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Untersuchungen zur Effizienz und zum Nebenwirkungsspektrum einer Interferon-haltigen Therapie der chronischen Hepatitis C unter besonderer Berücksichtigung hämatologischer Veränderungen / Studies on the effectiveness and side effect spectrum of a Interferon-based therapy for chronic hepatitis C with special Consideration of hematological changesDüll, Michaela January 2010 (has links) (PDF)
In der vorliegenden Arbeit wurden die Behandlungsabläufe von Patienten mit chronischer Hepatitis C unter Therapie mit Standard-Interferon (Kollektiv 1) bzw. mit pegyliertem Interferon (Kollektiv 2) ausgewertet. Die meisten Patienten erhielten eine Kombinationstherapie mit Ribavirin. Es bestand Strukturgleichheit für die Kollektive hinsichtlich Alter, Geschlecht, BMI vor Therapie, Übertragungsweg der Hepatitis, Hepatitis B-Infektion, HAI-Grading-Score und HAI-Staging-Score. Ein signifikanter Unterschied bestand für das Merkmal HIV-Koinfektion. Nach Therapiebeginn zeigte sich ein schnell einsetzendes serologisches und virologisches Ansprechen. Patienten unter Therapie mit pegyliertem Interferon und Ribavirin hatten die besten Chancen auf ein anhaltendes Therapieansprechen. Eine early virological Response war ein guter Prädiktor für das Erreichen einer sustained virological Response. Die meisten Patienten berichteten über Nebenwirkungen unter Therapie. Die häufigsten Nebenwirkungen waren Müdigkeit und Schmerzen, v.a. in Form von Kopfschmerzen. Diese kamen jeweils bei ca. 70% der Patienten vor. Eine Anämie trat bei ca. 9% der Patienten auf. Hämatokrit, Hämoglobin und Erythrozyten sanken im Kollektiv 2 stärker ab als im Kollektiv 1. Unter Kombinationstherapie mit Ribavirin sank das Hämoglobin zudem mehr ab als unter Interferon- Monotherapie, was auf den hämolytischen Effekt des Ribavirins zurückzuführen ist. Thrombozyten fielen unter Kombinationstherapie im Kollektiv 1 deutlich geringer ab als im Kollektiv 2, was durch einen stärkeren myelosuppressiven Effekt des pegylierten Interferons bedingt sein könnte. Im Kollektiv 1 sanken die Thrombozyten unter Monotherapie stärker ab als unter Kombinationstherapie. Leukopenien traten häufiger unter Therapie mit pegyliertem Interferon auf. Insgesamt zeigte sich im hier analysierten Kollektiv ein geringes Risiko für eine Neutropenie oder Lymphopenie. Vor allem ältere Patienten mit niedrigen neutrophilen Granulozyten bzw. Lymphozyten vor Therapie schienen ein erhöhtes Risiko für eine Neutropenie bzw. Lymphopenie zu haben. Das Therapieansprechen und die Therapiedauer waren für Patienten mit bzw. ohne Leukopenie, Neutropenie oder Lymphopenie ähnlich. Für Infektionen fand sich ebenfalls kein signifikant erhöhtes Risiko bei Patienten mit Leukopenie, Neutropenie oder Lymphopenie. 16% der Patienten im Gesamtkollektiv hatten eine Infektion unter Therapie. Es zeigte sich kein Unterschied zwischen Kollektiv 1 und 2 für Infektionen unter Therapie. Patienten mit bzw. ohne Infektion wurden hinsichtlich der Merkmale Alter, Geschlecht, BMI, Hepatitis B-Infektion, Hepatitis G/GB-Infektion und HIV-Infektion verglichen. Zudem wurden die prätherapeutischen Laborwerte Ferritin, Viruslast, Eisen, TSH, GPT, GOT, Hämoglobin, Hämatokrit, Leukozyten, neutrophile Granulozyten, Lymphozyten, Thrombozyten und Erythrozyten gegenübergestellt und Therapiedauer und Therapieansprechen für Patienten mit bzw. ohne Infektion erhoben. Für keines dieser Kriterien lag ein signifikanter Unterschied zwischen Patienten mit Infektion und Patienten ohne Infektion vor. Die meisten Infektionen waren unkomplizierte, respiratorische Infektionen. Diese traten für Patienten mit Neutropenie und Patienten ohne Neutropenie gleich häufig auf. HIV-Patienten hatten ein höheres Infektionsrisiko. Jedoch war der Unterschied nicht signifikant. Beim Vergleich des prozentualen Absinkens der Lymphozyten vom Ausgangswert zeigte sich ein schwach signifikanter Unterschied zwischen den Werten zu Infektionszeitpunkten und den Werte für Patienten ohne Infektion. Für die absoluten Werte war der Unterschied nicht signifikant. Für neutrophile Granulozyten und Leukozyten fanden sich keine Unterschiede zwischen den Werten für Infekt-Patienten zum Infektionszeitpunkt, den Werten zu infektfreien Zeitpunkten und den Werten für Patienten ohne Infektion. Insgesamt