- Email: [email protected]
Prevalence of HCV infection in Sardinia
AASLD A1333
April 1998 L0551 INTRAFAMILIAL SPREADING OF HCV INFECTION IN SARDINIA. G. Sanna, R. Irde, P. Usai Satta, A. Cinellu, W. Sarais, E. Cabiddu, V. Serpi, M. Moi. Sardinian Association For Study Of Liver Diseases, Oristano, Italy. The development of the screening assay for HCV and the decrease of posttransfusion hepatitis HCV-related showed IVDA as the main risk factor for HCV infection, but there is great concern as regards sexual and familial spreading. To investigate the HCV transmission routes in the familial setting of the HCV infected patients, we studied 134 (47 wives or sexual partners, 74 household and 18 non-household) familial members of 58 patients (43 males and 15 females) with HCV related chronic liver disease (CLD). They were aged 19-82 years (mean age ± SD = 57 ± 15): 46 diagnosis of CLD proven by biopsy and 12 with clinical and laboratory features of CLD. The risk factors in the familial members of index cases were only the unprotected sexual contacts or the household contacts. Serum samples were tested for HCV- Ah by ELISA II confirmed by RIBA 1I. Five (10,6%) of the 47 sexual partners of index cases were positive for anti-HCV. 74 household contact and non-household familial were negative for anti-HCV. RESULTS summarized in the table: Index cases data Mean Age Mode of contamination: Parental contact (non defined) Blood transfusion IVDA Mean ALT level Index cases
HCV-positive Sexual partners 63 ± 11
HCV-negative Sexual partners 58 ± 11
4 1 0 111 + 64
25 11 3 114 ± 68 HCV-positive Sexual partners
58
Total
6 11 1 1 12 3 39
Minimal Chronic Hepatitis Mild Chronic Hepatitis Severe Chronic Hepatitis Chronic Reactive Hepatitis Cirrhosis Hepatocellular carcinoma HCV-RNA Positive
1 (16.7%) 2 (18.2%) 0 0 2 (16.7%) 0 5 (12.8%)
Our data suggests that sexual contacts are more significant (p<0,007, Fisher Exact Test) as risk factor than household contacts in the families of patients with CLD HCV related. We conclude there may exist a unknown mode of contamination in the sexual partners of index cases other than sexual contact with the patients. L0552 PREVALENCE OF HCV INFECTION IN SARDINIA. G. Sanna, R. Irde, M.F .Fadda, P.C. Manca, M. Loche ,A. Cinellu, P. Usai Satta, W. Sarais, M. Moi, D. Melis, L. Corrias, B. Floris. Sardinian Association for Study of Liver Diseases, Oristano, Italy. The mode of HCV infection was unknown in most of the patients, whereas high risk behaviour such as imprisonement, drugs abuse, contacts with sexual partner who used IV drugs may play a role to accelerate the progression in the transmission rate of this infection. OBJECTIVE: To estimate the prevalence of HCV Antibody in asymptomatic outpatients versus blood donors from the Province of Oristano, in Central Sardinia, with 158,043 inhabitants. PATIENTS AND METHODS: This study was carried out from January to December 1996 in 2461 consecutive asymptomatic outpatients (19-82 yrs.) (Males :746/43.4%-Females:1715/56.6%) (Group A) and in 3813 blood donors (Males:3165/ 83%-Females:648/17%) (18-65 yrs.) (Group B) from five Clinical Units in the Province of Oristano. In Group B 73% were periodical and 27% occasional blood donors. We tested the collected serum samples for Anti-HCV by ELISA II confirmed by RIBA II. All the patients consecutively observed were symptom free, with no known risk factors for liver disease or viral hepatitis. Patients with existing clinical, laboratory or ultrasonographic features of liver disease were excluded. RESULTS: HCV Ab ~ GROUP A 157 (15.6%)* GROUP B 5 (0.2%) * p < 0.0001 Chi-square Test.
HCV Ab NEG 2304 (84.4%) 3808 (99.8%)
The prevalence of Anti HCV positivity in Group A was significantly higher than in Group B. Our results showed that HCV infection is more frequently in general population than in blood donors. In Group A 157 HCV-Ab positive subjects were without known factors associated to HCV infection exposure. CONCLUSION: High prevalence of HCV infection in symptom free outpatients is of great public health relevance and indicates the need for a careful monitoring of the mode of unclear transmission of HCV infection.
