Eliminación de la hepatitis C. Documento de posicionamiento de la Asociación Española para el Estudio del Hígado (AEEH) / Elimination of hepatitis C. Positioning document of the Spanish Association for the Study of the Liver (AEEH)

La Asociación Española para el Estudio del Hígado (AEEH) está convencida de que la eliminación de la hepatitis C en España es posible siempre y cuando seamos capaces de emplear los recursos y las herramientas necesarias para la misma. Este documento refleja la posición de la AEEH respecto a la eliminación del virus de la hepatitis C (VHC), estableciendo una amplia serie de recomendaciones que se pueden agrupar en cinco categorías: 1) cribado del VHC en función de la edad, de la existencia de factores de riesgo clásicos de adquisición de la infección, búsqueda activa de pacientes diagnosticados con anterioridad y desarrollo de estrategias de microeliminación en poblaciones vulnerables; 2) simplificación del diagnóstico del VHC (diagnóstico en un solo paso y diagnóstico en el punto de atención del paciente); 3) simplificación del tratamiento de los pacientes y mejora de los circuitos asistenciales; 4) medidas de política sanitaria, y, finalmente, 5) establecimiento de indicadores de eliminación del VHC

The Spanish Association for the Study of the Liver (AEEH) is convinced that the elimination of hepatitis C virus (HCV) in Spain is possible as long as we are able to use the resources and tools necessary for it. This document reflects the position of the AEEH regarding the elimination of HCV, establishing a wide range of recommendations that can be grouped into five categories: 1) Screening of HCV according to age, of the existence of classic acquisition risk factors of infection, active search of previously diagnosed patients and development of microelimination strategies in vulnerable populations; 2) Simplification of HCV diagnosis (one-step diagnosis and diagnosis at the point of patient care); 3) Simplification of patient treatment and improvement of care circuits; 4) Health policy measures, and, finally, 5) Establishment of HCV elimination indicators

Hepatitis aguda C seronegativa: informe de dos casos / Acute seronegative hepatitis C: two case reports

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Seroprevalencia de hepatitis C en población con factores de riesgo del suroeste de la Comunidad de Madrid / Hepatitis C seroprevalence in an at-risk population in the southwest Madrid region of Spain

INTRODUCCIÓN: La seroprevalencia estimada del VHC en España es del 1,7%, cifra que es muy superior en la población con factores de riesgo. Se desconoce cuál sería la estrategia de cribado más eficiente en nuestro país. OBJETIVOS: Estimar la prevalencia del VHC en la población con factores de riesgo atendida en Atención Primaria (AP) y conocer su perfil epidemiológico. MATERIAL Y MÉTODOS: Estudio descriptivo transversal de prevalencia que incluyó a pacientes adultos con factores de riesgo de infección por VHC asistidos en AP de la zona suroeste de la Comunidad de Madrid entre 2010 y 2012. RESULTADOS: Se incluyó a 158 pacientes (H: 51,3%) con una edad media de 46 años (DE=16,6). Los factores de riesgo más frecuentes fueron la hipertransaminasemia (44,3%) y cirugía mayor (13,3%). La inmigración, las prácticas sexuales de riesgo y los tatuajes o piercing fueron más prevalentes en los menores de 45 años. Del total de pacientes, 15 (9,5%) presentaron anti-VHC positivo, de ellos 9 tenían ARN-VHC positivo (5,7%). De los pacientes positivos, 4 (44,4%) presentaron fibrosis significativa al diagnóstico (F3-F4). Los pacientes varones presentaron una mayor tasa de anti-VHC positivo (13,8 vs. 5,3%; p = 0,072), y también los pacientes mayores de 45 años (12,8 vs. 6,3%; p = 0,167). El uso de drogas parenterales se asoció a mayor tasa de anti-VHC positivo (50 vs. 8,5%; p = 0,005), así como el uso de drogas vía nasal (66,7 vs. 8,4%; p = 0,001). CONCLUSIONES: Los pacientes con factores de riesgo de infección por VHC presentan una elevada seroprevalencia. Por tanto, es necesario implantar programas de detección de la infección VHC en esta población en AP