fand sich im hier untersuchten Kollektiv keine Assoziation von Infektionen unter Interferontherapie mit Leukopenien oder Neutropenien. Ein Absinken der neutrophilen Granulozyten scheint daher in größerem Maße ohne Dosisreduktion tolerierbar zu sein als bisher empfohlen. Ein relativer Lymphozytenmangel könnte mit dem Auftreten von Infektionen assoziiert sein. Für den absoluten Lymphozytenmangel fand sich diese Assoziation jedoch nicht. / In the present study, the treatment procedures for patients with chronic hepatitis C during therapy with standard interferon (group 1) or with pegylated interferon (group 2) were evaluated. Most patients received combination therapy with ribavirin. It was par for the collective structure in terms of age, gender, BMI before therapy, transmission of hepatitis, hepatitis B infection, HAI grading and staging score. A significant difference was found for the characteristic HIV co-infection. After starting therapy a rapid onset of serological and virological responses was seen. Patients treated with pegylated interferon and ribavirin had the best chances of sustained response to therapy. An early virological response was a good predictor of sustained virological response. Most patients reported side effects during treatment. The most common side effects were fatigue and pain (both for about 70% of patients), especially in the form of headache. Anaemia occurred in approximately 9 % of patients. The decreases of hematocrit, hemoglobin and erythrocytes was stronger in group 2 than in the first group Under combination therapy with ribavirin hemoglobin decreased also stronger than under interferon monotherapy, which is due to the haemolytic effect of ribavirin. On combination therapy in group 1 platelets were significantly lower than in group 2, which could be due to a greater myelosuppressive effect of pegylated interferon. In group 1, the platelets decreased stronger under monotherapy compared with combination therapy. Leukopenia occurred more frequently during treatment with pegylated interferon. Overall, the analyzed risk of neutropenia and lymphopenia in this collective was small. Especially elderly patients with low neutrophil granulocytes or lymphocytes before starting therapy seemed to have an increased risk for neutropenia and lymphopenia. The treatment response and duration of therapy were similar for patients with or without leukopenia, neutropenia and lymphopenia. There was also no significant increased risk for infections in patients with leucopenia, neutropenia and lymphopenia. 16 % of patients in the total group had an infection during treatment. There was no difference between the collective 1 and 2 for infections during treatment. Patients with and without infection were compared for age, gender, BMI, hepatitis B infection, hepatitis G / GB-infected and HIV-infection. In addition, the pretherapeutic laboratory values ferritin, viral load, iron, TSH, ALT, AST, hemoglobin, hematocrit, leukocytes, neutrophils, lymphocytes, platelets and red blood cells, treatment duration and response rate were compared for patients with and without infection. For none of these criteria a significant difference between patients with infection and patients without infection was found. Most infections were uncomplicated respiratory infections. These occurred equally in patients with neutropenia and patients without neutropenia. HIV patients had a higher risk of infection. However, the difference was not significant. Comparing the percentage drop in the lymphocytes from baseline a weak significant difference was shown between the values at infection times and the avarage values for patients without infection. For the absolute values the difference was not significant. For neutrophils and leukocytes, there were no differences between the values for patients at times of infection, the values at infection-free times and the values for patients without infections. In total no association of infection with interferon therapy with leukopenia or neutropenia was found. A decrease in neutrophils seems therefore to be more tolerable without dose reduction than recommended till now. A relative lack of lymphocytes could be associated with the occurrence of infections. For the absolute lymphocyte deficiency this association was not found.
