Detection of hepatitis C virus (HCV) among health care providers in an Egyptian university hospital: different diagnostic modalities

Towards a safe hospital: hepatitis C in-hospital micro-elimination program (HCV-HELP study)

Question

Is hepatitis C virus (HCV) micro-elimination achievable at the hospital level with the structured strategies?

Findings

The multidirectional program included the HCV reflex test for hospital personnel, outpatient surveillance, a call-back system, and surveillance of cancer patients prior to chemotherapy. Through the plans of the study, 97.8% of the HCV-viremic patients successfully received linkage-to-treat. The results of each strategy sufficiently met the 2030 elimination goal by the World Health Organization (WHO).

Meaning

HCV micro-elimination is achievable at the hospital level based on patient safety, staff occupational safety and infection control.

Background and aims

Scarce data are available on in-hospital hepatitis C virus (HCV) micro-elimination strategies. This pilot study was prospectively conducted to assess the outcomes of HCV in-hospital micro-elimination program (HCV-HELP) in a single center in Taiwan.

Methods

The study included the HCV reflex test for plans A (hospital personnel), B (outpatient surveillance), C (a call-back system for anti-HCV+ patients), and D (surveillance of cancer patients prior to chemotherapy). The primary outcome measurement was that > 80% of eligible patients were enrolled in linkage-to-treat; the secondary outcome measurement was the surveillance efficacy.

Results

We recruited 930, 6072, 2376 and 233 participants into plans A, B, C, and D, respectively, from Oct 2020 to May 2021. The anti-HCV-seropositivity prevalences were 0.22% for plan A, 4.3% for B, and 3.9% for D. Two staff members were identified as HCV-viremic in plan A; these staff members successfully achieved a sustained virological response (SVR). We identified 39, 95 and 2 HCV-viremic patients in plans B, C, and D, respectively. Of these 138 HCV-viremic patients, 135 (97.8%) received direct-acting antiviral therapy, and 134 achieved SVR. Two 4-month phases were stratified to compare efficacies in the liver clinic. In the late phase, the adjusted number of HCV-viremic patients was 4.36/10,000 outpatient visits (90/200,689), which was 3.18-fold higher than that of the early phase (1.37/10,000 outpatient visits [30/212,658], odds ratio 3.18; 95% confidence interval 2.10–4.81, p < 0.0001).

Conclusion

HCV micro-elimination is achievable at the hospital level as per the structured HCV-HELP study.

Hepatitis B and C virus infection among healthcare workers in Africa: a systematic review and meta-analysis

BACKGROUND

Healthcare workers are at risk of acquiring hepatitis B and C virus infections through patients' blood and bodily fluids exposure. So far, there is no pooled data that shows the prevalence of HBV and HCV among health care workers in Africa. This study aimed to determine the pooled prevalence of hepatitis B and C infections among health care workers in Africa.

METHODS

Studies reporting the prevalence of HBV and HCV were identified from major databases and gray literature. PubMed, CINAHL, POPLINE, ScienceDirect, African Journals Online (AJOL), and Google Scholar were systematically searched to identify relevant studies. A random-effect model was used to estimate the pooled prevalence of hepatitis B and C among health care workers in Africa. The heterogeneity of studies was assessed using Cochran Q statistics and I2 tests. Publication bias was assessed using Begg's tests.

RESULT

In total, 1885 articles were retrieved, and 44 studies met the inclusion criteria and included in the final analysis. A total of 17,510 healthcare workers were included. The pooled prevalence of hepatitis B virus infection among health care workers in Africa is estimated to be 6.81% (95% CI 5.67-7.95) with a significant level of heterogeneity (I2 = 91.6%; p < 0.001). While the pooled prevalence of hepatitis C virus infection using the random-effects model was 5.58% (95% CI 3.55-7.61) with a significant level of heterogeneity (I2 = 95.1%; p < 0.001).

CONCLUSION

Overall, one in fifteen and more than one in twenty healthcare workers were infected by HBV and HCV, respectively. The high burden of HBV and HCV infections remains a significant problem among healthcare workers in Africa.

Sugar Alcohols Have a Key Role in Pathogenesis of Chronic Liver Disease and Hepatocellular Carcinoma in Whole Blood and Liver Tissues

The major risk factors for hepatocellular carcinoma (HCC) are hepatitis C and B viral infections that proceed to Chronic Liver Disease (CLD). Yet, the early diagnosis and treatment of HCC are challenging because the pathogenesis of HCC is not fully defined. To better understand the onset and development of HCC, untargeted GC-TOF MS metabolomics data were acquired from resected human HCC tissues and their paired non-tumor hepatic tissues (n = 46). Blood samples of the same HCC subjects (n = 23) were compared to CLD (n = 15) and healthy control (n = 15) blood samples. The participants were recruited from the National Liver Institute in Egypt. The GC-TOF MS data yielded 194 structurally annotated compounds. The most strikingly significant alteration was found for the class of sugar alcohols that were up-regulated in blood of HCC patients compared to CLD subjects (p < 2.4 × 10⁻¹²) and CLD compared to healthy controls (p = 4.1 × 10⁻⁷). In HCC tissues, sugar alcohols were the most significant (p < 1 × 10⁻⁶) class differentiating resected HCC tissues from non-malignant hepatic tissues for all HCC patients. Alteration of sugar alcohol levels in liver tissues also defined early-stage HCC from their paired non-malignant hepatic tissues (p = 2.7 × 10⁻⁶). In blood, sugar alcohols differentiated HCC from CLD subjects with an ROC-curve of 0.875 compared to 0.685 for the classic HCC biomarker alpha-fetoprotein. Blood sugar alcohol levels steadily increased from healthy controls to CLD to early stages of HCC and finally, to late-stage HCC patients. The increase in sugar alcohol levels indicates a role of aldo-keto reductases in the pathogenesis of HCC, possibly opening novel diagnostic and therapeutic options after in-depth validation.