INTRODUCTION: The estimated seroprevalence of hepatitis C virus (HCV) in Spain is 1.7%, but is much higher in the at-risk population. The most efficient national screening strategy is unclear. AIMS: To estimate the prevalence of HCV among the at-risk population seen in primary care (PC), and to determine their epidemiological profile. MATERIALS AND METHODS: Cross-sectional descriptive prevalence study that included adult patients with risk factors for HCV infection seen in PC in the southwest Madrid region between 2010 and 2012. RESULTS: A total of 158 patients (men=51.3%), mean age 46 years (SD=16.6), were included. The most common risk factors were hypertransaminasaemia (44.3%) and major surgery (13.3%). Immigration, unsafe sexual practices, and tattoos or body piercing were more prevalent in patients younger than 45 years of age. Fifteen patients (9.5%) were positive for anti-HCV; 9 of these (5.7%) were HCV-ARN positive. Of the positive patients, 4 (44.4%) had significant fibrosis at diagnosis (F3-F4). Male patients had a higher rate of positive anti-HCV results (13.8 vs. 5.3%; P=.072), as did patients older than 45 years of age (12.8 vs. 6.3%; P=.167). Intravenous and intranasal drug use were associated with a higher rate of positive anti-HCV results (50 vs. 8.5%; P=.005 and 66.7 vs. 8.4%; P=.001, respectively). CONCLUSIONS: Patients with risk factors for HCV infection have high seroprevalence. Screening programmes must therefore be implemented to detect HCV infection in this population in PC

Seroprevalence of HCV markers among HIV infected patients from Curitiba and metropolitan region / Soroprevalência de marcadores do vírus da hepatite C (HCV) em pacientes infectados com HIV de Curitiba e Região Metropolitana

SUMMARY Objective: to determine the prevalence and epidemiological factors associated with hepatitis (HCV) coinfection in human immunodeficiency virus (HIV) patients from Curitiba and the metropolitan region. Methods: a study with 303 HIV+ patients, mean age 41.2 years (18-73); 50.5% men, followed at the Hospital de Clínicas, Universidade Federal do Paraná, between April 2008 and March 2009. Clinical and epidemiological data were obtained through questionnaires and retrospective analysis of medical records. Anti-HCV antibodies were detected by chemiluminescence immunoassay. Results: a total of 12.9% of HIV+ patients were positive for anti-HCV antibodies, 64.1% were men and 35.9% women, with mean age of 44.5 years (24-66). The frequency of HCV among men was 16.7% and among women 9.1% (p=0.06). HCV prevalence was associated to HIV infection when compared to the general population (p<10-6, OR=100.4; 95CI=13.7-734.9). The parenteral route of transmission was the most frequent among coinfected patients (46.1%), and the sexual transmission among HIV+/HCV- (71.8%) (p=0.02, OR=0.2; 95CI=0.1-0.7). The frequency of intravenous drug users was higher among the coinfected patients (61.5%) compared to the non coinfected (12.6%) (p<10-6, OR=11.1; 95CI=4.5-27.7). Conclusion: the prevalence of coinfection with HCV in HIV+ patients is 12.9%, 88 times higher than in the general population in Curitiba. The most frequent route of transmission in the coinfected patients is parenteral, but the sexual route is also representative (34.6%).

RESUMO Soroprevalência de marcadores do vírus da hepatite C (HCV) em pacientes infectados com HIV de Curitiba e Região Metropolitana Objetivo: verificar a prevalência e caracterizar fatores epidemiológicos associados à coinfecção por HCV em pacientes HIV+ de Curitiba e Região Metropolitana. Métodos: estudo envolvendo 303 pacientes HIV+, com idade média de 41,2 anos (18-73); 50,5% homens; acompanhados no Hospital de Clínicas da Universidade Federal do Paraná, entre abril de 2008 e março de 2009. Os dados clínico-epidemiológicos foram obtidos por meio de questionários e análise retrospectiva dos prontuários. Os anticorpos anti-HCV foram detectados por ensaio imunoenzimático quimioluminescente. Resultados: dos pacientes HIV+, 12,9% apresentaram sorologia positiva para o HCV, sendo 64,1% homens e 35,9% mulheres, com idade média de 44,5 anos (24-66). A frequência nos homens foi de 16,7%, e nas mulheres, 9,1% (p=0,06). A prevalência do HCV foi significativamente associada à infecção por HIV quando comparada à população geral (p<10-6, OR=100,4; IC95%=13,7-734,9). A via de transmissão parenteral foi a mais frequente entre os coinfectados (46,1%), e a sexual, a mais frequente entre os não coinfectados (71,8%) (p=0,02, OR=0,2; IC95%=0,1-0,7). A frequência de usuários de drogas injetáveis foi maior entre os coinfectados (61,5%) do que entre os não coinfectados (12,6%) (p<10-6, OR=11,1; IC95%=4,5-27,7). Conclusões: a prevalência da infecção por HCV nos pacientes HIV+ é de 12,9%, 88 vezes maior que a infecção na população geral de Curitiba. A via de transmissão mais frequente entre os coinfectados foi a parenteral, porém, a via sexual também é representativa para a transmissão do HCV (34,6%).

