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2.
BMC Infect Dis ; 19(1): 1019, 2019 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-31791253

RESUMO

BACKGROUND: Chronic hepatitis C is a major public health burden. With new interferon-free direct-acting agents (showing sustained viral response rates of more than 98%), elimination of HCV seems feasible for the first time. However, as HCV infection often remains undiagnosed, screening is crucial for improving health outcomes of HCV-patients. Our aim was to assess the long-term cost-effectiveness of a nationwide screening strategy in Germany. METHODS: We used a Markov cohort model to simulate disease progression and examine long-term population outcomes, HCV associated costs and cost-effectiveness of HCV screening. The model divides the total population into three subpopulations: general population (GEP), people who inject drugs (PWID) and HIV-infected men who have sex with men (MSM), with total infection numbers being highest in GEP, but new infections occurring only in PWIDs and MSM. The model compares four alternative screening strategies (no/basic/advanced/total screening) differing in participation and treatment rates. RESULTS: Total number of HCV-infected patients declined from 275,000 in 2015 to between 125,000 (no screening) and 14,000 (total screening) in 2040. Similarly, lost quality adjusted life years (QALYs) were 320,000 QALYs lower, while costs were 2.4 billion EUR higher in total screening compared to no screening. While incremental cost-effectiveness ratio (ICER) increased sharply in GEP and MSM with more comprehensive strategies (30,000 EUR per QALY for total vs. advanced screening), ICER decreased in PWIDs (30 EUR per QALY for total vs. advanced screening). CONCLUSIONS: Screening is key to have an efficient decline of the HCV-infected population in Germany. Recommendation for an overall population screening is to screen the total PWID subpopulation, and to apply less comprehensive advanced screening for MSM and GEP.


Assuntos
Erradicação de Doenças , Hepatite C/prevenção & controle , Programas de Rastreamento/economia , Programas de Rastreamento/métodos , Adulto , Antivirais/economia , Antivirais/uso terapêutico , Estudos de Coortes , Análise Custo-Benefício , Testes Diagnósticos de Rotina/economia , Testes Diagnósticos de Rotina/estatística & dados numéricos , Erradicação de Doenças/economia , Erradicação de Doenças/métodos , Erradicação de Doenças/estatística & dados numéricos , Usuários de Drogas/estatística & dados numéricos , Feminino , Alemanha/epidemiologia , Infecções por HIV/diagnóstico , Infecções por HIV/economia , Infecções por HIV/epidemiologia , Custos de Cuidados de Saúde , Hepacivirus/genética , Hepacivirus/isolamento & purificação , Hepatite C/diagnóstico , Hepatite C/economia , Hepatite C/epidemiologia , Hepatite C Crônica/diagnóstico , Hepatite C Crônica/economia , Hepatite C Crônica/epidemiologia , Hepatite C Crônica/prevenção & controle , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Masculino , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Vigilância da População/métodos , Anos de Vida Ajustados por Qualidade de Vida , Minorias Sexuais e de Gênero/estatística & dados numéricos
3.
Wiad Lek ; 72(11 cz 2): 2218-2221, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31860840

RESUMO

Chronic infection with hepatitis virus C affects more than 70 million individuals worldwide. Hepatitis C infection is the leading cause of end-stage liver disease, hepatocellular carcinoma, and multiple extrahepatic manifestations associated with immune system disorders and chronic inflammation. In the era of interferon-free anti-HCV regimens, clinical care for patients with HCV-related liver disease and extrahepatic complications has advanced significantly because of improvements in therapy and prevention. The antiviral capacity of a new generation of direct-acting agents provide high rates of sustained virological response, and it is expected to improve clinical outcomes in these patient populations. The article aims to review published data on the treatment strategy of hepatitis C, including the EASL (European Association for the Study of the Liver) recommendations.


Assuntos
Hepatite C , Antivirais , Hepacivirus , Hepatite C/diagnóstico , Hepatite C/tratamento farmacológico , Humanos , Interferon-alfa
4.
Medicine (Baltimore) ; 98(51): e18334, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31860986

RESUMO

The aim of this study was to evaluate the effectiveness of hospital-based hepatitis C epidemic surveillance initiated by China's CDC STD/AIDS (National Center for AIDS/STD Control and Prevention of Chinese Center for Disease Control and Prevention) Prevention and Control Center in 2017.A total of 104,666 anti-hepatitis C virus (HCV) and 633 HCV-RNA detection records in our hospital from 2014 to 2017 were used to analyze the anti-HCV and HCV-RNA detection rates and positive rates in patients before and after implementation of epidemic surveillance.We found that the estimated HCV positive rate was 0.395% in all patients, and this rate increased to 0.533% after the pilot research. The positive rates of anti-HCV were significantly enhanced, although certain differences were observed among different departments. Significant increase of positive rate of HCV-RNA was only found in the inpatients from nonsurgical departments. Eighty-one cases were diagnosed after this pilot research, exceeding the 70 total cases in the previous 3 years. Most cases were diagnosed by nonsurgical departments; the upward trend of the cases diagnosed by surgical departments cannot be ignored.Our study indicates expanding anti-HCV and HCV-RNA detection in the target populations in hospitals is a useful strategy for finding more occult HCV infection. In addition, our results provide useful pilot data of the seroepidemiology of Hepatitis C for the special populations in hospitals, which will provide valuable information for public health research.


