and chronic hepatitis among the hemodialysis population. To prevent cross infection between hemodialysis patients during the hemodialysis procedure, routine screening of anti-HCV antibody is recommended. However, a reactive anti-HCV EIA test is not equal to active HCV infection. An expensive RT-PCR study is required to confirm HCV viremia. This will significantly increase the cost burden because payment for each hemodialysis treatment is very low in Taiwan. Thus, it is useful to identify parameters that could predict HCV viremia among anti-HCV-reactive patients. In this study, we examined the usefulness of signal-to-cut (S/CO) ratio of anti-HCV antibody in discriminating HCV viremia from non-viremia among the anti-HCV-reactive hemodialysis population. MATERIALS AND METHODS In a cross-sectional measurement of anti-HCV antibody among 369 chronic hemodialysis patients, 44 showed reactive and 9 grey zone reaction for anti-HCV. These 53 patients underwent further blood tests for the measurement of AST, ALT and HCV RNA (by RT-PCR). The results of RT-PCR were used as a dependent variable. Then, S/CO ratios of anti-HCV, serum AST, ALT levels, age and duration of hemodialysis were used as independent variables to undergo ROC curve and logistic regression analysis. RESULTS Thirty-six of the 53 reactive and grey zone patients were positive for HCV RNA in the RT-PCR study. Patients who were positive for HCV RNA had a higher S/CO ratio (p < 0.01), higher AST and ALT levels (p < 0.01), and longer duration on hemodialysis (p < 0.05) than those negative for HCV RNA. Logistic regression revealed that only S/CO ratio was a significant predictor for HCV viremia (p = 0.004). ROC curve analysis showed that S/CO ratio had a highest area under curve (0.967, p < 0.001), followed by ALT (0.826, p < 0.001), AST (0.778, p = 0.001), duration on hemodialysis (0.606, p = 0.215) and age (0.426, p = 0.386) in discriminating HCV viremia from non-viremia. Using a cutoff S/CO ratio of 65, we can confirm HCV viremia with a diagnostic specificity of 100%, sensitivity of 80.1% and positive predictive value of 100%. CONCLUSION S/CO ratio is a useful indicator in predicting HCV viremia among anti-HCV-reactive hemodialysis patients. Patients with an S/CO ratio >65 can be regarded as those with active HCV infection. Alternatively, patients with reactive anti-HCV but with an S/CO ratio <65 should receive further RT-PCR test.
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Affiliation(s)
- Hao-Hsi Kao
- Division of Nephrology, Chang Gung Memorial Hospital, Keelung, Taiwan, ROC
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Li N, Zheng D, Xue J, Guo W, Shi J, Sun J, Lu C, Zheng W, Wu M, Cheng S. Cidan inhibits liver cancer cell growth by reducing COX-2 and VEGF expression and cell cycle arrest. Exp Ther Med 2015; 9:1709-1718. [PMID: 26136881 DOI: 10.3892/etm.2015.2351] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 06/04/2014] [Indexed: 12/12/2022] Open
Abstract
Cidan is a traditional Chinese medicine formula that has been used for >10 years as an antitumor drug. In the present study, the antitumor effect of cidan on hepatocellular carcinoma (HCC) and the underlying molecular mechanisms were investigated. A total of 372 patients with primary HCC, as confirmed by pathological examination in the Eastern Hepatobiliary Surgery Hospital and Beijing Oncology Hospital of Weida TCM, were prospectively enrolled in the study. In total, 92 patients were treated with cidan capsules for three months postoperatively, while 280 patients served as controls. The efficacy of cidan was analyzed by monitoring associated symptoms and liver function tests, including measuring the levels of α-1-fetoprotein, α-L-fucosidase, alkaline phosphatase, alanine aminotransferase, aspartate aminotransferase and γ-glutamyl transferase. In addition, in vivo analysis was performed using mice Hepa1-6 xenograft models, while in vitro studies were performed with SMMC-7721 and CSQT-1 cells; this included cidan-dependent cell viability and migration assays, cell cycle analyses and the evaluation of cidan effects on cyclooxygenase-2 (COX-2) and vascular endothelial growth factor (VEGF) mRNA transcription rates using quantitative polymerase chain reaction. The postoperative two-year overall survival (77 and 58% for the cidan and control groups, respectively; P<0.01) and disease-free survival (36 and 24% for the cidan and control groups, respectively; P<0.01) rates were superior in the cidan-treated group when compared with the control. In addition, the size and weight of the tumor xenografts in the C57BL/6 mice were significantly reduced in a time- and dose-dependent manner following cidan treatment (P<0.01). Cidan significantly reduced the cell viability of SMMC-7721 and CSQT-1 cells after four and five days when compared with the control (P<0.01). Furthermore, COX-2 and VEGF mRNA expression levels decreased following cidan treatment (P<0.01), and cidan treatment resulted in enhanced G1 and G2/M cell cycle arrest of CSQT-1 cells. Therefore, cidan effectively inhibited cell proliferation, reduced cell viability and downregulated COX-2 and VEGF expression levels in hepatoma cells.