Estrategias para la detección de infección por virus de la hepatitis C en población general / Strategies for the detection of hepatitis C viral infection in the general population

Objetivo: Evaluar cual de las 3 estrategias ensayadas es más efectiva para detectar nuevos casos de infección por virus de la hepatitis C (VHC) en atención primaria. Métodos: Estudio observacional, prospectivo y multicéntrico. Se evaluaron 3 estrategias: Estrategia 1: carta explicativa dirigida a personas adultas adscritas a 2 equipos de atención primaria (EAP), invitándoles a realizar un examen serológico. Estrategia 2: colocación en los EAP de pósteres y dípticos explicativos, ofreciendo la posibilidad de realizar un examen analítico. Estrategia 3: revisar el resultado de anti-VHC en los pacientes con hipertransaminasemia detectada en los últimos 2 años mediante la historia electrónica y efectuar determinación del anti-VHC en los casos en quienes no se había determinado. Resultados: Participaron 598 personas (51% mujeres con una media de edad de 50,6±13 años). Con la estrategia 1 se captaron 238 personas (4,1% de participación), con la estrategia 2, 69 personas (0,3%) y con la estrategia 3, 291 pacientes (100%). La detección de VHC oculto fue de un caso en las estrategias 1 y 2, representando una prevalencia del 0,4 y 1,4%, respectivamente, y de 2 casos en la estrategia 3 lo que representa una prevalencia de 0,7%. Conclusiones La búsqueda activa de casos ocultos de infección por VHC ha sido poco efectiva con los métodos ensayados, atendiendo al coste y esfuerzo que comportan (AU)

Objective: To evaluate which of the three studied strategies is the most effective to detect new cases of Hepatitis C virus (HCV) infections in primary care. Methods: This is an observational, prospective, and multicentre study evaluating three strategies. Strategy 1: provide an explanatory letter to adults assigned to two primary care teams (PCTs), inviting them to have a blood test. Strategy 2: place posters and leaflets in PCTs advertising the possibility of laboratory tests. Strategy 3: reexamine HCV antibody test results in patients with hypertransaminasemia diagnosed within the last two years through electronic records, and determine anti-HCV status in undiagnosed cases. Results: There were a total 598 participants (51% female with an average age of 50.6±13 years). There were 238 people (4.1% of letters sent) in Strategy 1, 69 people (0.3% of potential participation) in Strategy 2, and 291 people (100% participation) from Strategy 3. One new case of HCV was found in both Strategy 1 and Strategy 2, representing a prevalence of 0.4 and 1.4%, respectively. Two new cases of HCV were found in Strategy 3, representing a prevalence of 0.7%. Conclusions: The three studied strategies for detecting new cases of HCV infection are ineffective, especially in regards to their cost and effort (AU)

Infección oculta por el virus de la hepatitis C / Occult hepatitis C virus infection

La infección oculta por el virus de la hepatitis C (VHC) se caracteriza por la detección del ARN-VHC en hígado en ausencia de anti-VHC y de ARN-VHC en suero determinados mediante técnicas convencionales. El desarrollo de un nuevo EIA para la detección de anticuerpos frente a un epítopo conservado de la proteína core del VHC junto con la determinación del ARN-VHC en células mononucleares de sangre periférica y en suero tras concentrar las partículas virales mediante ultracentrifugación, permite diagnosticar a más del 90% de los pacientes con infección oculta por VHC sin necesidad de realizar una biopsia hepática. El daño histológico causado por la infección oculta por VHC comprende desde cambios mínimos hasta cirrosis y carcinoma hepatocelular, aunque en general es una enfermedad más benigna que la hepatitis crónica C clásica. Se ha detectado una prevalencia significativa de infección oculta por VHC en grupos de riesgo como pacientes en hemodiálisis y familiares de pacientes diagnosticados de hepatitis C oculta. Además, esta infección oculta puede darse en sujetos sin evidencias clínicas ni bioquímicas de enfermedad hepática (AU)

Occult hepatitis C virus (HCV) infection is characterized by the detection of HCV-RNA in liver in the absence of anti-HCV and serum HCV-RNA determined by conventional techniques. The development of a new enzyme immunoassay for the detection of antibodies against a conserved epitope in the HCV core protein, together with the detection of HCV-RNA in peripheral blood mononuclear cells and in serum after concentrating the viral particles by ultracentrifugation, allow diagnosis of more than 90% of patients with occult HCV without the need to perform a liver biopsy. Histological damage in occult HCV infection ranges from minimal changes to liver cirrhosis and hepatocellular carcinoma, although in general this disease isless severe than classical chronic hepatitis C. A significant prevalence of occult HCV infection has been identified in risk groups such as hemodialysis patients and the family members of patients with occult hepatitis C. This occult HCV infection can also be found in subjects without clinical or biochemical evidence of liver disease (AU)

Seroprevalencia de marcadores de hepatitis crónica vírica en 791 inmigrantes recientes en Cataluña, España. Recomendaciones de cribado y de vacunación contra la hepatitis B* / Seroprevalence of chronic viral hepatitis markers in 791 recent immigrants in Catalonia, Spain. Screening and vaccination against hepatitis B recommendations