Further investigations as HCV genotyping and HCV viremia will be able to suggest a better prevention of infection spread. • 10553 WORRISOME DISPOSITION OF HEPATITIS C ANTIBODY POSITIVE PATIENTS. SA Sarbah. P Kim, GN Levinthal, AJ McCullough, KD Mullen, Division of Gastroenterology at Metrohealth Medical Center and Case Western Reserve University, Cleveland, Ohio. Background: The prevalence of chronic hepatitis C virus (HCV) infection in the USA is estimated at about 4 million cases. An estimated 150,000 new cases occur annually with 60-80% of these developing chronicity. Sequelae of chronic HCV are currently the leading indication for liver transplantation in the USA. Identifying patients with existing hepatitis C is clearly important in attempts to reduce the morbidity and mortality from this epidemic. Many factors may influence therapeutic decisions however, as in the management of other chronic medical conditions, patient education remains the cornerstone of care whether the planned intervention is active therapy or careful monitoring. Even in centers with established liver expertise management of HCV antibody positive patients is often sub-optimal in this regard. Aim: To evaluate factors influencing educational strategies, referral patterns and treatment considerations in HCV antibody positive patients. Methods: Records on file in the serology lab at Metrohealth were used to construct a database of the 2239 patients with HCV antibody positive results between July 1992 and March 1997. An initial survey indicated that a minority of these patients were scheduled for follow up in the specialty liver clinic, furthermore chart records suggested that patients had often not been informed or educated about the possible implications of their HCV antibody positive test. Based on these initial findings a random sample of 300 patients was selected for an extensive 35 point chart review. The results of this survey are reported. Results: The Male: Female ratio in our patients was 2:1 with an ethnic composition 46% Caucasian, 44% African American, 7% Hispanic, 1% Asian, 2% other. 41% had documentation of prior IV drug abuse. There was chart documentation of patient being notified of their result in only 23% and of receiving some form of education in 18%. Factors accounting for this included that the positive test result only reached the medical chart in 62%, in addition the test was frequently ordered by someone other than the primary care provider (PCP), eg ordered in ER, surgery. There was no difference in referral based on gender. The higher proportion of females treated compared to males (10% vs 6%) was accounted for by the higher incidence of heavy ethanol use in the latter. African American patients were less likely to be referred or receive therapy than their Caucasian or Hispanic counterparts (referral in 19% vs 33% vs 27% respectively, therapy given in 3% vs 11% vs 9% respectively.) Conclusions: The surprisingly low proportion of patients informed or educated about their positive HCV antibody test in a hospital with established liver expertise is worrisome and may reflect a more significant problem in the community at large. Poor charting of results and test ordering by non-PCP (eg ER) are often to blame. The apparent racial discrepancies in referral patterns & treatment need further evaluation. • L0554 COLOR DOPPLER SIGNALS AFTER TRANSCATHETER ARTERIAL EMBOLIZATION (TAE) TO EVALUATE RESPONSE TO TREATMENT FOR HEPATOCELLULAR CARCINOMA(ttCC). S.Sato, S.Shiina, M.Imamura, T.Teratani, S.Obi, K.Hamamura, H.Yoshida, Y.Koike, Y.Dan, T.Okudaira, N.Kato, T.Kawabe, H.Yoshida, Y. Shirutori, and M.Omata. Second Department of Internal Medicine, University of Tokyo, Japan. Objective: TAE is often used for the treatment of HCC by means of ablation of feeding artery to tumor.. The present study was conducted to determine the re-canalization of feeding artery by color Doppler US in relation to the viable tumor cells conformed by fine needle biopsy. Materials and Methods: Between November 1996 and October 1997, 26 patients with 36 HCC lesions (range 2.1 to 7.5cm in diameters, with the mean of 3.5cm) in which arterial Doppler flow is visualized in the central or peritumoral areas before TAE, underwent treatment at our institute. We performed color Doppler US to examine residual color signals 1 day and 2 weeks after TAE. Fine needle biopsy was performed in 14 lesions with arterial signals and 13 lesions without arterial signals at the 2 weeks after TAE. Results: Although the color Doppler signal was found in only 4 out of 36(1 I%) lesions at 1 day after TAE, it was demonstrable in 23 lesions (64%) 2 weeks later. We also carried out histopathological examination for 27 lesions at 2 weeks after TAE. Residual viable HCC was found in 1! out of 14 (78%) with arterial Doppler signal, in contrast of 4 of 13 lesions (31%) without color Doppler signal. Conclusion: Viable HCCs were frequently found in the lesions in which residual color signals were positive. Lesions with color Doppler signals required additional treatment. Color Doppler ultrasound may be a useful tool to evaluate residual tumor after TAE.