Evaluation of a hepatitis B virus protection intervention among interns at Zagazig University Hospitals, Egypt

BACKGROUND

Hepatitis B virus (HBV) infection is the most common serious liver infection. The study aimed to evaluate the effect of a HBV protection intervention on interns, as regards their knowledge, attitude and immune response to HB vaccine and to identify the factors affecting their compliance and immune response to HB vaccination at Zagazig University Hospitals.

METHODS

A quasi-experimental study was conducted in 3 phases over 10 months. Phase 1: assessment of knowledge, attitude and HCV/HBV immune status. Phase 2: the implementation of HBV protection campaign; vaccine administration and health education sessions. Phase 3: the assessment of the immune response to the vaccine and the change in knowledge and attitude.

RESULTS

Out of 120 participants, 60% were compliant to the vaccination schedule. Needle-stick injury, the seriousness of HBV infection and attendance of infection control courses are the motivating factors to vaccination (p < 0.05). After the 3rd dose, 9.7% were non-responders. BMI and diabetes were the statistically significant predictors of the immune response. The HCWs compliant with vaccination schedule had higher mean scores regarding; total knowledge (15.5 ± 2.1), p < 0.0001 and attitude (14.34 ± 3.8) p < 0.05. A significant improvement is recorded from the posttest results, p < 0.000.

CONCLUSIONS

A comprehensive protective program against HBV is an effective tool. A compulsory vaccination program is still needed for interns. Post vaccination monitoring program, including protective measures for vaccine non responders is urgently needed with strict follow up of at risk groups. Occult HBV cases should not be overlooked when screening for immune response to vaccine.

A novel point-of-care oral anti-HCV assay: Is it reliable for screening hepatitis C virus infection in the era of direct-acting antivirals?

Recent advance in the direct-acting antivirals (DAAs) offers the potentials to eradicate hepatitis C virus (HCV) worldwide and makes universal screening more urgent. A point-of-care (POC) oral anti-HCV assay, the Fortune assay, was developed and its performance was evaluated. Individuals with or without HCV infection were recruited in three Centers. Paired oral and serum samples were tested using the Fortune and InTec anti-HCV assays. The Kehua serum anti-HCV assay served as a supplemental test to verify the discordant results. Some oral samples were also tested using the OraQuick anti-HCV assay. Furthermore, the Fortune assay results were compared with the documented RNA results. Sensitivity, specificity, and accuracy of the Fortune assay was 93.11%, 98.48%, and 96.58%, respectively (n = 1,022). Consistency between the Fortune and OraQuick assays was 96.35% (264/274); the Fortune assay detected additional 8 positive oral samples missed by the OraQuick assay. The Fortune assay demonstrated a 97.46% (115/118) positivity among the viremic patients. Furthermore, its sensitivity was HCV genotype independent. In conclusion, the Fortune assay was highly specific and accurate. It had comparable sensitivity as the serum assays for the diagnosis of active HCV infection. It provides a completely non-invasive and reliable tool for HCV screening in the DAA era.

Serum inducible protein-10 chemokine as a biomarker for clearance of HCV with and without treatment in Egyptian patients

BACKGROUND AND AIMS

Assessment of the potential predictive value of serum inducible protein-10 chemokine (IP-10) in the clearance of HCV in Egyptian patients with and without treatment.

MATERIALS AND METHODS

Ninety Egyptian individuals were involved in the current study where, 20 patients (23%) were chronic HCV (positive HCV antibodies and positive HCV RNA without treatment, 20 (22%) were healthy individuals (negative for both HCV antibodies and HCV RNA, 20 (22%) were natural clearance (positive HCV antibodies and negative for HCV RNA without treatment), 20 (22%) were achieved SVR after treatment (responders group, HCV positive and negative for HCV RNA after treatment) and 10 (11%) were non responders (positive HCV antibodies and still positive HCV RNA after treatment). HCV RNA was quantitated by real time PCR and serum IP10 level was measured by commercial ELISA kit. All biochemical and hematological examinations included liver function, CBC and alphefeto protein were assessed.

RESULTS

The mean serum levels of IP-10 were significantly higher (p< 0.001) in CHC patients (345.4 ± 100) pg/ml compared with healthy control group (101.5 ± 31.4) and natural clearance group (103.2 ± 40.7). Also serum levels of IP-10 was significantly elevated in non-responders group (257.4 ± 52.5) compared with each of SVR group (103.5 ± 43.5) (p< 0.001) and healthy group (101.5 ± 31.4), (p< 0.001). Prediction of a clinical response based on a IP10 chemokine revealed high sensitivity (93%), specificity (96%), negative predictive value (96%), and area under curve is (1.00). Moreover, there is no correlation ((R= 0.05), P value p< 0.795) between serum level of IP-10 and HCV viral load.

CONCLUSION

IP10 is a useful non-invasive biomarker for viral clearance and might be used to apply patients according to the predictable treatment outcome. Accordingly, patients who are unlikely to respond to treatment would avoid unnecessary exposure to medication that is related with high morbidity.