Introducción. La prevalencia de las hepatitiscrónicas víricas en la Unión Europea variará debidoa la recepción de inmigrantes procedentes de paísescon elevada endemia de infección crónica por virusde la hepatitis B (VHB) y C (VHC). La inclusión desu cribado en inmigrantes sanos es un temadebatido en los planos de factibilidad, ética y decoste-efectividad.Los objetivos del estudio fueron: a) conocer laprevalencia de marcadores contra la hepatitiscrónica y, b) determinar una estrategia costeefectivade vacunación contra la hepatitis B.Población y método. Estudio observacionalprospectivo y multicéntrico a nivel de AtenciónPrimaria en Cataluña (España), definido sobrela población de inmigrantes sanos con menos de 5años de residencia en la Unión Europea.Resultados. Se estudiaron 791 individuos.Presentaron HBcAc+ 33% (intervalo de confianza[IC] 95% 29,6-36,1) y HBsAc+ 16,1% (IC 95%11,4-20,8). Presentaron antígeno de superficiepositivo (HBsAg+) 5,9% (IC 95% 3-8,7), de loscuales el antígeno soluble positivo (HBeAg+)15,62% (IC 95% 5,3-32,8). La poblaciónsubsahariana presentó la mayor prevalencia deHBcAc+ (77,3%) y de HBsAg+ (18,2%) y la latinoamericana, la menor (12,5% y 1,2%, respectivamente). La determinación serológica prevacunación se mostró coste-efectiva a partir de una seroprevalencia HBcAc+ >48,72%, valor sólo superado por el IC de la población subsahariana (IC 95% 68,6-86). Presentaron anticuerpos contra el virus de la hepatitis C (HCAc+) 6,1% (IC 95%4,3-7,8), especialmente el colectivo de EuropaOriental (19,6%) e Indostán (14,9%). La comunidadcon menor prevalencia fue asimismo lalatinoamericana (1,4%).Discusión. La prevalencia de marcadores dehepatitis crónica vírica se sitúa en un nivelintermedio entre las descritas en los ámbitos deAtención Primaria y especializada. La poblacióninmigrante en su conjunto muestra prevalencias demarcadores HBsAg+ y HCAc+ que hacenrecomendable su cribado excepto para el colectivolatinoamericano. La determinación serológica previaa la vacunación sólo es coste-efectiva en el colectivosubsahariano

Introduction. The prevalence of chronic viralhepatitis in the European Union (EU) will varybecause of the immigrants coming from countrieshaving an elevated with a higher endemicity ofhepatitis B (HBV) and C virus (HCV). Serologicscreening in healthy immigrants is a subject that hasbeen discussed in the areas of feasibility, ethics andcost-effectiveness. The main study aims were: a) toknow the prevalence of chronic hepatitis markersand, b) to determine the best cost-effectivenessstrategy of vaccination against hepatitis B.Population and Method. An observational,perspective and multicenter study was performed onthe Primary Care level in Catalonia (Spain) amonghealthy immigrants who had lived in the EU for lessthan 5 years.Results. Data from 791 individuals were analyzed.They presented anti-HBc+ 33% (95% CI 29.6 -36.1),and anti-HBs+ 16.1% (95% CI 11.4 -20.8). HBsAg+was 5.9% (95% CI 3-8.7), of those were HBeAg+15.62% (95% CI 5.3-32.8). The sub-Saharan grouppresented the higher prevalence of anti-HBc+(77.3%) and HBsAg+ (18.2%), whereas the LatinAmerican-origin population displayed the lowest one(12.5% and 1.2%, respectively). Determination ofantibodies prior to vaccination was found ascost-effective from a seroprevalence anti-HBc+>48.72%; only overcome by the CI of sub-Saharanpopulation (95% CI 5.3-32.8). The prevalence ofanti-HC+ was 6.1% (95% CI 4.3-7.8), especially highamong the Eastern European (19.6%) and Indostanic(14.9%) population. The Latin American group hadthe lowest prevalence (1.4%).Conclusions. The prevalence of chronic viralhepatitis markers is found to be at an intermediatelevel between those described by primary andspecialized care levels. The prevalences of HBsAg+and anti-HC+ in the immigrant population, on thewhole, are such that it is advisable to screening forthem, with the exception of the Latin Americancommunity. Previous serologic determination ofmarkers is only cost-effective among the sub-Saharan community