Assuntos
Hepatite C/diagnóstico , Hepatite C/epidemiologia , Vigilância da População , Anticorpos/sangue , China/epidemiologia , Hepacivirus/genética , Hepacivirus/imunologia , Humanos , Imunoglobulina G/imunologia , Pacientes Internados , Pacientes Ambulatoriais , Projetos Piloto , RNA Viral/sangue , Estudos Soroepidemiológicos
5.
Klin Lab Diagn ; 64(10): 607-612, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31742954

RESUMO

Liver cirrhosis in the outcome of hepatitis C is the leading cause of hepatocellular carcinoma (HCC) in the world. Early diagnosis and timely treatment of HCC are important for reducing mortality and increasing life expectancy of patients with hepatocellular carcinoma. To assess the risk of HCC, the definition of alpha-fetoprotein (AFP) in the blood is most widely used, but low sensitivity limits its diagnostic value. In 2012, a new HCC biomarker - osteopontin (OPN), which is a secreted phosphoprotein that has a high affinity for integrins was proposed. The level of acute renal failure begins to rise in the early stages of malignancy, before the period of HCC detection by imaging methods, and has significantly better sensitivity than AFP. The purpose of this study is to evaluate the diagnostic efficacy of the combined determination of alpha-fetoprotein and osteopontin in prospective monitoring of patients with chronic hepatitis C in the advanced phase of liver fibrosis. Monitoring of 588 patients with hepatitis C was carried out from February 2013 to February 2019. HCC was detected in 55 of them (2.6% per year). The combination of 2 biomarkers showed better diagnostic efficacy than alpha-fetoprotein and osteopontin separately: AUC 0.85 (95% CI 0.80-0.90) versus AUC 0.63 (95% CI 0.57-0, 70) and AUC 0.82 (95% CI 0.77-0.88), respectively. This combination showed a sensitivity of 85.5% and made it possible to diagnose HCC with a prognostic level of a positive result of 72.3% at 19,4±0,8 weeks before the diagnosis was confirmed by instrumental imaging methods (ultrasound, MRI, CT). In the combined variant, ARF made the greatest contribution to the increase in diagnostic efficacy (AUC). At an early and very early stage of HCC development, isolated HCC elevations were found in only 5.4% of patients. Conclusion: the combined use of alphafetoprotein and osteopontin as a diagnostic panel can be recommended for monitoring patients with liver cirrhosis in the outcome of hepatitis C and predicting HCC at an early stage of development.


Assuntos
Carcinoma Hepatocelular/diagnóstico , Hepatite C/diagnóstico , Neoplasias Hepáticas/diagnóstico , Osteopontina/sangue , alfa-Fetoproteínas/análise , Biomarcadores Tumorais/sangue , Detecção Precoce de Câncer , Humanos , Fragmentos de Peptídeos , Estudos Prospectivos
6.
BMC Infect Dis ; 19(1): 840, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31615434

RESUMO

BACKGROUND: CD40, encoded by TNFRSF5, participates in the survival of B cells, process of antigen presentation and generation of CD8+ T cell memory. It also has an important effect on HCV antiviral immune response. This study aims to investigate whether TNFRSF5 gene polymorphisms are associated with HCV infection outcomes among Chinese population. METHODS: Three single nucleotide polymorphism (SNPs) (rs1535045, rs1883832, rs4810485) on TNFRSF5 were genotyped by TaqMan assay among Chinese population, including 1513 uninfected subjects, 496 spontaneous viral clearance subjects and 768 persistent HCV-infected subjects. Logistic analysis was used to compare these SNPs among different groups in this cross-sectional study. Functional annotations of the identified SNPs were further evaluated by bioinformatics analysis. RESULTS: After adjusted by age, gender and routes of infection, the results of logistic analysis indicated that individuals carrying rs1535045 T allele had a higher risk to infect HCV compared with C allele (in recessive model, adjusted OR = 1.368, 95%CI = 1.070-1.749, P = 0.012). Subjects carried rs1535045 TT genotype were more likely to infect HCV than wild CC genotype (adjusted OR = 1.397, 95%CI = 1.078-1.809, P = 0.011). For rs1883832, T allele was significantly associated with an increased risk of HCV infection (in recessive model, adjusted OR = 1.337, 95%CI = 1.069-1.673, P = 0.011). Subjects with TT genotype had more possibility to infect HCV (adjusted OR = 1.351, 95%CI = 1.060-1.702, P = 0.015). In the stratified analysis, rs1535045 and rs1883832 were remained in various subgroups and the heterogeneity test showed no pronounced heterogeneity in any pairwise comparison (all P > 0.05). In addition, the results of the cumulative effects showed a tendency of that the more risk alleles (rs1535045 T and rs1883832 T) subjects carried, the more possibility of HCV infection exhibited (P<0.001). In haplotype analyses, compared with the CC haplotype, CT, TC and TT was correlated with an increased risk to infect HCV (P = 0.029, P = 0.047 and P<0.001, respectively). CONCLUSIONS: In conclusion, CD40 polymorphisms were significantly associated with the susceptibility to HCV among Chinese populations.


