High genetic diversity of Echinococcus canadensis G10 in northeastern Asia: is it the region of origin?

Echinococcus canadensis consists of 4 genotypes: G6, G7, G8 and G10. While the first 2 predominantly infect domestic animals, the latter are sylvatic in nature involving mainly wolves and cervids as hosts and can be found in the northern temperate to Arctic latitudes. This circumstance makes the acquisition of sample material difficult, and little information is known about their genetic structure. The majority of specimens analysed to date have been from the European region, comparatively few from northeast Asia and Alaska. In the current study, Echinococcus spp. from wolves and intermediate hosts from the Republic of Sakha in eastern Russia were examined. Echinococcus canadensis G10 was identified in 15 wolves and 4 cervid intermediate hosts. Complete mitochondrial cytochrome c oxidase subunit 1 (cox1) sequences were obtained from 42 worm and cyst specimens from Sakha and, for comparison, from an additional 13 G10 cysts from Finland. For comparative analyses of the genetic diversity of G10 of European and Asian origin, all available cox1 sequences from GenBank were included, increasing the number of sequences to 99. The diversity found in northeast Asia was by far higher than in Europe, suggesting that the geographic origin of E. canadensis (at least of G10) might be northeast Asia.

The sol-gel transition of ultra-low solid content TEMPO-cellulose nanofibril/mixed-linkage ß-glucan bionanocomposite gels.

We present the preparation, morphological analysis, and rheological characterization of ultra-low solid content gels prepared by physically cross-linking TEMPO-oxidized cellulose nanofibrils (TEMPO-CNF) with the soluble plant-cell-wall polysaccharide, mixed-linkage ß-glucan (MLG). Of particular note, gel formation was rapidly induced by very small amounts of MLG (e.g. 0.125% w/v) at extremely low TEMPO-CNF concentration (0.05% w/v), which independently were otherwise fluid and thus easily handled. Rheology of these bionanocomposite gel systems as a function of MLG and TEMPO-CNF concentrations revealed that the critical gel concentration of MLG and TEMPO-CNF followed a power-law relation of the concentration of the other component. Surprisingly, these systems also exhibited an additional transition to thick gels at high TEMPO-CNF and MLG concentrations that was visible only at low frequencies. Cryogenic scanning electron microscopy (cryo-SEM) imaging of admixture solutions and gels revealed increased network crowding with increasing MLG amounts. The data are consistent with the hypothesis that non-covalent cellulose-MLG interactions, analogous to those occurring within plant cell walls, drive gel formation. The ability to tune gel physical properties simply by controlling CNF (a promising forest bioproduct) and MLG (a readily available agricultural polysaccharide) fractions at very low solid and polymer content opens new possibilities for material applications in diverse industries.

Application of hepatocellular carcinoma surveillance in a European setting. What can we learn from clinical practice?

BACKGROUND & AIMS: Surveillance for hepatocellular carcinoma (HCC) in patients with cirrhosis is recommended in clinical guidelines. In real-life management, surveillance rates below 20% have been reported from the United States. We aimed to determine the use of HCC-surveillance in patients diagnosed with HCC in a European setting, and to identify the reasons for surveillance failures. METHODS: Age, gender, tumour characteristics, BCLC classification, Child-Pugh stage, pre-existing liver disease, treatment, survival, frequency of HCC surveillance and reasons for surveillance failures were retrospectively determined in 616 patients diagnosed with HCC at Karolinska University Hospital 2005-2012. RESULTS: Hepatitis C, alcoholic liver disease and non-alcoholic fatty liver disease (NAFLD) were the most common diagnoses. The proportion of HCC patients diagnosed through surveillance was 22%. In 35% of cases, surveillance was missed due to doctor's failure to order surveillance or to diagnose the underlying liver disease. Diagnosis of NAFLD or alcoholic liver disease increased the risk of not receiving surveillance more than two-fold. Undiagnosed liver disease was most common in NAFLD patients. Patients who underwent surveillance had smaller tumours, more frequently received curative treatment, and had better survival compared to those in whom surveillance was indicated but missed. CONCLUSION: In a European setting, only 22% of HCCs were diagnosed by surveillance, and in more than one-third of cases, surveillance was indicated but missed. NAFLD and alcoholic liver disease were associated with deficient surveillance. Survival was significantly better in patients who underwent surveillance compared with those in whom surveillance was missed although indicated.