Hepatitis C en España / Hepatitis C in Spain

La prevalencia de anticuerpos frente al virus de la hepatitis C (VHC) en España se sitúa entre la de los países del centro de Europa y la de Italia y varía de unas regiones a otras. Oscila entre el 1,6 y el 2,6%, lo que permite calcular que en España debe de haber entre 480.000 y 760.000 personas infectadas por el VHC. En la población de menos de 20 años la prevalencia es muy baja y a partir de los 30 años va aumentando en relación con la edad. Presos y drogadictos son quienes presentan las tasas más elevadas de infección, entre un 40 y un 98%. Algunas poblaciones de inmigrantes tienen una prevalencia elevada de infección por el VHC, como los asiáticos y los subsaharianos, mientras que los procedentes de Latinoamérica presentan tasas más bajas que la población autóctona. Los pacientes españoles con hepatitis C crónica se infectaron mayoritariamente por transfusiones de sangre, uso de droga por vía intravenosa o durante alguna hospitalización médica y quirúrgica. La reducción del consumo de drogas intravenosas y los programas de intercambio de jeringuillas, así como la eliminación de las hepatitis postransfusionales, han determinado que la incidencia de nuevas infecciones se haya reducido progresivamente: se ha pasado de 6,8 por 100.000 habitantes en 1997 a 2,3 en 2003. Datos preliminares indican que una proporción importante de los nuevos casos de hepatitis C se debe a transmisión nosocomial. En los niños pequeños la transmisión es casi exclusivamente de carácter vertical. A pesar de la reducción de dos tercios de los casos incidentes de hepatitis C que se ha producido en España en los últimos años, es previsible que en los próximos aumente el número de pacientes con enfermedad hepática avanzada debida al VHC que serán atendidos en el sistema sanitario, ya que es previsible que muchos casos ahora no diagnosticados sean reconocidos por primera vez a raíz de algunas de las complicaciones de la enfermedad. Todos los esfuerzos para incrementar el cribado de casos ocultos de hepatitis crónica C en los centros de atención primaria a fin de que reciban tratamiento antes de que alcancen una fase avanzada tendrán un impacto beneficioso en términos económicos y sociales

Spain has a medium endemicity of hepatitic C infection among central Europe countries and Italy. Prevalence of anti-HCV varies among regions and it ranges from 1.6 to 2.6%, which means that there may be between 480,000 and 760,000 people infected with hepatitis C virus in Spain. The prevalence is very low in people under 20 years of age and it increases from age 30 years. Prisoners and drug addicts have the highest infectious rates, between 40 and 98%. Some populations of immigrants also have a high prevalence of HCV infection, especially people from Asia and sub-Saharan countries, whereas people from Latin America have rates lower than those in the autochtones population. Spanish people with chronic hepatitis C were mainly infected via blood transfusions, IV drug use, or during some medical and surgical hospitalization. The reduction in the use of IV drugs and the programs of needle sharing, as well as the eradication of post-transfusional hepatitis, have led to a progressive reduction in the incidence of new infections (from 6.8 per 100,000 in-habitants in 1997 to 2.3 in 2003). Preliminary data suggest that an important rate of new hepatitis C cases owe to nosocomial transmission. Transmission is almost exclusively vertical in children. In spite of a two-third reduction of incident cases of hepatitis C in Spain in last few years, it is foreseeable that the number of patients with advanced HCV liver disease attended in the health-care system will increase in forthcoming years. This is due to the fact that many, still undiagnosed patients will be likely recognized for the first time as a result of some complication of the disease. All efforts to increase the screening of hidden cases of hepatitis C in primary health-care centers, allowing a prompt treatment before an advanced stage, will have a beneficial impact both in economic and social terms

Características y situación clínica de la población reclusa infectada por el VIH de los centros penitenciarios españoles / Characteristics and clinical situation of the HIV infected inmate population in spanish prisons

Objetivos: Conocer características sociodemográficas/clínicas de los presos VIH +Pacientes y Método: Estudio observacional de tipo transversal. Se selecciona a los 25 primeros pacientes de 8 Centros Penitenciarios que pasaron consulta un día designado de julio de 2003. Se analizan 199 pacientes.Resultados: El 76,4% llevan ingresados en prisión más de 3 años. Presentan antecedentes UDI el 92,5%. Un 21,6% (47) refieren consumo actual de heroína y/o cocaína. En tratamiento con metadona están 132 (66,3%). 32 pacientes han padecido TBC y el 35,2% ITL. 178 de 193 (92%) presentaban anticuerpos de VHC, 150 de 189 (79,3%) presentaban HBC Ac. positivo. 11 de 186 (5,9%) HBSAg positivo. De 178 pacientes coinfectados por VHC, tienen realizada PCR de virus C 65 (36,5%) y es positiva en 62 (95,4%). Cumplen criterios de SIDA 44 (22,3%). 32 (16,8%) presentaban CD4<200. La media de CD4 esde 443,3 (±251,0). 110 (55,3%) han recibido algún TARV. 106 (54,8%) reciben TARV actualmente y de los 192 que tienen realizada una CV de VIH en 82 (42,7%) es < 400.Conclusiones: El control de la infección VIH es correcto en el medio penitenciario, presentando los pacientes una buena situación clínica de media. Es necesario el establecimiento de programas para el control y tratamiento de las hepatitis virales

