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.
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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.Annals of King Edward Medical University. 03/2010; 16(1):84-87.
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ABSTRACT: To evaluate mildly abnormal liver function test (LFT) results in general practice among patients who do not have known liver disease. Prospective cohort study of people with abnormal LFT results identified in primary care. Participants were intensively investigated using a common protocol and followed up for 2 years. Substudies investigated the psychological sequelae of abnormal test results, clinicians' reasons for testing, decision options when LFT results were abnormal and early detection of liver fibrosis. Eleven primary-care practices: eight in Birmingham and three in Lambeth. Adults with abnormal LFT results who did not have pre-existing or obvious liver disease. Eight analytes were included in the panel of LFTs. Statistical tests were used to identify the interactions between clinical features, the initial pattern of abnormal LFT results and (1) specific viral, genetic and autoimmune diseases, such as viral hepatitis, haemochromatosis and primary biliary cirrhosis; (2) a range of other serious diseases, such as metastatic cancer and hypothyroidism; (3) 'fatty liver' not associated with the above; and (4) the absence of detectable disease. Fewer than 5% of people with abnormal LFT results had a specific disease of the liver, and many of these were unlikely to need treatment. The diagnostic potential of the LFT panel is largely subsumed into just two analytes: alanine aminotransferase (ALT) and alkaline phosphatase (ALP). Gamma-glutamyltransferase (GGT) offers a small increase in sensitivity at the margin at the cost of a large loss of specificity. Eighty-four per cent of abnormal LFT results remain abnormal on retesting 1 month later. In many cases, carrying out a definitive or specific test will be more efficient than repeating LFTs, with a view to specific testing only if the test remains abnormal. An ultrasound diagnosis of 'fatty liver' was present in nearly 40% of patients with abnormal LFTs and a small amount of weight loss over 2 years was associated with a reduced incidence of liver fat. There was a J-shaped relationship between alcohol intake and fatty liver in men. An abnormal LFT result causes temporary anxiety, which does not appear to promote sustained behaviour change. Liver disease is rare among people with abnormal LFT results in primary care. Only two analytes (ALT and ALP) are helpful in identifying the majority of liver disease. GGT adds little information in return for a high false-positive rate but it is sensitive to alcohol intake. LFT results seldom revert from abnormal to normal over a 1-month period, and modelling shows that repeating an abnormal LFT panel, as recommended in the current guidelines, is inefficient. LFTs are often undertaken to meet perceived patient need for a blood test, but as they are neither specific nor indicative of any particular disease they are among the least suitable tests for this purpose. Obesity and raised ALT provide strong evidence for a presumptive diagnosis of 'fatty' liver. Abnormal LFTs and 'fatty' liver provoke only short-term anxiety and neither is associated with sustained weight loss. Even a small amount of weight loss reduces liver fat. (1) the cases of 'fatty liver' and controls should be followed up in the long term to identify features that predict development of hepatosteatosis and then cirrhosis; (2) the acceptability of replacing the traditional six- to eight-analyte LFT panel with a drop down menu including the ALT/ALP combination should be evaluated. The National Institute for Health Research Health Technology Assessment programme.Health technology assessment (Winchester, England). 07/2013; 17(28):1-307.
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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. · 1.80 Impact Factor