Assuntos
Grupo com Ancestrais do Continente Asiático/genética , Antígenos CD40/genética , Hepatite C/diagnóstico , Adulto , Idoso , Alelos , Feminino , Frequência do Gene , Predisposição Genética para Doença , Genótipo , Haplótipos , Hepatite C/genética , Humanos , Masculino , Pessoa de Meia-Idade , Polimorfismo de Nucleotídeo Único
7.
BMC Public Health ; 19(1): 1326, 2019 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-31640639

RESUMO

BACKGROUND: It is well documented that Egypt has the highest prevalence of hepatitis C virus (HCV) infection in the world. The recent development of highly effective direct acting antiviral drugs (DAAs), has opened the possibility of treating and curing HCV infection in the Egyptian population on a large scale. METHODS: A screening demonstration project was implemented in southern Egypt in and around the city of Luxor. Free screening and if indicated, treatment, was offered to those 16 years or older for anti-HCV antibodies (anti-HCV) and hepatitis B surface antigen (HBsAg) using third generation enzyme immunoassays (Enzygnost® Anti-HCV and HbsAg). Statistical methods included estimation of odds ratios (OR) and 95% confidence intervals (95% CI). RESULTS: There was a large turnout of 67,042 persons who were screened in a 12-month period starting in June 2016. Thirty-one thousand nine hundred sixty-four males (47.7%) and 35,074 females (52.3%) were screened with a mean age of 43.6 ± 14.3 years. Nine thousand seven hundred one patients (14.5%) were positive for anti-HCV and 2950 (4.4%) for HBsAg. Prevalence of anti-HCV was significantly higher in males than females (19.67% vs.9.73% OR = 2.27; CI 2.2 to 2.4; p < 0.001) and the same for HBsAg (6.2% vs. 2.8% OR = 2.3; CI 2.2 to 2.5; p < 0.001). The prevalence of anti-HCV was significantly associated with age (p < 0.001), ranging from between 1 and 4% in individuals below the age of 40 years, then increased steadily to 42% at age 60 followed by a precipitous decline in age specific prevalence. CONCLUSIONS: The results showed unanticipated patterns in the Luxor area of anti-HCV and HBsAg by age and gender in contrast to previous reports on this unique HCV epidemic in Egypt. Moreover, the level and rate of turnout, cost, and other logistical issues, provided essential information for effective planning, design, and evaluation methods for larger national mass screening and treatment programs.


Assuntos
Serviços de Saúde Comunitária/organização & administração , Hepatite B/diagnóstico , Hepatite C/diagnóstico , Programas de Rastreamento/estatística & dados numéricos , Adolescente , Adulto , Egito/epidemiologia , Feminino , Hepacivirus/isolamento & purificação , Hepatite B/epidemiologia , Antígenos de Superfície da Hepatite B/sangue , Hepatite C/epidemiologia , Anticorpos Anti-Hepatite C/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Soroepidemiológicos
8.
BMC Health Serv Res ; 19(1): 765, 2019 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-31660966

RESUMO

BACKGROUND: Direct Acting Antiviral (DAAs) drugs have a much lower burden of treatment and monitoring requirements than regimens containing interferon and ribavirin, and a much higher efficacy in treating hepatitis C (HCV). These characteristics mean that initiating treatment and obtaining a virological cure (Sustained Viral response, SVR) on completion of treatment, in non-specialist environments should be feasible. We investigated the English-language literature evaluating community and primary care-based pathways using DAAs to treat HCV infection. METHODS: Databases (Cinahl; Embase; Medline; PsycINFO; PubMed) were searched for studies of treatment with DAAs in non-specialist settings to achieve SVR. Relevant studies were identified including those containing a comparison between a community and specialist services where available. A narrative synthesis and linked meta-analysis were performed on suitable studies with a strength of evidence assessment (GRADE). RESULTS: Seventeen studies fulfilled the inclusion criteria: five from Australia; two from Canada; two from UK and eight from USA. Seven studies demonstrated use of DAAs in primary care environments; four studies evaluated integrated systems linking specialists with primary care providers; three studies evaluated services in locations providing care to people who inject drugs; two studies evaluated delivery in pharmacies; and one evaluated delivery through telemedicine. Sixteen studies recorded treatment uptake. Patient numbers varied from around 60 participants with pathway studies to several thousand in two large database studies. Most studies recruited less than 500 patients. Five studies reported reduced SVR rates from an intention-to-treat analysis perspective because of loss to follow-up before the final confirmatory SVR test. GRADE assessments were made for uptake of HCV treatment (medium); completion of HCV treatment (low) and achievement of SVR at 12 weeks (medium). CONCLUSION: Services sited in community settings are feasible and can deliver increased uptake of treatment. Such clinics are able to demonstrate similar SVR rates to published studies and real-world clinics in secondary care. Stronger study designs are needed to confirm the precision of effect size seen in current studies. Prospero: CRD42017069873.