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Affiliation(s)
- Nan Li
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, P.R. China
| | - Donghai Zheng
- Beijing Oncology Hospital Of Weida TCM, Beijing 100023, P.R. China
| | - Jie Xue
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, P.R. China
| | - Weixing Guo
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, P.R. China
| | - Jie Shi
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, P.R. China
| | - Juxian Sun
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, P.R. China
| | - Chongde Lu
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, P.R. China
| | - Weida Zheng
- Beijing Oncology Hospital Of Weida TCM, Beijing 100023, P.R. China
| | - Mengchao Wu
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, P.R. China
| | - Shuqun Cheng
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, P.R. China
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Carvalho-Filho RJ, Feldner ACCA, Silva AEB, Ferraz MLG. Management of hepatitis C in patients with chronic kidney disease. World J Gastroenterol 2015; 21:408-422. [PMID: 25593456 PMCID: PMC4292272 DOI: 10.3748/wjg.v21.i2.408] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 09/07/2014] [Accepted: 12/08/2014] [Indexed: 02/06/2023] Open
Abstract
Hepatitis C virus (HCV) infection is highly prevalent among chronic kidney disease (CKD) subjects under hemodialysis and in kidney transplantation (KT) recipients, being an important cause of morbidity and mortality in these patients. The vast majority of HCV chronic infections in the hemodialysis setting are currently attributable to nosocomial transmission. Acute and chronic hepatitis C exhibits distinct clinical and laboratorial features, which can impact on management and treatment decisions. In hemodialysis subjects, acute infections are usually asymptomatic and anicteric; since spontaneous viral clearance is very uncommon in this context, acute infections should be treated as soon as possible. In KT recipients, the occurrence of acute hepatitis C can have a more severe course, with a rapid progression of liver fibrosis. In these patients, it is recommended to use pegylated interferon (PEG-IFN) in combination with ribavirin, with doses adjusted according to estimated glomerular filtration rate. There is no evidence suggesting that chronic hepatitis C exhibits a more aggressive course in CKD subjects under conservative management. In these subjects, indication of treatment with PEG-IFN plus ribavirin relies on the CKD stage, rate of progression of renal dysfunction and the possibility of a preemptive transplant. HCV infection has been associated with both liver disease-related deaths and cardiovascular mortality in hemodialysis patients. Among those individuals, low HCV viral loads and the phenomenon of intermittent HCV viremia are often observed, and sequential HCV RNA monitoring is needed. Despite the poor tolerability and suboptimal efficacy of antiviral therapy in CKD patients, many patients can achieve sustained virological response, which improve patient and graft outcomes. Hepatitis C eradication before KT theoretically improves survival and reduces the occurrence of chronic graft nephropathy, de novo glomerulonephritis and post-transplant diabetes mellitus.