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Seroprevalencia y factores de riesgo de hepatitis B y C en donantes de banco de sangre del Hospital Naval, enero de 1999 - abril de 2004Ramos Miraval, Rocío del Rosario January 2005 (has links)
El objetivo del presente trabajo fue determinar la seroprevalencia del virus de la hepatitis C (VHC) y de la B (VHB) en donadores militares y civiles que acudieron al Banco de Sangre del Hospital Naval así como los factores de riesgo asociados. Se trata de un estudio transversal, descriptivo y retrospectivo, cuyos datos epidemiológicos y resultados del tamizaje general se obtuvieron de los Libros de registros del Banco de Sangre e Historias Clínicas en el caso de los donantes militares, en el período comprendido de Enero de 1999 hasta Abril de 2004. El Test de MUREX HBsAg Versión 3 y Hepanostika Anti-HBc UniForm fueron empleados para Hepatis B, mientras que para el virus de la Hepatitis C se utilizó el Test de Elisa de tercera generación.
Un total de 7009 donantes fueron registrados entre 1999 y 2004. Se incluyeron en el presente estudio 320, aquellos que presentaban anticuerpos contra el virus C (anti-VHC) y, para el virus de la hepatitis B: Antígeno de superficie (AgSupHBV) y/o Antígeno Core-IgG. Los datos recolectados fueron procesados y analizados en el paquete estadístico SPSS versión 10 para Windows: Prueba de Ji cuadrado o Prueba de Fisher.
RESULTADOS: La prevalencia de portadores de VHC y VHB fue de 0.74% y 0.34%, respectivamente. La mayor población de infectados se encuentra entre los 18 y 30 años y corresponde al personal de la sanidad naval para la Hepatitis B y de Infantería de Marina para la Hepatitis C. No se pudo encontrar factores de riesgo relacionados en ninguna de las dos etiologias debido a una tasa de negación del 96,4% del total de donantes.
CONCLUSIONES: Los resultados demuestran una baja prevalencia de infección por virus de hepatitis B, pero elevada para la hepatitis C de acuerdo a los reportes nacionales e internacionales. La pobre o nula asociación entre los factores de riesgo y la enfermedad por hepatitis B y C, que estaría en relación a la limitada efectividad y poca utilidad de la AEC. Se hace necesario que el escrutinio, a través de la encuesta de predonación, sea mas completo, diseñando un cuestionario capaz de detectar más factores de riesgo, probablemente determinanates en la transmisión de los virus de la hepatitis B y C. / The aim of the present work was to determine the seroprevalence of the virus of the hepatitis C (VHC) and of the hepatitis B (VHB) in military and civil donors who came to the Bank of Blood of the Navy Hospital as well as the associate factors of risk. It is a question of a transverse, descriptive and retrospective study realized in the Bank of Blood, which information epidemiological and proved from the general tamizaje was obtained of the Books of records of the Bank of Blood and Clinical Histories in case of the military donors, in the included period of January, 1999 until April, 2004. Murex’s Test HBsAg Version 3 and Hepanostika Anti-HBc UniForm were used for Hepatitis B, whereas for the virus of the Hepatitis C there was in use Elisa's Test of third generation.
A whole of 7009 donors was registered between 1999 and 2004.Were included in the present study 320, those who were presenting antibodies against the virus C (anti-VHC) and for the virus of hepatitis B: Surface antigen (HBsAg) and/or Antigen Core-IgG. The information was gathered, percentages were obtained and the results were analyzed by means of SPSS 10 Windows version Statistics Program: chi-square or Fisher’s Tests.
RESULTS: The prevalence of carriers of VHC and VHB was 0.74% and 0.34%, respectively. The principal infection people are between 18 to 30 years old, and belong to health navy personal for HBV infection and Marine Infantry for HCV infection. It couldn’t find risks factors in relation to the two etiologists, due a negative rate of 96,4%.