Assuntos
Antivirais/uso terapêutico , Serviços de Saúde Comunitária/estatística & dados numéricos , Hepatite C/diagnóstico , Hepatite C/tratamento farmacológico , Programas de Rastreamento/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Pesquisa sobre Serviços de Saúde , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
9.
Rev Soc Bras Med Trop ; 52: e20190202, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31596352

RESUMO

INTRODUCTION: The prevalence of hepatitis C virus (HCV) infection is affected by demographic, virological, clinical, and lifestyle-related factors and varies in different regions in Brazil or worldwide. The present study aimed to clarify the epidemiological patterns of HCV infection in the interior region of Brazil. METHODS: This study was conducted in the Southern Triangle Macro-region of the state of Minas Gerais, Brazil, according to the guidelines of the National Program for the Prevention and Control of Viral Hepatitis. The participants answered a structured questionnaire on social and epidemiological factors. Immunochromatographic rapid tests were used for the qualitative detection of antibodies against HCV in whole blood (Alere HCV® Code 02FK10) in adult subjects by a free-standing method. RESULTS: Of 24,085 tested individuals, 184 (0.76%) were anti-HCV positive. The majority of anti-HCV-positive individuals were born between 1951 and 1980 (n=146 [79.3%]), with 68 women and 116 men. Identified risk factors included syringe and/or needle sharing (p = 0.003), being in prison (p = 0.004), and having tattoos or piercings (p = 0.005) and were significantly associated with the decade of birth. CONCLUSIONS: The study shows the importance of testing populations at risk for HCV infection, including incarcerated individuals, those with tattoos or piercings, those who share or have shared syringes or needles, and those in high-risk birth cohorts (1950s, 1960s, and 1970s) in the Southern Triangle Macro-region.


Assuntos
Hepacivirus/imunologia , Anticorpos Anti-Hepatite C/sangue , Hepatite C/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Estudos Transversais , Monitoramento Epidemiológico , Feminino , Hepatite C/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Adulto Jovem
10.
Acta Gastroenterol Belg ; 82(3): 379-387, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31566325

RESUMO

BACKGROUND AND STUDY AIMS: Hepatitis C virus (HCV) infection often causes asymptomatic disease and patients are frequently diagnosed at an advanced stage. Oral direct acting antivirals (DAAs) are successful in treating HCV with high sustained virologic response (SVR) and excellent tolerability. The aim of this study is to evaluate cost-effectiveness of a broad screening strategy proposing screening to all undiagnosed members of a population (comprehensive HCV screening), in the general adult population, emergency department (ED) attendees, men who have sex with men (MSM) and people who inject drugs (PWID). PATIENTS AND METHODS: We populated a theoretical model with Belgian data. A decision tree model simulating HCV screening and diagnosis was combined with a Markov state transition model simulating treatment. There was one screening round per year during five years. In the ED population only one screening round was considered. RESULTS: The model calculated that more HCV patients could be detected and treated with comprehensive screening compared to the current situation. Incremental cost per incremental quality adjusted life years (QALY) gained was lower than 10.000€/QALY for one and for five screening rounds in the general population (5.139 and 5.200 respectively), in ED attendees (one screening round 5.967), in MSMs (4.292 and 4.302 respectively) and in PWIDs (3.504 and 3.524 respectively). CONCLUSION: A broad screening strategy combined with treatment is likely to be a cost-effective strategy to detect and treat HCV infected patients and diminish the HCV burden in Belgium.


Assuntos
Testes Diagnósticos de Rotina/economia , Hepacivirus/isolamento & purificação , Hepatite C/diagnóstico , Hepatite C/economia , Programas de Rastreamento/economia , Vigilância da População/métodos , Adulto , Antivirais/uso terapêutico , Bélgica/epidemiologia , Análise Custo-Benefício , Hepatite C/tratamento farmacológico , Humanos , Masculino , Programas de Rastreamento/métodos , Minorias Sexuais e de Gênero
11.
Lancet ; 394(10207): 1451-1466, 2019 10 19.
Artigo em Inglês | MEDLINE | ID: mdl-31631857