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12
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Marco A, Gallego C, Caylà JA. Incidence of hepatitis C infection among prisoners by routine laboratory values during a 20-year period. PLoS One 2014; 9:e90560. [PMID: 24587394 PMCID: PMC3938777 DOI: 10.1371/journal.pone.0090560] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 02/03/2014] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND To estimate the incidence of Hepatitis C virus (HCV) and the predictive factors through repeated routine laboratory analyses. METHODS An observational cohort study was carried out in Quatre Camins Prison, Barcelona. The study included subjects with an initial negative HCV result and routine laboratory analyses containing HCV serology from 1992 to 2011. The incidence of infection was calculated for the study population and for sub-groups by 100 person-years of follow-up (100 py). The predictive factors were determined through Kaplan-Meier curves and a Cox regression. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated. RESULTS A total of 2,377 prisoners were included with a median follow-up time of 1,540.9 days per patient. Among the total population, 117 HCV seroconversions were detected (incidence of 1.17/100 py). The incidence was higher between 1992 and 1995 (2.57/100 py), among cases with HIV co-infection (8.34/100 py) and among intravenous drug users (IDU) without methadone treatment (MT) during follow-up (6.66/100 py). The incidence rate of HCV seroconversion among cases with a history of IDU and current MT was 1.35/100 py, which is close to that of the total study population. The following variables had a positive predictive value for HCV infection: IDU (p<0.001; HR = 7,30; CI: 4.83-11.04), Spanish ethnicity (p = 0.009; HR = 2,03; CI: 1.93-3.44) and HIV infection (p = 0.015; HR = 1.97; CI: 1.14-3.39). CONCLUSION The incidence of HCV infection among prisoners was higher during the first part of the study and among IDU during the entire study period. Preventative programs should be directed toward this sub-group of the prison population.
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Affiliation(s)
- Andrés Marco
- Health Services of Barcelona Men’s Penitentiary Centre, Barcelona, Department of Justice, Government of Catalonia, Barcelona, Spain
| | - Carlos Gallego
- Health Services of Quatre Camins Penitentiary Centre, La Roca del Vallés, Barcelona, Department of Justice, Government of Catalonia, Barcelona, Spain
| | - Joan A. Caylà
- Epidemiology Service of the Public Health Agency of Barcelona, CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain
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Rorat M, Jurek T, Szleszkowski L, Gladysz A. Outbreak of hepatitis C among patients admitted to the Department of Gynecology, Obstetrics, and Oncology. Am J Infect Control 2014; 42:e7-e10. [PMID: 24388479 DOI: 10.1016/j.ajic.2013.07.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Revised: 07/16/2013] [Accepted: 07/16/2013] [Indexed: 11/15/2022]
Abstract
BACKGROUND In Poland, nosocomial infections account for 32% of all patients' claims against public hospitals, with hepatitis B virus and hepatitis C virus (HCV) being the most common causes. We present a major nosocomial outbreak of the HCV infection in the Department of Gynecology, Obstetrics, and Oncology and the results of detailed sanitary and epidemiologic research. METHODS A retrospective analysis of medicolegal opinions issued at the request of the civil court regarding the suspicion of HCV nosocomial infections was conducted. RESULTS The detailed medical data analysis proved 26 patients aged 19 to 72 years with recent HCV hepatitis hospitalized on the same gynecology ward. Twenty women were operated on for neoplasm. The State Sanitary Inspection's investigation revealed a number of malpractices: incorrect sterilization procedures, insufficient hygiene habits of health care workers, poor condition of premises, and equipment being in poor condition. Numerous cases of staff breaking basic sanitary rules and hygiene standards and a lack of crucial procedures were discovered. The high number of women infected and the multiple errors recognized led to closure of the ward. CONCLUSION Outbreaks of HCV hepatitis may be the result of ineffective infection control systems and remains a significant public health problem. Asymptomatic HCV nosocomial infections might go unnoticed or concealed and underreported. Auditing medical centers and health care workers for compliance with sanitary and epidemiologic requirements is an essential need.
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Affiliation(s)
- Marta Rorat
- Department of Forensic Medicine, Wroclaw Medical University, Wroclaw, Poland.
| | - Tomasz Jurek
- Department of Forensic Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Lukasz Szleszkowski
- Department of Forensic Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Andrzej Gladysz
- Department of Forensic Medicine, Wroclaw Medical University, Wroclaw, Poland
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