CONCLUSIONS: The results suggest a low prevalence of infection for VHB but high for VHC infection in the studied population as it are indicate in the national and international reports. The poor or useless association between de risks factors and the illness it could be in relation to a limited effective and a poor utility of de Confidential Autoexclusion Exam. It’s necessary that this exam must be complete and have the property to identify more risks factors on the transmission of HBV and HCV. / Tesis de segunda especialidad
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The role of microRNAs during hepatitis C viral infection and liver regenerationMarquez, Rebecca Therese 01 December 2009 (has links)
microRNAs (miRNAs) are newly discovered small RNAs that repress gene expression and are evolving as clinical predictors for diagnosis and prognosis of human disease. Persistent hepatitis C virus (HCV) infection causes chronic inflammation and can lead to fibrosis, cirrhosis and liver cancer. HCV-associated liver injury is characterized by increased hepatocyte proliferation. Studies have demonstrated interactions between HCV and miRNAs. We investigated the role of miRNAs during HCV infection. We used global expression analysis to measure the expression levels of 380 miRNAs comparing HCV infected human livers with uninfected livers. We correlated the altered miRNA expression levels with clinical patient data, such as stage of fibrosis, liver transaminases, and viral load. We identified several miRNAs that correlated with these parameters, including miR-21. miR-21 correlated with stage of fibrosis, liver transaminases, and viral load. We used the mouse carbon tetrachloride model to induce fibrosis and identified correlations with miR-21 expression and stage of fibrosis. Furthermore, we identified, SMAD7, an inhibitor of fibrosis, as a novel target of miR-21 providing further evidence of miR-21's possible involvement in fibrosis development. In our patient samples, miR-21 expression also correlated with viral load. Establishing a further connection between miR-21 and HCV, we measured miR-21 expression levels in HCV replicons and infectious HCVcc tissue culture models. Altered expression of miR-21 varied depending on replicon genotype and tissue culture model preventing us from establishing a consistent relationship between miR-21 expression level and HCV infection. Interestingly, miR-21 inhibition in replicon cells resulted in decreased viral replication suggesting a possible miR-21 anti-viral effect.
Hepatocyte replication is associated with chronic HCV-induced liver injury. To investigate whether miR-21 correlation with HCV and fibrosis was a consequence of hepatocyte proliferation caused by viral infection and fibrosis, we measured miR-21 expression during liver regeneration. miR-21 was up-regulated during the early proliferative phase of liver regeneration. We identified Pellino-1 (PELI1), an adapter molecule involved in Nuclear factor-ĸB (NF-κB) signaling, as a novel target of miR-21. During liver regeneration, PELI1 mRNA levels were reduced, consistent with miR-21 targeting. We also found miR-21 over-expression decreased the activity of a NF-κB reporter. These studies investigated the role of miR-21 during HCV viral infection, fibrosis, and liver regeneration. We found miR-21 correlates with fibrosis in both human patient samples infected with HCV and in a mouse carbon tetrachloride mouse model. miR-21 may be pro-fibrogenic by targeting SMAD7, an inhibitor of fibrosis. miR-21's correlation with HCV viral load may be an anti-viral response by the host, which was demonstrated by increased HCV replication upon inhibition of miR-21. Furthermore, miR-21 is associated with hepatocyte replication during liver regeneration and inhibits NF-κB signaling, possibly by targeting PELI1. These studies identified several new roles for miR-21 during HCV viral infection, fibrosis, and liver regeneration.
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Molecular evolution of hepatitis C virus quasispecies.Oon, Aileen, Biotechnology & Biomolecular Sciences, Faculty of Science, UNSW January 2007 (has links)
The viral dynamics of the hepatitis C virus (HCV) in newly acquired infection are not well understood. HCV exists within an individual as a spectrum of minor variants termed quasispecies. The evolution of minor variants may contribute to viral escape of the host?s immune response, thereby facilitating development of chronic infection. The hypervariable 1 region (HVR1) is the most heterogeneous part of the HCV genome and contains a putative B-cell epitope. Thus, diversity in HVR1 could be a strategy used to evade neutralising antibodies. Acutely infected individuals (n=24) were examined with the aim of defining HVR1 quasispecies diversity in acute infection. The characterisation of the E1/HVR1 sequence and host specific evolution of HCV minor variants in treatment nonresponders was also investigated. HCV E1/HVR1 fragments were amplified from 48 sera using a combined reverse transcription-polymerase chain reaction (RT-PCR). Products were TA cloned into pCRIITOPO and approximately 10-20 clones were sequenced from each sample. HVR1 quasispecies diversity was examined longitudinally via sequence analysis. Quasispecies diversity was characterised primarily by mean nucleotide diversity. The mean HVR1 diversity of the acute cohort (n=48; 2.12% ?? 2.22) was lower than the diversity obtained for a cohort of chronically infected individuals (n=99; 4.5% ?? 5.1). There was no significant difference in mean HVR1 diversity between the HIV/HCV co-infected and HCV mono-infected groups (p=0.99) or between the clearer and non-clearer groups (p=0.85). Examination of amino acid usage and the hydropathic profile of each position in HVR1 revealed that sequence variation was confined to specific sites. The investigation of host specific evolution of HVR1 quasispecies demonstrated that minor variants (comprising 10- 20% of a population) became the dominant species over time in two treatment non-responders. These variants bore mutations that were not reflected in the consensus sequence of their respective populations at the initial timepoint analysed. Common infection was identified by 98% HVR1 sequence homology within two pairs of individuals. The evolution of common strains appeared to be different between individuals, suggesting host pressures may influence quasispecies evolution. This thesis provided an insight into the viral dynamics and host specific evolution of acute phase quasispecies.