An autochthonous case of cystic echinococcosis in Finland, 2015.

We report a case of pulmonary cystic echinococcosis in a child from eastern Finland with no history of travelling abroad. The cyst was surgically removed and the organism molecularly identified as Echinococcus canadensis genotype G10. This parasite is maintained in eastern Finland in a sylvatic life cycle involving wolves and moose; in the present case, the infection was presumably transmitted by hunting dogs.

The reindeer abomasal nematode (Ostertagia gruehneri) is naturally transmitted to sheep when sharing pastures.

The increasing number of sheep (Ovis aries) in northern Finland, often alternately corralled with winter-fed reindeer (Rangifer tarandus tarandus), creates potential for cross-infection of gastrointestinal nematodes. The aim of this study was to elucidate this possibility with 43 animals. Eleven reindeer and 8 sheep had shared a corral by turns, reindeer during winters, and sheep in summers. Another 12 reindeer had no known contact with sheep. Twelve sheep had no close contact to other ruminants. Both reindeer groups were free-ranging during summers. During slaughter in September to November, 2003, abomasa and parts of intestines were collected. Gastrointestinal nematodes were counted and identified. The species found were the following: in reindeer, Ostertagia gruehneri/Ostertagia arctica, Mazamastrongylus dagestanica, Nematodirus tarandi, Nematodirella longissimespiculata and Bunostomum trigonocephalum; in sheep, Teladorsagia circumcincta/Teladorsagia trifurcata, O. gruehneri/O. arctica, Nematodirus filicollis and N. spathiger. In the sheep sharing corral with reindeer, the only abomasal nematode species found was O. gruehneri, a reindeer parasite. The generation interval of O. gruehneri in Finnish reindeer appears to be shorter than in Canadian Arctic caribou, where complete larval inhibition leading to only one generation yearly has been reported.

From wildlife to humans: The global distribution of Trichinella species and genotypes in wildlife and wildlife-associated human trichinellosis.

Zoonotic nematodes of the genus Trichinella are foodborne parasites that have a global distribution in wild carnivores and omnivores, with spillover and spillback into domestic livestock and people, with concomitant trade and health consequences. Historically, most human cases were linked to domestic pigs infected with Trichinella spiralis, but under current high biosecurity swine production in many countries, wildlife have become a more important source of human trichinellosis. The aim of this review is to update the global distribution of Trichinella species and genotypes reported in wildlife, as well as reported human outbreaks from the consumption of wildlife. Using several online databases and by "snowballing" references, hundreds of reports of Trichinella spp. in wildlife published between January 1991 and December 2023 provide an important update to the host and geographic range for each of the recognized 13 species/genotypes, grouped by continent. Surveillance effort was highest in Europe and North America, while Africa, Asia, Central and South America have had limited surveillance, in some instances with human cases serving as sentinels of transmission in a region. Dozens of human outbreaks are described, with wild boars (Sus scrofa) being the most frequently implicated wildlife species in human outbreaks globally. Bears are an important source of infection in North America, for wildlife tourism, and importation of bear meat has also been implicated in multicountry outbreaks. The largest study limitation was the dearth of molecular identification of larvae in both wildlife surveillance studies and human outbreaks, particulary in under-studied regions. We highlight the need for enhanced molecular epidemiological approaches to outbreaks of this important foodborne parasite, and emphasize the need for a One Health approach to manage Trichinella spp. which transmit among terrestrial and marine wildlife (including migratory birds), pigs, horses, and people, often across large geographic scales and borders.

A survey for antibodies against Fasciola hepatica in cattle and sheep in finland indicates a low level of exposure.

BACKGROUND: Fasciolosis is a parasitic infection caused by the liver fluke Fasciola hepatica that can have a major economic impact on livestock industry. The prevalence of the disease has recently been increasing in many North European countries. The objective of this study was to determine the prevalence of antibody against F. hepatica in Finnish cattle herds and sheep flocks during 2019 by using a commercial enzyme-linked immunosorbent assay (ELISA). Randomly selected bulk tank milk samples were obtained from 660 dairy herds. Blood samples were collected at slaughterhouses from 1944 suckler cows from 309 herds and from 1120 sheep from 95 flocks. RESULTS: Antibodies against F. hepatica were found in 0.45% (95% confidence interval (CI): 0.15-1.33) of the dairy herds and 0.97% (95% CI: 0.33-2.82) of the suckler cow herds. The seropositive herds were located in eastern and central Finland. None of the sampled sheep flocks tested had antibodies against F. hepatica (95% CI: 0-3.89). The results of the assays were compared with meat inspection data received from the slaughterhouses. All positive herds also had liver condemnations due to F. hepatica based on the meat inspection reports. CONCLUSIONS: Compared to other North European countries, the prevalence of fasciolosis in Finland can be considered low, and according to meat inspection reports, there are no indications of the prevalence increasing in Finland.

