Epidemiological changes in hepatitis C virus genotypes in France: evidence in intravenous drug users.

Hepatitis C virus (HCV) genotypes are distributed differently depending on geography and route of infection. We characterized the distribution of genotypes in a large cohort of patients with chronic hepatitis C in the South-east of France and evaluated the relative prevalence according to time of acquisition. One thousand, one hundred-and-eighty-three patients who were anti-HCV-positive were studied. HCV genotype distribution has changed significantly from the 1960s to 2000. The prevalence of genotype 1b decreased from 47% before 1978 to 18.8% in the 1990s while the prevalence of genotype 1a and 3a increased during the same period from 18% and 15.3% to 28.8% and 26.3%, respectively. The logistic regression model showed that genotype 1a was significantly more common in patients infected through intravenous drug injection odds ratio ((OR): 2.08, P < 0.01) and after 1990 (OR: 1.98, P < 0.05). Genotype 1b was significantly less frequent in patients infected through intravenous drug injection (OR: 0.17, P < 0.001) and has decreased since 1978 (OR: 0.27, P < 0.001). Genotype 3a was independently associated with intravenous drug injection (OR: 6.1, P < 0.001) and tattooing (OR: 8.01, P < 0.001) and was more frequent in the 1979-90 period (OR: 2.05 and 1.74, P < 0.001 and P < 0.05). Our results show a modification of HCV genotypes distribution over the last four decades due to an increase of intravenous drug use (IVDU) contamination and an evolution of HCV genotypes distribution only in IVDU population characterized by a decrease of genotype 1b, an increase of genotype 3a from 1970 to 1990 and a higher increase of genotype 1a which is currently the predominant genotype in our population.

Covert transmission of hepatitis C virus during bloody fisticuffs.

Hepatitis C virus (HCV) is transmitted primarily through direct percutaneous exposure to infected blood. Sporadic HCV cases exist and may represent more than 10% of HCV transmission. We report the first case of documented transmission of HCV during a fight from a person who unknowingly had chronic HCV infection to a person who subsequently contracted acute hepatitis C. Patient-to-patient transmission was ascertained by sequence analysis of part of the NS5B genome and phylogenetic analysis. This case report suggests that sporadic HCV infection may be a result of blood exposure. This example of transmission could have a major impact in sports such as boxing or rugby. We suggest that in any fight, single use or nondisposable material should be used to dry blood to avoid such contamination.

[Needle puncture biopsy: the contribution of extemporaneous examination of samples in the diagnosis of malignant liver tumors]. / Ponction-biopsie à l'aiguille: apport de la lecture extemporanée des prélèvements dans le diagnostic des tumeurs malignes hépatiques.

In this retrospective study, the authors compared the sensitivity and specificity, in terms of the diagnosis of malignancy, of two techniques of ultrasound-guided biopsy of liver tumours. The first technique involving fine needle biopsy with cytological and histological analysis of the specimen was carried out in 39 patients. A technique using a wide calibre needle with frozen section examination of the fragment obtained was performed in 27 patients. All patients had one or more malignant liver tumours. Sensitivity and specificity of the technique with frozen section histology were both 100 per cent, while figures for the technique with delayed histological study were 84.6 and 87.4 per cent. This study suggests that frozen section histology might be associated with greater sensitivity than delayed histology.