Background: We set out to establish the socio-demographical and clinical characteristics of HIV infected inmates.Patients and Methods: Cross-sectional observation study. The first 25 patients in 8 diffferent prisons were selected during surgery time on a designated day in July 2003. 199 patients were analysed.Results: 76.4% had been in prison for more than 3 years. 92.5% had an IDU history. 21.6% (47) required consumptionof heroin and/or cocaine at the time. 66.3% (132) were receiving methadone treatment. 32 patients had TB and 35.2% LTI. 178 out of 193 (92.2%) had HCV antibodies, 150 out of 189 (79.4%) were HBC Ac positive. 11 out of 186 (5.9%) were HBSAg positive. Out of the 178 HIV co-infected patients, 65 (36.5%) carried out PCRof virus C and were positive in 62 cases (95.4%). AIDS criteria were complied with in 44 cases (22.3%). 32 (16.8%) showed CD4<200. The CD4 mean was 443.3 (± 251.0). 110 (55.3%) had received some type of ARVT. 106 (54.8%) were receiving ARVT at the time and out of the 192 thathad recived an HIV VC the result was <400 in 82 (42.7%) of them.Conclusions: Controls of HIV were adequate for the prison population. Inmates showed a good mean clinical condition. The establishment of viral hepatitis control and treatment programs are necessary

Glucogenosis hepática y diabetes / Hepatic glycogenosis and diabetes mellitus

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Aceptación de un programa de diagnóstico y tratamiento de la Infección por el virus de la Hepatitis C por la población interna en el C.P. de Sevilla / Acceptance of a diagnosis programme and treatment of infection caused by the hepatitis C virus by inmates of Seville prison

Fundamento: La Hepatitis C es un serio problema de salud en las prisiones, por su altísima prevalencia y por la gravedad de sus complicaciones. Por ello pusimos en marcha un programa para combatir esta infección, en colaboración con nuestro hospital de referencia. Objetivos: Obtener información sobre prevalencia de genotipos virales y lesiones histológicas más frecuentes. Proporcionar la mejor atención posible a los afectos de esta patología. Valorar el grado de aceptación de las intervenciones previstas en el programa por parte de los internos. Método y pacientes: Diseño y puesta en marcha de un protocolo de actuación conjunto con la unidad de referencia hospitalaria. Dirigido a los internos con anticuerpos anti-VHC del C.P. de Sevilla. Se describen las características generales de los pacientes incluidos en el período estudiado (01-06-00/31-05-02) y el grado de aceptación obtenido. Los resultados se expresan en numerales absolutos y porcentajes. Resultados: 117 pacientes incluidos. 114 (97,4%) aceptan participar y 3 no. 112 hombres y 5 mujeres con un rango de edad entre 21 y 50 años. 86 pacientes ya iniciaron el programa. El genotipo más frecuente es el 1 (a ó b). 52 biopsias hepáticas realizadas y 10 más programadas. 44 tratamientos iniciados con 11 abandonos, sólo dos por efectos secundarios. Distribución genotípica: Genotipo 1 (a ó b): 51,02%; Genotipo 2: 6,12%; Genotipo 3: 32,65%; Genotipo 4 (c ó d): 10,20%. Conclusiones: El programa es mayoritariamente aceptado por los internos. Se debe potenciar la implantación de estos programas en las prisiones como mejor manera de prevenir la futura mortalidad por esta causa (AU)

Background: Hepatitis C is a major health problem in prisons because of its high prevalence and the seriousness of its complications. For this reason we implemented a programme to combat this infection, in collaboration with our referral hospital. Objectives: To obtain information on the prevalence of the most common viral genotypes and histological lesions. To provide the optimum attention possible to those affected with this pathology. To assess the degree of acceptance of the treatments envisaged in the programme by the inmates. Method and patients: Design and implementation of a joint action protocol with the referral hospital. Directed at inmates with anti-HCV antibodies in Seville Prison. The general characteristics of the patients included in the period under study (01-06-00 to 31-05-02) are described, and the degree of acceptance obtained. The results are expressed in absolute numbers and percentages. Results: 117 patients included. 114 (97,4%) agreed to take part and three declined. 112 men and 5 women with ages ranging between 21 and 50 years. 86 had already begun the programme. The most frequent genotype was 1 (a or b). 52 hepatic biopsies carried out and 10 more programmed. 44 treatments begun with 11 interruptions, with just two because of side effects. Genotype distribution: Genotype 1 (a or b): 51,02%; Genotype 2: 6,12%; Genotype 3: 32,65%; Genotype 4 (c or d): 10,20%. Conclusions: The programme was mostly accepted by the inmates. Implementation of these programmes in prisons should be enhanced as the best way of preventing future mortality from this cause (AU)

Transmisión familiar del virus de la hepatitis C en un grupo de población chilena / Familial transmission of hepatitis C virus infection in Chilean subjects

