Hepatitis C virus infection: the new global epidemic.
ABSTRACT Hepatitis C virus infects an estimated 170 million people worldwide. It is a major cause of liver cirrhosis, end-stage liver disease and hepatocellular carcinoma. It is also a leading cause of liver transplant in the USA. The virus is primarily transmitted parenterally, but there is significant mother-to-child transmission. Partly due to the virus's genetic diversity, it evades the host immune response and it has been difficult to identify candidate vaccines. However, significant advances have been made in the treatment of chronic hepatitis C virus infection. Currently, the combination of pegylated interferon-alpha and ribavirin is the standard treatment for chronic hepatitis C virus infection, and leads to long-term eradication of the virus in approximately 54% of people. Treatment response is dependent on the infecting genotype, with 76 to 80% of those with genotypes 2 and 3, but only approximately 40% with genotype 1 or 4 achieving a sustained virologic response. Since treatment is expensive and associated with significant adverse effects, more effective strategies for the prevention of transmission are needed, especially in resource-limited countries, where the burden of disease is the highest.
SourceAvailable from: Humayoon Shafique Satti[Show abstract] [Hide abstract]
ABSTRACT: Study Design: An experimental study conducted at the King Edward Medical University, Lahore during the period between November 2009 and January 2010. Four rapid immunochromatographic assays - ONE STEP HBsAg One Check, One step HBsAg test Accurate; Rapid anti HCV test One Check and Hepatitis C virus one step device Accurate were evaluated for detection of hepatitis B surface antigen and anti HCV. A collection of ELISA tested samples (57 tested for Hepatitis B by ELISA, 68 tested for Anti HCV antibodies by ELISA) were stored at -20°C and subsequently tested with rapid ICT tests (devices) (Accurate and One Check brands). Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of these tests were calculated using ELISA as the gold standard. Aims: The study was aimed to evaluate the performance of two commercially available rapid immuno-chromatographic testing (ICT) kits for HBsAg and anti HCV antibodies. Materials and Methods: Elisa tested samples for HBV (n = 57) and HCV (n = 68) were allotted random numbers to the positive and negative specimens. The medical officers allotting the numbers and the one performing the tests were double blind. Results: Among the 38 ELISA HBV positive sera, 20 were positive by Hepatitis B surface antigen one check and 19 were positive by accurate. Among the 53 ELISA Anti HCV positive sera 24 were positive by one check, 32 were positive by accu-rate and 4 were weakly positive by accurate. The sensitivity for rapid Hepatitis B surface antigen was found to be 53% and 50 % for one check and accurate respectively. The sensitivity of rapid HCV devices was found to be 66% and 45% for Accurate and One Check kits respectively. The negative predictive value for rapid HBsAg devices was 51% and 49% for One Check and Accurate kits respectively. The positive predictive values for HCV were 96% and 97% with One Check and Accu-rate respectively; for HBV, these were 100% and 95% with Accurate and One Check respectively. Conclusion: These results suggest that the rapid immuno-chromatographic kits for HBsAg and HCV have only limited efficacy and should be backed by superior methods like ELISA and PCR where possible.
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ABSTRACT: Various aspects of adherence to HCV treatment such as frequency, risk factors as well as causes of non-adherence, and its real role in clinical and virological outcome of the infected patients have remained largely unknown. The current study aimed to evaluate patients' adherence to anti-HCV medications in Iran. From October 2010 to March 2011, socio-demographic characteristics, features of HCV infection, clinical properties, and habitual history of 190 patients were collected. Adherence of each patient to anti-HCV medications was determined at months 1, 3, and 6 of treatment by self-reporting and pill or empty ampoule counting. Adherence to anti-HCV treatment regimen was determined based on the 80/80/80 rule. Adherence rate to interferon, ribavirin, or a combination of them over the first 6 months of therapy in Iranian HCV patients measured by both methods of self-reporting and pill counting were 35.4-65.8%, 46.3-56.8%, and 28.4-51.1%, respectively. Delay in receiving new prescription, financial issues, and adverse drug reactions were the most common causes of non-adherence in the patients. Adherence to ribavirin was identified as an independent predictor of achieving the end of treatment response, or sustained virological response. The rate of adherence to interferon and ribavirin varied significantly according to the method of calculation. Over the treatment course, adherence to interferon alpha and ribavirin, each or their combination, diminished significantly.Hepatitis Monthly 06/2013; 13(6):e11038. DOI:10.5812/hepatmon.11038 · 1.80 Impact Factor
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ABSTRACT: Antiviral therapy for the hepatitis C virus (HCV) reduces all-cause and liver-related morbidity and mortality. Few studies are available from populations with multiple medical and psychiatric comorbidities where the impact of successful antiviral therapy might be limited. The purpose of this study was to determine the effect of sustained virologic response (SVR) on all-cause and liver-related mortality in a cohort of HCV patients treated in an integrated hepatitis/mental health clinic. This was a retrospective review of all patients who initiated antiviral treatment for chronic HCV between January 1, 1997 and December 31, 2009. Cox regression analysis was used to determine factors involved in all-cause mortality, liver-related events and hepatocellular carcinoma. A total of 536 patients were included in the analysis. Median follow-up was 7.5 years. Liver and non-liver-related mortality occurred in 2.7 and 5.0 % of patients with SVR and in 17.8 and 6.4 % of patients without SVR. In a multivariate analysis, SVR was the only factor associated with reduced all-cause mortality (HR 0.47; 95 % CI 0.26-0.85; p = 0.012) and reduced liver-related events (HR 0.23; 95 % CI 0.08-0.66, p = 0.007). Having stage 4 liver fibrosis increased all-cause mortality (HR 2.50; 95 % CI 1.23-5.08; p = 0.011). Thrombocytopenia at baseline (HR 2.66; 95 % CI 1.22-5.79; p = 0.014) and stage 4 liver fibrosis (HR 4.87; 95 % CI 1.62-14.53; p = 0.005) increased liver-related events. Despite significant medical and psychiatric comorbidities, SVR markedly reduced liver-related outcomes without a significant change in non-liver-related mortality after a median follow-up of 7.5 years.Digestive Diseases and Sciences 02/2014; 59(4). DOI:10.1007/s10620-014-3050-5 · 2.26 Impact Factor