RESUMO

Hepatitis C is a global health problem, and an estimated 71·1 million individuals are chronically infected with hepatitis C virus (HCV). The global incidence of HCV was 23·7 cases per 100 000 population (95% uncertainty interval 21·3-28·7) in 2015, with an estimated 1·75 million new HCV infections diagnosed in 2015. Globally, the most common infections are with HCV genotypes 1 (44% of cases), 3 (25% of cases), and 4 (15% of cases). HCV transmission is most commonly associated with direct percutaneous exposure to blood, via blood transfusions, health-care-related injections, and injecting drug use. Key high-risk populations include people who inject drugs, men who have sex with men, and prisoners. Approximately 10-20% of individuals who are chronically infected with HCV develop complications, such as cirrhosis, liver failure, and hepatocellular carcinoma over a period of 20-30 years. Direct-acting antiviral therapy is now curative, but it is estimated that only 20% of individuals with hepatitis C know their diagnosis, and only 15% of those with known hepatitis C have been treated. Increased diagnosis and linkage to care through universal access to affordable point-of-care diagnostics and pangenotypic direct-acting antiviral therapy is essential to achieve the WHO 2030 elimination targets.


Assuntos
Hepatite C/epidemiologia , Hepatite C/terapia , Hepatite C/diagnóstico , Humanos
12.
BMC Infect Dis ; 19(1): 821, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533734

RESUMO

BACKGROUND: Hepatitis C virus (HCV) is common in men who have sex with men (MSM) with HIV. The Swiss HCVree Trial targeted a micro-elimination by using a treat and counsel strategy. Self-reported condomless anal intercourse with non-steady partners was used as the selection criterion for participation in a counselling intervention designed to prevent HCV re-infection. The purpose of this study was to assess the ability of this criterion to identify men who engaged in other sexual risk behaviours associated with HCV re-infection. METHODS: Men who disclosed their sexual and drug- use behaviours during the prior 6 months, at study baseline, were included in the current study. Using a descriptive comparative study design, we explored self-reported sexual and drug-use risk behaviours, compared the odds of reporting each behaviour in men who reported and denied condomless anal intercourse with non-steady partners during the prior year and calculated the sensitivity/specificity (95% CI) of the screening question in relation to the other at-risk behaviours. RESULTS: Seventy-two (61%) of the 118 men meeting eligibity criteria reported condomless anal intercourse with non-steady partners during the prior year. Many also engaged in other potential HCV transmission risk behaviours, e.g., 52 (44%) had used drugs. In participants disclosing drug use, 44 (37%) reported sexualised drug use and 17 (14%) injected drugs. Unadjusted odds ratios (95% CI) for two well-known risk behaviours were 2.02 (0.80, 5.62) for fisting and 5.66 (1.49, 37.12) for injecting drug use. The odds ratio for sexualised drug use - a potential mediator for increased sexual risk taking - was 5.90 (2.44, 16.05). Condomless anal intercourse with non-steady partners showed varying sensitivity in relation to the other risk behaviours examined (66.7-88.2%). CONCLUSIONS: Although condomless anal intercourse with non-steady partners was fairly sensitive in detecting other HCV relevant risk behaviours, using it as the only screening criterion could lead to missing a proportion of HIV-positive men at risk for HCV re-infection due to other behaviours. This work also points to the importance of providing access to behavioral interventions addressing other sexual and drug use practices as part of HCV treatment. TRIAL REGISTRATION: Clinical Trial Number: NCT02785666 , 30.05.2016.


Assuntos
Infecções por HIV/patologia , Hepatite C/diagnóstico , Adulto , Infecções por HIV/complicações , Hepatite C/complicações , Homossexualidade Masculina , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Assunção de Riscos , Autorrelato , Comportamento Sexual , Transtornos Relacionados ao Uso de Substâncias/patologia
13.
BMC Res Notes ; 12(1): 523, 2019 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-31429797

RESUMO

OBJECTIVE: Dried blood spots (DBSs) can be used as an alternative to serum samples because they are easily collected and can be transported without refrigeration to reference laboratories for diagnosis. The present study was performed to evaluate the utility of electrochemiluminescence immunoassay "ECLIA" for anti-HCV, HBsAg and anti-HBc detection from DBS samples. RESULTS: Anti-HCV was detected in 103 DBS samples from 108 paired, positive serum and undetected in 364 DBS samples from 366 paired, negative specimens, giving a sensitivity of 95.4% and a specificity of 99.4%. HBsAg was detected in 67 DBS samples out of 71 positive, paired serum and was undetected among 295 DBS samples from 298 paired, negative specimens, giving a sensitivity and specificity of 94.4% and 99%, respectively. Anti-HBc was detected in 160 DBS samples from 185 paired, positive serum specimens and undetected in 349 DBS samples from 357 paired, negative serum specimens, giving a sensitivity of 86.5% and a specificity of 97.8%. Overall, the Kappa index indicated a high agreement between results obtained for the serum and DBS samples (k: 0.95, 0.93 and 0.86 for anti-HCV, HBsAg, anti-HBc, respectively). In conclusion, the ECLIA test could be used for detecting hepatitis B and C markers in DBS.