BACKGROUND: Intravenous drug use, sexual promiscuity and a longer cohabitation period are considered risk factors for familial transmission of hepatitis C virus. The relative importance of this type of transmission is a subject of controversy. AIM: To study familial clustering of hepatitis C virus infection and its risk factors. MATERIAL AND METHODS: HCV positive patients (91 with chronic hepatitis, 88 with cirrhosis, nine with hepatic carcinoma and 29 hemophiliacs) were the index cases. HCV antibodies were measured by ELISA and the type of relationship with the index case was investigated in 317 family members. RESULTS: Positive anti HVC antibodies were detected in 12 of 243 family members of patients with chronic liver disease and in none of the family members of patients with hemophilia. Of these, five were couples of an index case with a long cohabitation period. Ten members had an index case with a severe liver disease (three with Child C cirrhosis and seven with liver carcinoma). CONCLUSIONS: Family transmission of HCV infection is uncommon in Chile. The association of severe liver disease and family transmission could be due to a higher viral load as responsible for transmission during the early periods of a long lasting disease.

Evaluation of an enzyme immunoassay for hepatitis C virus antibody detection using a recombinant protein derived from the core region of hepatitis C virus genome

This study was undertaken to evaluate an enzyme immunoassay (EIA) for hepatitis C virus antibody detection (anti-HCV), using just one antigen. Anti-HCV EIA was designed to detect anti-HCV IgG using on the solid-phase a recombinant C22 antigen localized at the N-terminal end of the core region of HCV genome, produced by BioMérieux. The serum samples diluted in phosphate buffer saline were added to wells coated with the C22, and incubated. After washings, the wells were loaded with conjugated anti-IgG, and read in a microtiter plate reader (492 nm). Serum samples of 145 patients were divided in two groups: a control group of 39 patients with non-C hepatitis (10 acute hepatitis A, 10 acute hepatitis B, 9 chronic hepatitis B, and 10 autoimmune hepatitis) and a study group consisting of 106 patients with chronic HCV hepatitis. In the study group all patients had anti-HCV detected by a commercially available EIA (Abbott(r)), specific for HCV structural and nonstructural polypeptides, alanine aminotransferase elevation or positive serum HCV-RNA detected by nested-PCR. They also had a liver biopsy compatible with chronic hepatitis. The test was positive in 101 of the 106 (95 percent) sera from patients in the study group and negative in 38 of the 39 (97 percent) sera from those in the control group, showing an accuracy of 96 percent. According to these results, our EIA could be used to detect anti-HCV in the serum of patients infected with hepatitis C virus.

A clinical, epidemological, laboratorial, histological and ultrasonographical evaluation of anti-HCV EIA-2 positive blood donors

Between 1992 and 1997, 790 blood donors with anti-HCV EIA-2 strongly reagent (relationship between the sample optical density/cut-off > 3) detected at the blood bank serological screening, were evaluated in ambulatory environment. They were all negative for Chagas disease, syphilis, hepatitis B (HBsAg) and AIDS. Blood samples were collected at the first ambulatorial evaluation, for hemogram, biochemical tests and new serological tests for HCV (anti-HCV EIA-2). In blood samples of 226 repeatedly reagent anti-HCV EIA-2 blood donors, supplementary "immunoblot" test for HCV (RIBA-2) was used. In 209 donors, the presence of HCV-RNA was investigated by the PCR test. The abdominal ultrasonography was realized in 366 donors. In 269 patients liver biopsy was performed for the histopathological study. The follow-up of blood donors showed that 95.6 percent were repeatedly EIA-2 reagent, 94 percent were symptomless and denied any hepatitis history, with only 2 percent mentioning previous jaundice. In 47 percent of this population at least one risk factor has been detected for the HCV transmission, the use of intravenous drugs being the main one (27.8 percent). Blood transfusion was the second factor for HCV transmission (27.2 percent). Hepatomegaly was detected in 54 percent of the cases. Splenomegaly and signs of portal hypertension have seldom been found in the physical examination, indicating a low degree of hepatic compromising in HCV. Abdominal ultrasound showed alterations in 65 percent of the subjects, being the steatosis the most frequent (50 percent). In 83.5 percent of the donors submitted to the liver biopsy, the histopathological exam showed the presence of chronic hepatitis, usually classified as active (89 percent) with mild or moderate grade in most of the cases (99.5 percent). The histopathological exam of the liver was normal in 1.5 percent of blood donors. The RIBA-2 test and the HCV-RNA investigation by PCR were positive in respectively 91.6 and 75 percent of the anti-HCV EIA-2 reagent donors. The HCV-RNA research was positive in 82 percent of the RIBA-2 positive subjects, in 37.5 percent of the indeterminate RIBA-2 donors and in 9 percent of the negative RIBA-2 donors. Chronic hepatitis has also been observed in 50 percent of the histopathological exams of the anti-HCV EIA-2 reagent donors which were indeterminate RIBA-2...