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Hepatitis B and hepatitis C virus in an antenatal population : an epidemiological studyPolis, Suzanne, Public Health & Community Medicine, Faculty of Medicine, UNSW January 2005 (has links)
Although Australian epidemiology of HBV and HCV has been well described for populations groups at higher risk, but the information available for groups generally considered to be lower risk is much more limited. An understanding of the prevalence of these infections and their risk factors in antenatal women is important to guide testing policy and practice. A study was therefore conducted of the epidemiology of hepatitis B and hepatitis C infection in women. In addition, women were asked about their experience with antenatal testing. A total of 516 women participated in the survey, of these 479 (95%) women had been tested for HCV antibodies .The prevalence of HCV antibodies was 4% overall, and 2% among women who were unaware of their HCV status prior to their antenatal test. A history of injecting drug use and residing with a HCV positive person were significantly associated with HCV infection in multivariate analyses. HBV testing was conducted in 468 (99.6%) of women, and the overall prevalence was 2%. Risk factors identified were birthplace in countries of South East Asia. Women were asked about their perception of antenatal testing and pre-test information. Nearly a third (143, 30.5%) of women who had been tested for HCV infection either said that they did not know whether they had been tested, or said that they had declined testing. The corresponding proportion for HBV infection was 28.8% (135). Over 65% and 66% of women said that had not received any information about testing for HCV and HBV respectively. The finding that virtually all antenatal women were being tested for HCV was in contrast to government and non-government organisation policies of ???selective??? screening in place during the study period. Of concern was the substantial proportion of women who were tested despite reporting that they had declined their clinician???s offer to test for HCV and HBV, and the large number of women who reported an absence of pre-test information. Women who said they had received information reported the delivery and quality of information varied according to the antenatal clinician group, but perceived the overall quality as poor.
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Studies of the hepatic expression of hepatitis C virus markers / Keril Jaye Blight.Blight, Keril Jaye January 1994 (has links)
Includes five copies of author's previously published articles in back pocket. / Bibliography: leaves 120-142. / xvi, 142, [59] leaves, [25] leaves of plates : ill. (some col.) ; 35 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Examines HCV-specific (Hepatis C virus-specific) protein and RNA expression in liver tissue from anti-HCV positive patients. / Thesis (Ph.D.)--University of Adelaide, Dept. of Microbiology and Immunology, 1995?
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Epidemiological insights on the association between female genital mutilation and Hepatitis C Infection in Egypt: An Examination using Demographic and Health Survey data of Egypt, 2008.Jabbar, Shameem F 17 May 2013 (has links)
Purpose: Egypt has the highest prevalence of chronic Hepatitis C virus (HCV) infections and also a high prevalence of female genital mutilation (FGM). The high prevalence chronic hepatitis C has been attributed to HCV transmission by contaminated injections for the control of schistosomiasis. HCV infection has not been well studied in the context of female genital mutilation (FGM). We sought to identify associations between FGM and HCV using the Egypt Demographic and Health Survey (EDHS), 2008.
Methods: FGM was chosen as the main independent variable of interest. Other independent variables such as age, education, marital status, residence, beliefs associated with FGM, history of blood transfusion, surgery, sharing needles, and history of schistosomiasis were included in the analysis. Throughout the analysis, HCV infection was used as the main dependent variable.