Unveiling the incidences and trends of the neglected zoonosis cystic echinococcosis in Europe: a systematic review from the MEmE project.

The neglected zoonosis cystic echinococcosis affects mainly pastoral and rural communities in both low-income and upper-middle-income countries. In Europe, it should be regarded as an orphan and rare disease. Although human cystic echinococcosis is a notifiable parasitic infectious disease in most European countries, in practice it is largely under-reported by national health systems. To fill this gap, we extracted data on the number, incidence, and trend of human cases in Europe through a systematic review approach, using both the scientific and grey literature and accounting for the period of publication from 1997 to 2021. The highest number of possible human cases at the national level was calculated from various data sources to generate a descriptive model of human cystic echinococcosis in Europe. We identified 64 745 human cystic echinococcosis cases from 40 European countries. The mean annual incidence from 1997 to 2020 throughout Europe was 0·64 cases per 100 000 people and in EU member states was 0·50 cases per 100 000 people. Based on incidence rates and trends detected in this study, the current epicentre of cystic echinococcosis in Europe is in the southeastern European countries, whereas historical endemic European Mediterranean countries have recorded a decrease in the number of cases over the time.

Dispersal of taeniid eggs: Experimental faecal contamination of forest environment followed by DNA detection in wild berries.

To understand Taeniidae epidemiology, the principles of egg-dispersion dynamics under natural conditions must be known. In this study, non-zoonotic Taenia laticollis was used as a model parasite for the family Taeniidae (including Echinococcus spp.). An experiment to investigate dispersion from contaminated faeces to the surroundings was performed both with bilberries (Vaccinium myrtillus) and lingonberries (Vaccinium vitis-idaea), both of which are commercially harvested wild berries in Finland. For this experiment, 30 g of fox faeces was inoculated with 30,000 T. laticollis eggs for the bilberry experiment and 100,000 eggs for the lingonberry experiment. The faecal material was placed in the middle of good berry growth areas in four locations for bilberries and eight locations for lingonberries. After 41-42 days, berries at different distances (0-15 m) from the original contamination spot were collected and delivered to our laboratory. DNA was extracted from washed and sieved material and analysed using T. laticollis-specific semi-quantitative SYBR Green real-time polymerase chain reaction (qPCR). Taenia laticollis-specific DNA was recovered from 67% (8/12) of bilberry samples but not reliably from any of the lingonberry samples 0% (0/24), although the exposure dose was higher for those. The qPCR results suggest that under natural conditions, taeniid egg dispersion from the contamination spot is demonstrated but attachment is berry specific. The surface of bilberries may be more adhesive for taeniid eggs than the waxier and harder pericarp of the lingonberries or there might be a difference in the dispersal mechanism caused by different biotopes.

Research on Selected Wildlife Infections in the Circumpolar Arctic-A Bibliometric Review.

One Health, a multidisciplinary approach to public health, which integrates human, animal, and environmental studies, is prudent for circumpolar Arctic health research. The objective of our bibliometric review was to identify and compare research in select infectious diseases in Arctic wildlife species with importance to human health indexed in English language databases (PubMed, Scopus) and the Russian database eLibrary.ru. Included articles (in English and Russian languages) needed to meet the following criteria: (1) data comes from the Arctic, (2) articles report original research or surveillance reports, (3) articles were published between 1990 and 2018, and (4) research relates to naturally occurring infections. Of the included articles (total n = 352), most were from Russia (n = 131, 37%), Norway (n = 58, 16%), Canada (n = 39, 11%), and Alaska (n = 39, 11%). Frequently reported infectious agents among selected mammals were Trichinella spp. (n = 39), Brucella spp. (n = 25), rabies virus (n = 11), Echinococcus spp. (n = 10), and Francisella tularensis (n = 9). There were 25 articles on anthrax in eLibrary.ru, while there were none in the other two databases. We identified future directions where opportunities for further research, collaboration, systematic reviews, or monitoring programs are possible and needed.