Infección por el virus de la hepatitis C y embarazo / Hepatitis C virus infection and pregnancy

Objetivo: Revisar la epidemiología de la transmisión del virus de la hepatitis C (HCV), haciendo énfasis en los riesgos y conductas durante la gestación.Fuentes: Literatura médica desde el año 1988 hasta junio de 1999 a través del MEDLINE.Método de selección de los estudios: Series de casos que evaluaron la transmisión vertical del HCV.Resultados: La transmisión vertical de la infección se evalúa en relación con la infección concomitante del virus de inmunodeficiencia humana (HIV). El riesgo de transmisión perinatal de HCV es del 15,4 por 100 (IC95 por 100 11,1-20,8) en infectadas además con el HIV y de 2,6 por ciento (IC95 por 100 1,3-4,8) en no infectadas. La transmisión a través de la lactancia se ha demostrado en casos de enfermedad activa.Conclusión: Durante la gestación el HCV se puede transmitir de madre a feto principalmente durante el trabajo de parto y el riesgo de transmisión vertical depende de la carga viral, del estado de la enfermedad y de la coinfección por el HIV. El cuidado obstétrico de las pacientes infectadas pretende evitar las intervenciones que supongan intercambio sanguíneo materno fetal. La vía final de evacuación del feto no está lo suficientemente estudiada. La lactancia debe evitarse en pacientes sintomáticas o con viremia alta (AU)

Pesquisaje del anti-hcv en pacientes trasfundidos, pertenecientes a un área de salud atendida por el médico de la familia. Consultorio Médico 19 de abril / Research of anti-HCV in patients transfused, in a health area attended by a physician of the family. Medical office 19 de abril

The infection by the virus the hepatitis C (VHC) constitutes a health problem at world level. This situation has resulted in numerous researchers developing and using different means of diagnosis in order to know the actual prevalence of the virus. The main way of VHC transmission is blood and/or haemoderivates transfusion. It has been estimated that 90 per cent of post-transfusional hepatitis are VHC. This situation motivated us to make a descriptive and transversal study in order to screen VHC in a group of patients who had been transfused with blood and/or haemoderivates. The patients came from the medical doctor's office N(o) 36 belonging the polyclinic "19 de April", in the city of Havana. The objective was to study the prevalence of the virus in our area and also to precise the main causes of the transfusion and the relationship between their number and the presence of anti-HVC. We found 35 patients who had been transfused (5.3 per cent) in the population (653), and from these, three patients (8.5 per cent) were anti-HVC positive. The main cause for having been transfused was anemia, being sicklemia the entity, which reported more patients with anti VHC positive. We also conclude that the probability of having an anti-HVC positive increases proportionally to the number of transfusions; these were significant differences between the groups who received a greater and a smaller number of transfusions.

Pesquisaje del anti-hcv en pacientes trasfundidos, pertenecientes a un área de salud atendida por el médico de la familia. Consultorio Médico 19 de abril / Research of anti-HCV in patients transfused, in a health area attended by a physician of the family. Medical office 19 de abril

The infection by the virus the hepatitis C (VHC) constitutes a health problem at world level. This situation has resulted in numerous researchers developing and using different means of diagnosis in order to know the actual prevalence of the virus. The main way of VHC transmission is blood and/or haemoderivates transfusion. It has been estimated that 90 per cent of post-transfusional hepatitis are VHC. This situation motivated us to make a descriptive and transversal study in order to screen VHC in a group of patients who had been transfused with blood and/or haemoderivates. The patients came from the medical doctors office N(o) 36 belonging the polyclinic "19 de April", in the city of Havana. The objective was to study the prevalence of the virus in our area and also to precise the main causes of the transfusion and the relationship between their number and the presence of anti-HVC. We found 35 patients who had been transfused (5.3 per cent) in the population (653), and from these, three patients (8.5 per cent) were anti-HVC positive. The main cause for having been transfused was anemia, being sicklemia the entity, which reported more patients with anti VHC positive. We also conclude that the probability of having an anti-HVC positive increases proportionally to the number of transfusions; these were significant differences between the groups who received a greater and a smaller number of transfusions. (Au)

The seroprevalence of hepatitis B and C in an Amerindian population in the southwestern Brazilian Amazon

A soroprevalência de hepatite B e C foi investigada na comunidade indígena Karitiana (n = 119), que habita o Estado de Rondônia, Amazônia Ocidental Brasileira. A prevalência de anticorpos anti-HBs e anti-HBc foi respectivamenre de 16,1 por cento e 35,3 por cento, sendo detectado HBsAg em somente quatro (3,4 por cento) indivíduos. Anticorpos anti-HCV foram encontrados em dois (1,7 por cento), indivíduos. Os dados estratificados por idade sugerem que tanto as vias de transmissäo vertical como horizontal (esta entre adultos) säo importantes nesta comunidade