Results: Univariate analysis of FGM and HCV showed a statistically significant association with a Prevalence Odds Ratio of 4.82 (2.91 -7.96), after adjusting for age and schistosomiasis injection, the association between FGM and HCV remained statistically significant with an odds of 2.98 (1.76 – 5.05)Among the category for FGM performer and association with HCV infection, the OR was 4.28 (2.31 – 7.91) when the FGM was performed by a ghagaria, 3.68 (2.76 - 4.90) when the FGM was performed by daya, and 3.30 (1.81 -5.88) when the FGM was performed by a barber. Among other independent variables, a lack of education, rural residence, and having religious precepts for FGM had statistically increased odds of association with HCV infection.
Conclusion: There is a statistically significant association between FGM and HCV infection. There are increased odds of HCV when the FGM is performed by providers other than doctors. Participants from a rural residence and who those who did not have any education were at increased odds of HCV. Subjects who believed in religious precepts for FGM and also who answered that FGM can continue had increased odds of association with HCV infections.
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Chronic Hepatitis C Viral Infection: Natural History and Treatment Outcomes in Substance AbusersJohn-Baptiste, Ava Ayana 01 January 2011 (has links)
Hepatitis C is the most common blood-borne viral illness in the North America. Chronic hepatitis C infection may lead to cirrhosis of the liver, liver failure and liver cancer. In North America, injection drug use is the most important risk factor for infection and substance abusing populations are disproportionately affected by the disease. Antiviral therapy exists and approximately 50% of infected individuals can be cured. The aim of this thesis was to provide information to help clinicians and policy-makers minimize the impact of hepatitis C in substance abusers. The thesis is comprised of three studies. The first assessed the rate of progression to cirrhosis for those acquiring infection through injection drug use, using a meta-analysis of 44 studies from the published literature. We estimated that fibrosis progression occurs at a rate of 8.1 per 1000 person-years (95% Credible Region (CR), 3.9 to 14.7) corresponding to a 20-year cirrhosis prevalence of 14.8% (95% CR, 7.5 to 25.5). The second study measured the association between successful antiviral therapy and quality of life. We demonstrated that sustained responders to therapy had higher scores on the hepatitis-specific Medical Outcomes Survey Short-Form-36 (SF-36), Health Utilities Index Mark 2/3 (HUI2/3), and time-tradeoff (TTO) than treatment failures, an average of 3.7 years following antiviral therapy. The third study assessed rates of adherence to antiviral therapy and rates of sustained response in current or former
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substance abusers on methadone maintenance. We demonstrated that while use of illicit substances prior to therapy negatively affected adherence, rates of sustained response were comparable to non-substance abusing populations. Our work indicates the future burden of disease in current and former substance abusers, demonstrates that antiviral therapy can be successful in this population, and indicates that the benefits of successful therapy may extend beyond decreased disease burden to improved quality of life.
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Chronic Hepatitis C Viral Infection: Natural History and Treatment Outcomes in Substance AbusersJohn-Baptiste, Ava Ayana 01 January 2011 (has links)
Hepatitis C is the most common blood-borne viral illness in the North America. Chronic hepatitis C infection may lead to cirrhosis of the liver, liver failure and liver cancer. In North America, injection drug use is the most important risk factor for infection and substance abusing populations are disproportionately affected by the disease. Antiviral therapy exists and approximately 50% of infected individuals can be cured. The aim of this thesis was to provide information to help clinicians and policy-makers minimize the impact of hepatitis C in substance abusers. The thesis is comprised of three studies. The first assessed the rate of progression to cirrhosis for those acquiring infection through injection drug use, using a meta-analysis of 44 studies from the published literature. We estimated that fibrosis progression occurs at a rate of 8.1 per 1000 person-years (95% Credible Region (CR), 3.9 to 14.7) corresponding to a 20-year cirrhosis prevalence of 14.8% (95% CR, 7.5 to 25.5). The second study measured the association between successful antiviral therapy and quality of life. We demonstrated that sustained responders to therapy had higher scores on the hepatitis-specific Medical Outcomes Survey Short-Form-36 (SF-36), Health Utilities Index Mark 2/3 (HUI2/3), and time-tradeoff (TTO) than treatment failures, an average of 3.7 years following antiviral therapy. The third study assessed rates of adherence to antiviral therapy and rates of sustained response in current or former
iii
substance abusers on methadone maintenance. We demonstrated that while use of illicit substances prior to therapy negatively affected adherence, rates of sustained response were comparable to non-substance abusing populations. Our work indicates the future burden of disease in current and former substance abusers, demonstrates that antiviral therapy can be successful in this population, and indicates that the benefits of successful therapy may extend beyond decreased disease burden to improved quality of life.