April 1998 L0551 INTRAFAMILIAL SPREADING OF HCV INFECTION IN SARDINIA. G. Sanna, R. Irde, P. Usai Satta, A. Cinellu, W. Sarais, E. Cabiddu, V. Serpi, M. Moi. Sardinian Association For Study Of Liver Diseases, Oristano, Italy. The development of the screening assay for HCV and the decrease of posttransfusion hepatitis HCV-related showed IVDA as the main risk factor for HCV infection, but there is great concern as regards sexual and familial spreading. To investigate the HCV transmission routes in the familial setting of the HCV infected patients, we studied 134 (47 wives or sexual partners, 74 household and 18 non-household) familial members of 58 patients (43 males and 15 females) with HCV related chronic liver disease (CLD). They were aged 19-82 years (mean age ± SD = 57 ± 15): 46 diagnosis of CLD proven by biopsy and 12 with clinical and laboratory features of CLD. The risk factors in the familial members of index cases were only the unprotected sexual contacts or the household contacts. Serum samples were tested for HCV- Ah by ELISA II confirmed by RIBA 1I. Five (10,6%) of the 47 sexual partners of index cases were positive for anti-HCV. 74 household contact and non-household familial were negative for anti-HCV. RESULTS summarized in the table: Index cases data Mean Age Mode of contamination: Parental contact (non defined) Blood transfusion IVDA Mean ALT level Index cases
HCV-positive Sexual partners 63 ± 11
HCV-negative Sexual partners 58 ± 11
4 1 0 111 + 64
25 11 3 114 ± 68 HCV-positive Sexual partners
58
Total
6 11 1 1 12 3 39
Minimal Chronic Hepatitis Mild Chronic Hepatitis Severe Chronic Hepatitis Chronic Reactive Hepatitis Cirrhosis Hepatocellular carcinoma HCV-RNA Positive
1 (16.7%) 2 (18.2%) 0 0 2 (16.7%) 0 5 (12.8%)
Our data suggests that sexual contacts are more significant (p<0,007, Fisher Exact Test) as risk factor than household contacts in the families of patients with CLD HCV related. We conclude there may exist a unknown mode of contamination in the sexual partners of index cases other than sexual contact with the patients. L0552 PREVALENCE OF HCV INFECTION IN SARDINIA. G. Sanna, R. Irde, M.F .Fadda, P.C. Manca, M. Loche ,A. Cinellu, P. Usai Satta, W. Sarais, M. Moi, D. Melis, L. Corrias, B. Floris. Sardinian Association for Study of Liver Diseases, Oristano, Italy. The mode of HCV infection was unknown in most of the patients, whereas high risk behaviour such as imprisonement, drugs abuse, contacts with sexual partner who used IV drugs may play a role to accelerate the progression in the transmission rate of this infection. OBJECTIVE: To estimate the prevalence of HCV Antibody in asymptomatic outpatients versus blood donors from the Province of Oristano, in Central Sardinia, with 158,043 inhabitants. PATIENTS AND METHODS: This study was carried out from January to December 1996 in 2461 consecutive asymptomatic outpatients (19-82 yrs.) (Males :746/43.4%-Females:1715/56.6%) (Group A) and in 3813 blood donors (Males:3165/ 83%-Females:648/17%) (18-65 yrs.) (Group B) from five Clinical Units in the Province of Oristano. In Group B 73% were periodical and 27% occasional blood donors. We tested the collected serum samples for Anti-HCV by ELISA II confirmed by RIBA II. All the patients consecutively observed were symptom free, with no known risk factors for liver disease or viral hepatitis. Patients with existing clinical, laboratory or ultrasonographic features of liver disease were excluded. RESULTS: HCV Ab ~ GROUP A 157 (15.6%)* GROUP B 5 (0.2%) * p < 0.0001 Chi-square Test.