Epidemiology of Trichinella in the Arctic and subarctic: A review.

The finding of Trichinella in the Arctic was foreseen because captive polar bears and arctic foxes had been found infected during the first decades of the 20th century. Human trichinellosis outbreaks were reported to have taken place in 1944 in Franz Josef Archipelago and 1947 in Greenland, and previous outbreaks in Greenland also appeared to have been trichinellosis. Now, it is known that Trichinella parasites thrive in the Arctic and subarctic and pose a risk for public health. We collated the available information, which show that infection prevalences are high in many animal host species, and that outbreaks of human trichinellosis have been described also recently. The species diversity of Trichinella in the Arctic and subarctic is relatively high, and the circulation is in non-domestic cycles with transmission by predation, scavenging and cannibalism. There are also sporadic reports on the synanthropic species Trichinella spiralis in arctic wild mammals with little known or assumed contact to potential synanthropic cycles. In this paper, we summarize the knowledge on epidemiology of Trichinella parasites in the circumpolar Arctic and subarctic regions, and discuss the challenges and solutions for their control.

Infection with brainworm (Elaphostrongylus rangiferi) in reindeer (Rangifer tarandus ssp.) in Fennoscandia.

Sami reindeer herders have considerable traditional knowledge about a neurological reindeer disease resembling elaphostrongylosis, but the causative agent was not identified prior to the description of the brainworm Elaphostrongylus rangiferi in Russia in 1958. Elaphostrongylosis was quickly recognised as a serious cause of reindeer morbidity and mortality. The ecology, epidemiology and pathophysiology of the disease were studied in Sweden and Norway during the 1960s and in particular the 1970s to 1990s. In Finland, elaphostrongylosis was not recognised as an important disease for Finnish reindeer husbandry, even though the presence of brainworm infection has been documented. Brainworm has an indirect lifecycle with snail and slug intermediate hosts. The free-living L1 larvae have extremely good freeze tolerance and can survive > 360 days at - 80 °C in water (solid ice). Even though reindeer brainworm is clearly well adapted to the Arctic chill, the lifecycle stages outside the reindeer final host are sped up at warmer environmental temperatures. Arctic summer temperatures are close to the developmental threshold of the parasite in the intermediate gastropod hosts (8-10 °C), and the parasite has typically had a 2-year life cycle. Disease outbreaks generally occur during the winter following the infection of reindeer with infected snails and slugs during the summer and autumn. Warmer summers result in faster development of brainworm larvae in the intermediate hosts. Clinical symptoms have been seen reported as early as August, such as in the outbreak in Trøndelag, Norway in 2018. The reindeer brainworm is also a cause of conflict between reindeer herders and small ruminant farmers, because it can cause severe disease in goats and sheep, which share pasture with reindeer. Many knowledge gaps remain if we wish to successfully predict and mitigate for large-scale outbreaks in a future with a predicted warmer, wetter and wilder climate.

Parasites in the changing world - Ten timely examples from the Nordic-Baltic region.

The world is changing, and parasites adapt. The Nordic-Baltic region in northern Europe - including the Nordic countries Denmark, Finland, Iceland, Norway and Sweden, and the Baltic States Estonia, Latvia and Lithuania - is facing new parasitological challenges due to changes in populations of parasites and their hosts and the spread of new parasites to the region due to climate change. Some changes can also be ascribed to increased awareness and detection. In this paper, we review and discuss a convenience selection of ten timely examples of recent observations that exemplify trends and challenges from different fields of parasitology, with particular focus on climate change and potential changes in epidemiology of pathogens in northern Europe. The examples illustrate how addressing parasitological challenges often requires both intersectoral and international collaboration, and how using both historical baseline data and modern methodologies are needed.

Health-related quality of life in patients with different stages of liver disease induced by hepatitis C.