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Seroprevalencia y factores de riesgo de hepatitis B y C en donantes de banco de sangre del Hospital Naval, enero de 1999 - abril de 2004Ramos Miraval, Rocío del Rosario January 2005 (has links)
El objetivo del presente trabajo fue determinar la seroprevalencia del virus de la hepatitis C (VHC) y de la B (VHB) en donadores militares y civiles que acudieron al Banco de Sangre del Hospital Naval así como los factores de riesgo asociados. Se trata de un estudio transversal, descriptivo y retrospectivo, cuyos datos epidemiológicos y resultados del tamizaje general se obtuvieron de los Libros de registros del Banco de Sangre e Historias Clínicas en el caso de los donantes militares, en el período comprendido de Enero de 1999 hasta Abril de 2004. El Test de MUREX HBsAg Versión 3 y Hepanostika Anti-HBc UniForm fueron empleados para Hepatis B, mientras que para el virus de la Hepatitis C se utilizó el Test de Elisa de tercera generación. Un total de 7009 donantes fueron registrados entre 1999 y 2004. Se incluyeron en el presente estudio 320, aquellos que presentaban anticuerpos contra el virus C (anti-VHC) y, para el virus de la hepatitis B: Antígeno de superficie (AgSupHBV) y/o Antígeno Core-IgG. Los datos recolectados fueron procesados y analizados en el paquete estadístico SPSS versión 10 para Windows: Prueba de Ji cuadrado o Prueba de Fisher. RESULTADOS: La prevalencia de portadores de VHC y VHB fue de 0.74% y 0.34%, respectivamente. La mayor población de infectados se encuentra entre los 18 y 30 años y corresponde al personal de la sanidad naval para la Hepatitis B y de Infantería de Marina para la Hepatitis C. No se pudo encontrar factores de riesgo relacionados en ninguna de las dos etiologias debido a una tasa de negación del 96,4% del total de donantes. CONCLUSIONES: Los resultados demuestran una baja prevalencia de infección por virus de hepatitis B, pero elevada para la hepatitis C de acuerdo a los reportes nacionales e internacionales. La pobre o nula asociación entre los factores de riesgo y la enfermedad por hepatitis B y C, que estaría en relación a la limitada efectividad y poca utilidad de la AEC. Se hace necesario que el escrutinio, a través de la encuesta de predonación, sea mas completo, diseñando un cuestionario capaz de detectar más factores de riesgo, probablemente determinanates en la transmisión de los virus de la hepatitis B y C. / The aim of the present work was to determine the seroprevalence of the virus of the hepatitis C (VHC) and of the hepatitis B (VHB) in military and civil donors who came to the Bank of Blood of the Navy Hospital as well as the associate factors of risk. It is a question of a transverse, descriptive and retrospective study realized in the Bank of Blood, which information epidemiological and proved from the general tamizaje was obtained of the Books of records of the Bank of Blood and Clinical Histories in case of the military donors, in the included period of January, 1999 until April, 2004. Murex’s Test HBsAg Version 3 and Hepanostika Anti-HBc UniForm were used for Hepatitis B, whereas for the virus of the Hepatitis C there was in use Elisa's Test of third generation. A whole of 7009 donors was registered between 1999 and 2004.Were included in the present study 320, those who were presenting antibodies against the virus C (anti-VHC) and for the virus of hepatitis B: Surface antigen (HBsAg) and/or Antigen Core-IgG. The information was gathered, percentages were obtained and the results were analyzed by means of SPSS 10 Windows version Statistics Program: chi-square or Fisher’s Tests. RESULTS: The prevalence of carriers of VHC and VHB was 0.74% and 0.34%, respectively. The principal infection people are between 18 to 30 years old, and belong to health navy personal for HBV infection and Marine Infantry for HCV infection. It couldn’t find risks factors in relation to the two etiologists, due a negative rate of 96,4%. CONCLUSIONS: The results suggest a low prevalence of infection for VHB but high for VHC infection in the studied population as it are indicate in the national and international reports. The poor or useless association between de risks factors and the illness it could be in relation to a limited effective and a poor utility of de Confidential Autoexclusion Exam. It’s necessary that this exam must be complete and have the property to identify more risks factors on the transmission of HBV and HCV.
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