Assuntos
Bioensaio/métodos , Biomarcadores/sangue , Teste em Amostras de Sangue Seco/métodos , Hepatite B/diagnóstico , Hepatite C/diagnóstico , Automação , Humanos , Valor Preditivo dos Testes , Sensibilidade e Especificidade
14.
Indian J Med Microbiol ; 37(1): 60-66, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31424012

RESUMO

Introduction: Confirmatory diagnosis of hepatitis C virus (HCV) infection (HCV RNA detection) is essential before start of the therapy. HCV RNA detection is not available in many parts of India. Shipment of plasma from distant places to referral laboratories may affect HCV RNA titres. Dried blood spots (DBS) provide an easy alternative for transporting samples to centres where HCV RNA testing is done. Aim: Evaluation of DBS as a feasible alternative to plasma for HCV diagnosis. Methods: In this cross-sectional study, 40 consecutive patients' blood samples were collected from patients referred from the Liver Clinic. Whole blood was spotted onto two Whatman 903TM cards. One card was incubated at ≥37°C and other at 4°C for 15 days, after drying. DBS was eluted and run in Abbott RealTime HCV assay. HCV was also quantified using the Abbott ARCHITECT HCV core antigen assay for 29 of the study patients. Results were compared with normal plasma values. Results: The median log HCV RNA value (in log10IU/mL) of plasma was 5.74, with normalised DBS it was 4.92 (≥37°C) and 4.66 (4°C); difference in plasma and DBS median log values was 0.82 (≥37°C) and 1.08 (4°C) logs, respectively. Interclass correlation values were 0.943, P < 0.0001 (≥37°C) and 0.950, P < 0.0001 (4°C), showing high agreement. The median HCV core antigen value (in fmol/L) for plasma was 325.35, whereas it was 4.77 (≥37°C) and 4.64 (4°C) for DBS samples. Conclusions: DBS can be used for sampling patients from distant resource-limited settings as an alternative to plasma for HCV RNA estimation. Larger studies are required to evaluate the feasibility of DBS in the Indian subcontinent, especially for HCV core antigen estimation.


Assuntos
Teste em Amostras de Sangue Seco , Hepacivirus/isolamento & purificação , Hepatite C/diagnóstico , RNA Viral/sangue , Adulto , Estudos Transversais , Hepacivirus/genética , Hepatite C/virologia , Humanos , Pessoa de Meia-Idade , Projetos Piloto , Sensibilidade e Especificidade , Manejo de Espécimes/métodos
15.
BMC Infect Dis ; 19(1): 738, 2019 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-31438880

RESUMO

BACKGROUND: The technique most frequently used to genotype HCV is quantitative RT-PCR. This technique is unable to provide an accurate genotype/subtype for many samples; we decided to develop an in-house method with the goal of accurately identifying the genotype of all samples. As a Belgium National Centre of reference for hepatitis, we developed in-house sequencing not only for 5'UTR and core regions starting from VERSANT LiPA amplicons but also for NS5B regions. The sequencing of VERSANT LiPA amplicons might be useful for many laboratories worldwide using the VERSANT LiPA assay to overcome undetermined results. METHODS: 100 samples from Hepatitis C virus infected patients analysed by the VERSANT HCV Genotype 2.0 LiPA Assay covering frequent HCV types and subtypes were included in this study. NS5B, 5'UTR and Core home-made sequencing were then performed on these samples. The sequences obtained were compared with the HCV genomic BLAST bank. RESULTS: All the samples were characterised by the VERSANT LiPA assay (8 G1a, 17 G1b, 6 G2, 11 G3, 13 G4, and 10 G6). It was not possible to discriminate between G6 and G1 by the VERSANT LiPA assay for 8 samples and 27 had an undetermined genotype. Forty-one samples were sequenced for the three regions: NS5B, 5'UTR and Core. Twenty-three samples were sequenced for two regions: 5' UTR and Core and 36 samples were sequenced only for NS5B. Of the 100 samples included, 64 samples were analysed for 5'UTR and Core sequencing and 79 samples were analysed for NS5B sequencing. The global agreement between VERSANT LiPA assay and sequencing was greater than 95%. CONCLUSIONS: In this study, we describe a new, original method to confirm HCV genotypes of samples not discriminated by a commercial assay, using amplicons already obtained by the screening method, here the VERSANT LiPA assay. This method thus saves one step if a confirmation assay is needed and might be of usefulness for many laboratories worldwide performing VERSANT LiPA assay in particular.