OBJECTIVE: Patients with hepatitis C have been shown to have impaired health-related quality of life (HRQoL). The aim of this study was to determine HRQoL in patients in different stages of hepatitis C virus (HCV) and to compare HRQoL in HCV cirrhosis with non-HCV-induced cirrhosis. MATERIAL AND METHODS: Out of 489 consecutive patients who fulfilled the inclusion criteria, 472 (96%) agreed to participate in the study: 158 patients with mild/moderate fibrosis with chronic hepatitis C (CHC group), 76 patients with HCV compensated cirrhosis (CC), 53 patients with HCV decompensated (DC) cirrhosis, 52 non-cirrhotic patients with sustained viral response (SVR), and a control group consisting of 32 patients with non-HCV CC and 101 with non-HCV DC who completed the Short Form-36 (SF-36) and EQ-5D questionnaire. RESULTS: The CHC group had significantly lower SF-36 scores than healthy controls, with the exception of scores for the dimensions physical function and bodily pain. HCV patients with DC had lower scores in all SF-36 dimensions in comparison with those of the CHC group, as well as in physical and mental component summaries (p<0.001). In comparison with the CHC group, the HCV CC group had lower scores on the SF-36 general health dimension (p<0.05) and lower SF-36 physical component summary (PCS) scores (p<0.05). No major differences were seen in patients with HCV- and non-HCV-induced cirrhosis. CONCLUSIONS: Impairment in HRQoL in patients with HCV was associated with the severity of liver disease, patients with decompensated cirrhosis exhibiting the highest impairment in HRQoL. The etiology of liver disease does not seem to be important in determining HRQoL in cirrhosis.

Gastrointestinal parasites in reindeer (Rangifer tarandus tarandus): A review focusing on Fennoscandia.

Reindeer (Rangifer tarandus tarandus) are known to host a wide variety of parasites, including those in the gastrointestinal system. Here, we review the current knowledge of the main gastrointestinal parasites of reindeer focusing on northern Fennoscandia, which comprises parts of Finland, Sweden, Norway and Russia. We explore both the historical baseline data for diversity and distribution and recent advancements in our understanding of parasite faunas in reindeer across this region. It is evident that the balance between reindeer and their gastrointestinal parasites, along with the potential for emergent disease in the changing world warrants careful monitoring and further studies.

Gastrointestinal parasites in reindeer (Rangifer tarandus tarandus) calves from Fennoscandia: An epidemiological study.

Reindeer (Rangifer tarandus tarandus) host numerous parasites. Although there is a general knowledge about parasite diversity in reindeer, detailed baseline information about parasitic infections is limited. Detailed knowledge of parasite prevalence and diversity provide a pathway for more targeted parasite control, an increasing need expected in the future. The main aim of our cross-sectional study was to estimate the prevalence of gastrointestinal parasites in semidomesticated reindeer calves. The 480 reindeer calves included in our study were aged 6-7 months, originated from 9 reindeer herding cooperatives in Finland and 1 in Norway, and were slaughtered during September-November 2015 in 10 reindeer slaughterhouses. All the reindeer calves passed meat inspection, and the detected parasitic infections were subclinical. As the reindeer included in this study were young animals intended for slaughter, they had never been administrated any antiparasitic treatment. Assessments of gastrointestinal parasitism among these reindeer calves were based on fecal examination and morphological identification of coccidian oocysts or helminth eggs. Individual fecal samples collected from the rectum of each of the reindeer were examined using a modified McMaster method. Most (78.3%) of the reindeer calves had eggs or oocysts of at least one parasite species in their feces, and more than half (53.5%) had a mixed infection. Strongylid eggs were detected in 75.6%, Eimeria sp. oocysts in 50.6%, Moniezia sp. eggs in 28.1%, Nematodirus sp. eggs in 22.1%, Capillaria sp. eggs in 9.4%, and Trichuris sp. eggs in 0.6% of the samples. The prevalence of gastrointestinal parasites was similar or higher relative to previous estimates from the region; the proportion of reindeer calves shedding strongylid eggs and the proportion of reindeer calves shedding Moniezia sp. eggs had increased. Prevalence varied by geographical region, which may reflect different herding practices or environmental parameters. Higher reindeer density was a risk factor for testing positive for Eimeria sp. oocysts, and the odds of testing positive for Nematodirus sp. eggs were higher if a peroral route was used for antiparasitic treatment in the reindeer herding cooperative. The mean proportion of reindeer estimated to receive antiparasitic treatment in Finland was 86% in 2004-2005 and 91% in 2014-2015. During the historical time frames of current management practices, this routine annual antiparasitic treatment of breeding reindeer has not decreased the prevalence of gastrointestinal parasites in reindeer calves, which can be seen as sentinels or indicators of the infection pressure.

A new SYBR green real-time PCR assay for semi-quantitative detection of Echinococcus multilocularis and Echinococcus canadensis DNA on bilberries (Vaccinium myrtillus).

Berries and vegetables are potential transmission vehicles for eggs of pathogenic parasites, such as Echinococcus spp. We developed a SYBR Green based semi-quantitative real-time PCR (qPCR) method for detection of Echinococcus multilocularis and Echinococcus canadensis DNA from berry samples. A set of primers based on the mitochondrial NADH dehydrogenase subunit 1 (nad1) gene was designed and evaluated. To assess the efficacy of the assay, we spiked bilberries (Vaccinium myrtillus) with a known amount of E. multilocularis eggs. The detection limit for the assay using the NAD1_88 primer set was 4.37 × 10-5 ng/µl of E. multilocularis DNA. Under artificial contamination of berries, 50 E. multilocularis eggs were reliably detected in 250 g of bilberries. Analytical sensitivity of the assay was determined to be 100% with three eggs. As an application of the assay, 21 bilberry samples from Finnish market places and 21 bilberry samples from Estonia were examined. Previously described sieving and DNA extraction methods were used, and the samples were analyzed for E. multilocularis and E. canadensis DNA using semi-quantitative real-time PCR and a melting curve analysis of the amplified products. Echinococcus DNA was not detected in any of the commercial berry samples. This easy and fast method can be used for an efficient detection of E. multilocularis and E. canadensis in bilberries or other berries, and it is applicable also for fruits and vegetables.

Berries as a potential transmission vehicle for taeniid eggs.

Potential role of wild forest berries as a transmission vehicle for taeniid eggs was examined using non-zoonotic Taenia laticollis eggs as a model. The berries studied were bilberries (Vaccinium myrtillus) (1 m2 plot, n = 10) and lingonberries (Vaccinium vitis-idaea) (1 m2 plot, n = 11). The plots in the managed forest were evenly sprayed with 30,000 or 60,000 T. laticollis eggs suspended in water, and berries were collected 24 h after spraying. The berries were rinsed with water, and the water was sieved through a 1-mm and a 63-µm sieve to remove coarse material and through a 20-µm sieve to collect possible eggs. A small proportion of the sieved material was examined by microscopy after treatment with fluorescent Calcofluor White stain, which binds to eggshell chitin. In the recovery tests in artificially spiked samples, the detection limit was 5 eggs in 100 g of commercial frozen bilberries and lingonberries. Taeniid eggs were detected in all of the 10 experimentally contaminated bilberry samples and in 10 of 11 lingonberry samples. The sieved debris was also analyzed for T. laticollis DNA using semi-quantitative PCR. All samples were positive in quantitative SYBR Green real-time PCR using a T. laticollis-specific primer pair amplifying a short fragment of mitochondrial NADH dehydrogenase subunit 1 gene. This indicates that forest berries contaminated in shrubs contained T. laticollis eggs, and that berries can serve as a vehicle for taeniid eggs and may pose a possible risk to humans.

Pegylated interferon and ribavirin combination therapy for chronic hepatitis C virus infection in patients with Child-Pugh Class A liver cirrhosis.

OBJECTIVE: Pegylated interferon (peg-IFN) and ribavirin (RBV) treatment is less effective in patients with hepatitis C virus (HCV) and liver cirrhosis than in non-cirrhotic patients. Many patients with advanced liver disease have been excluded from the pivotal randomized controlled studies. The aim of this study was to investigate the efficacy and tolerability of combination therapy in unselected patients with Child-Pugh Class A liver cirrhosis at a Swedish university clinic. MATERIAL AND METHODS: The virologic response and adverse events were retrospectively analyzed in 104 patients with HCV-associated Child-Pugh Class A liver cirrhosis who had been treated with peg-IFN and RBV. RESULTS: Overall sustained virologic response (SVR) was achieved in 13% genotype 1-, 60% genotype 2-, and 31% genotype 3-infected patients. In treatment-naive patients, the corresponding rates were 13%, 82%, and 38%, respectively. In 46% of patients, treatment was discontinued prematurely owing to lack of virologic response in the majority. CONCLUSIONS: SVR rates found in our study, in particular for genotype 1 patients (13%), were lower than those generally found in randomized controlled studies. For cirrhotic patients, new treatment alternatives are urgently needed to improve treatment outcome.