Assuntos
Técnicas de Genotipagem/métodos , Hepacivirus/genética , Hepatite C/diagnóstico , Técnicas de Sonda Molecular , Kit de Reagentes para Diagnóstico , Análise de Sequência de RNA/métodos , Regiões 5' não Traduzidas , Sequência de Bases , Comércio , Genômica/métodos , Genótipo , Técnicas de Genotipagem/economia , Hepacivirus/isolamento & purificação , Hepatite C/virologia , Humanos , Técnicas de Sonda Molecular/economia , Filogenia , RNA Viral/análise , RNA Viral/isolamento & purificação , Kit de Reagentes para Diagnóstico/economia , Estudos Retrospectivos , Análise de Sequência de RNA/economia , Centros de Atenção Terciária
16.
BMC Res Notes ; 12(1): 466, 2019 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-31366401

RESUMO

OBJECTIVE: HIV positive individuals infected with viral hepatitis B (HBV) or C (HCV) are at an increased risk of progression to kidney and liver failures. Therefore, prior to initiation of antiretroviral therapy, early diagnosis and initiation of appropriate treatment protocols are imperative for co-infected individuals. This study evaluated the prevalence of HBV and HCV, and extent of liver and renal dysfunction among 90 newly diagnosed HIV patients attending the Cape Coast Teaching Hospital HIV clinic. RESULTS: Levels of alanine aminotransferase, aspartate-platelet ratio index and estimated glomerular filtration rate were used respectively to diagnose hepatotoxicity, liver fibrosis and chronic kidney disease (CKD). Association analyses were evaluated by Pearson's Chi-square test or Fisher's exact test and considered significant at p < 0.05. Using rapid diagnostic tests, 75.6% (n = 68) had HIV1 mono-infection, 24.4% (n = 22) had HIV1/HBV co-infection while 0.0% (n = 0) had HIV1/HCV co-infection. The prevalence of hepatotoxicity, liver fibrosis, and CKD were 7.8% (n = 7), 2.2% (n = 2), and 15.5% (n = 14) respectively. Similar proportions of HIV1/HBV and HIV1 were diagnosed with liver fibrosis (p = 0.431). In relation to hepatotoxicity Grade, a high proportion of HIV1/HBV were diagnosed with Grade 2 (p = 0.042). Also, severely reduced kidney function (CKD stage 4) was observed in only HIV1/HBV (n = 2, 9.1%, p = 0.053).


Assuntos
Infecções por HIV/fisiopatologia , Hepatite B/fisiopatologia , Hepatite C/fisiopatologia , Rim/fisiopatologia , Cirrose Hepática/fisiopatologia , Fígado/fisiopatologia , Insuficiência Renal Crônica/fisiopatologia , Adulto , Alanina Transaminase/sangue , Ácido Aspártico/sangue , Plaquetas/patologia , Coinfecção , Estudos Transversais , Feminino , Gana/epidemiologia , Taxa de Filtração Glomerular , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Infecções por HIV/virologia , Hepatite B/diagnóstico , Hepatite B/epidemiologia , Hepatite B/virologia , Hepatite C/diagnóstico , Hepatite C/epidemiologia , Hepatite C/virologia , Humanos , Rim/metabolismo , Rim/virologia , Fígado/metabolismo , Fígado/virologia , Cirrose Hepática/diagnóstico , Cirrose Hepática/epidemiologia , Cirrose Hepática/virologia , Testes de Função Hepática , Masculino , Pessoa de Meia-Idade , Prevalência , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/virologia
17.
J Pregnancy ; 2019: 7917894, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31316835

RESUMO

Background: Hepatitis B and hepatitis C viruses (HBV and HCV) are life-threatening infections of public health importance due to their association with cirrhosis and hepatocellular carcinoma. Despite HBV being moderately endemic in many low-income countries, there is no routine HBV vaccination among child bearing aged women making them at risk of transmitting infections to the foetus during pregnancy. This study investigated the seroprevalence of antihepatitis B surface antibodies (anti-HBs) and HCV antibodies among pregnant women in Mwanza city to provide data that can be used in devising preventive strategies. Methods: A cross-sectional hospital-based study involving 339 pregnant women was conducted between June and July 2017. Data were collected using structured data collection tool. Detection of anti-HBs was performed using enzyme immunoassay while qualitative rapid immunochromatographic tests were employed to detect HCV antibodies. Data was analyzed by using STATA version 13. Results: The mean age of the study participants was 25.6±5.8 years. The prevalence of anti-HBs was 85/339 (25.1%, 95% CI: 20.4-29.6) while that of HCV antibodies was 1/333 (0.3%, 95% CI: 0.1-0.4). By univariate logistic regression analysis, increase in age (OR: 1.04, 95% CI: 1.00-1.09, P=0.03), unknown HIV status (OR: 0.3, 95% CI: 0.11-0.79, P=0.035), and multigravidity (OR: 2.12, 95% CI: 1.18-3.8, P=0.038) were significantly associated with anti-HBs seropositivity. Conclusion: A significant proportion of pregnant women have anti-HBs while the seroprevalence of HCV is low among pregnant women in the city of Mwanza. Routine screening of HBV among pregnant women coupled with appropriate management should be emphasized in developing countries. Further studies to determine seroprevalence of HCV are recommended across the country.


Assuntos
Hepatite B/epidemiologia , Hepatite C/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Adolescente , Adulto , Estudos Transversais , Feminino , Hepatite B/sangue , Hepatite B/diagnóstico , Anticorpos Anti-Hepatite B/sangue , Antígenos de Superfície da Hepatite B/imunologia , Hepatite C/sangue , Hepatite C/diagnóstico , Anticorpos Anti-Hepatite C/sangue , Humanos , Modelos Logísticos , Gravidez , Complicações Infecciosas na Gravidez/sangue , Complicações Infecciosas na Gravidez/diagnóstico , Prevalência , Fatores de Risco , Estudos Soroepidemiológicos , Tanzânia/epidemiologia , Adulto Jovem
19.
BMC Infect Dis ; 19(1): 626, 2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-31307403

RESUMO

BACKGROUND: In the United States Hepatitis C virus (HCV) viral clearance is estimated to range between 20 and 30%. The objective of this study was to estimate the frequency of HCV clearance and identify correlates of viral clearance among patients newly identified as HCV antibody positive in a large urban health system in Los Angeles, California. METHODS: We identified patients between November 2015 and September 2017 as part of a newly implemented HCV screening and linkage-to-care program at University of California Los Angeles (UCLA) Health System. All patients were eligible for screening, though there were additional efforts to screen patients born between 1945 and 1965. We reviewed Medical records to categorize anti-HCV antibody positive patients as having spontaneously cleared HCV infection (HCV RNA not detected) or not (HCV RNA detected). We excluded those with a prior history of anti-HCV positivity or history of HCV treatment. We compared differences between those with and without detectable HCV RNA using chi-square test, Fisher's exact test, and t-test as appropriate. We assessed factors associated with HCV clearance using logistic regression analysis. RESULTS: Among the 320 patients included in this study, 56% were male. Baby boomers (52-72 years of age) comprised the single largest age group (62%). We found spontaneous HCV clearance in 58% (n = 185). HCV viral clearance was slightly higher among women as compared to men (63% vs. 53%; p value = 0.07) and varied by race/ethnicity: clearance among Blacks/African Americans was 37% vs. 58% among whites (p value = 0.02). After adjusting for age, race/ethnicity, and sex we found that those diagnosed with chronic kidney disease had a tendency of decreased HCV viral clearance (adjusted OR = 0.34; 95% CI 0.14-1.03). CONCLUSION: Of those patients newly identified as anti-HCV positive, 58% had cleared HCV virus, while the rest showed evidence of active infection. In addition, we found that clearance varied by race/ethnicity and clinical characteristics.


Assuntos
Hepacivirus/isolamento & purificação , Hepatite C/diagnóstico , Adolescente , Adulto , Afro-Americanos , Idoso , California/epidemiologia , Grupo com Ancestrais do Continente Europeu , Feminino , Hepacivirus/genética , Hepatite C/epidemiologia , Hepatite C/etnologia , Anticorpos Anti-Hepatite C/sangue , Humanos , Masculino , Pessoa de Meia-Idade , RNA Viral/sangue , Remissão Espontânea , Insuficiência Renal Crônica/diagnóstico , Estudos Retrospectivos , Adulto Jovem
20.
Vet Med Sci ; 5(3): 372-378, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31267690

RESUMO

BACKGROUND: Equine hepacivirus (EqHV) in equids represents the closest homologue to hepatitis C virus (HCV) infecting humans. A majority of HCV infected patients develop a chronic course of infection leading to liver fibrosis, cirrhosis and liver failure. However, in horses mostly transient mild subclinical infections are reported for EqHV to date. OBJECTIVES: EqHV can be involved in chronic liver diseases of horses. METHODS: Biochemical parameters in serum samples were measured. Viral load was determined using qPCR. Next generation sequencing (NGS) of serum was performed. Liver tissue was stained with haematoxylin and eosin and analysed for viral RNA with fluorescent in situ-hybridization. RESULTS: The horse showed symptoms of severe hepatopathy and was chronically infected with EqHV. Viral RNA was detectable in the liver during disease. To rule out other infectious agents NGS was performed and showed the highest abundance for EqHV. The identified virus sequence was similar to other circulating equine hepaciviruses. CONCLUSIONS: EqHV can be associated with liver disease in horses. Whether it causes the disease or contributes in a multifactorial manner needs further investigation.


Assuntos
Hepacivirus/isolamento & purificação , Hepatite C/veterinária , Doenças dos Cavalos/diagnóstico , Hepatopatias/veterinária , Animais , Doença Crônica/veterinária , Hepatite C/diagnóstico , Hepatite C/virologia , Doenças dos Cavalos/virologia , Cavalos , Hepatopatias/diagnóstico , Hepatopatias/patologia , Hepatopatias/virologia , Masculino
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