HCV Ab NEG 2304 (84.4%) 3808 (99.8%)
The prevalence of Anti HCV positivity in Group A was significantly higher than in Group B. Our results showed that HCV infection is more frequently in general population than in blood donors. In Group A 157 HCV-Ab positive subjects were without known factors associated to HCV infection exposure. CONCLUSION: High prevalence of HCV infection in symptom free outpatients is of great public health relevance and indicates the need for a careful monitoring of the mode of unclear transmission of HCV infection.
Further investigations as HCV genotyping and HCV viremia will be able to suggest a better prevention of infection spread. • 10553 WORRISOME DISPOSITION OF HEPATITIS C ANTIBODY POSITIVE PATIENTS. SA Sarbah. P Kim, GN Levinthal, AJ McCullough, KD Mullen, Division of Gastroenterology at Metrohealth Medical Center and Case Western Reserve University, Cleveland, Ohio. Background: The prevalence of chronic hepatitis C virus (HCV) infection in the USA is estimated at about 4 million cases. An estimated 150,000 new cases occur annually with 60-80% of these developing chronicity. Sequelae of chronic HCV are currently the leading indication for liver transplantation in the USA. Identifying patients with existing hepatitis C is clearly important in attempts to reduce the morbidity and mortality from this epidemic. Many factors may influence therapeutic decisions however, as in the management of other chronic medical conditions, patient education remains the cornerstone of care whether the planned intervention is active therapy or careful monitoring. Even in centers with established liver expertise management of HCV antibody positive patients is often sub-optimal in this regard. Aim: To evaluate factors influencing educational strategies, referral patterns and treatment considerations in HCV antibody positive patients. Methods: Records on file in the serology lab at Metrohealth were used to construct a database of the 2239 patients with HCV antibody positive results between July 1992 and March 1997. An initial survey indicated that a minority of these patients were scheduled for follow up in the specialty liver clinic, furthermore chart records suggested that patients had often not been informed or educated about the possible implications of their HCV antibody positive test. Based on these initial findings a random sample of 300 patients was selected for an extensive 35 point chart review. The results of this survey are reported. Results: The Male: Female ratio in our patients was 2:1 with an ethnic composition 46% Caucasian, 44% African American, 7% Hispanic, 1% Asian, 2% other. 41% had documentation of prior IV drug abuse. There was chart documentation of patient being notified of their result in only 23% and of receiving some form of education in 18%. Factors accounting for this included that the positive test result only reached the medical chart in 62%, in addition the test was frequently ordered by someone other than the primary care provider (PCP), eg ordered in ER, surgery. There was no difference in referral based on gender. The higher proportion of females treated compared to males (10% vs 6%) was accounted for by the higher incidence of heavy ethanol use in the latter. African American patients were less likely to be referred or receive therapy than their Caucasian or Hispanic counterparts (referral in 19% vs 33% vs 27% respectively, therapy given in 3% vs 11% vs 9% respectively.) Conclusions: The surprisingly low proportion of patients informed or educated about their positive HCV antibody test in a hospital with established liver expertise is worrisome and may reflect a more significant problem in the community at large. Poor charting of results and test ordering by non-PCP (eg ER) are often to blame. The apparent racial discrepancies in referral patterns & treatment need further evaluation. • L0554 COLOR DOPPLER SIGNALS AFTER TRANSCATHETER ARTERIAL EMBOLIZATION (TAE) TO EVALUATE RESPONSE TO TREATMENT FOR HEPATOCELLULAR CARCINOMA(ttCC). S.Sato, S.Shiina, M.Imamura, T.Teratani, S.Obi, K.Hamamura, H.Yoshida, Y.Koike, Y.Dan, T.Okudaira, N.Kato, T.Kawabe, H.Yoshida, Y. Shirutori, and M.Omata. Second Department of Internal Medicine, University of Tokyo, Japan. Objective: TAE is often used for the treatment of HCC by means of ablation of feeding artery to tumor.. The present study was conducted to determine the re-canalization of feeding artery by color Doppler US in relation to the viable tumor cells conformed by fine needle biopsy. Materials and Methods: Between November 1996 and October 1997, 26 patients with 36 HCC lesions (range 2.1 to 7.5cm in diameters, with the mean of 3.5cm) in which arterial Doppler flow is visualized in the central or peritumoral areas before TAE, underwent treatment at our institute. We performed color Doppler US to examine residual color signals 1 day and 2 weeks after TAE. Fine needle biopsy was performed in 14 lesions with arterial signals and 13 lesions without arterial signals at the 2 weeks after TAE. Results: Although the color Doppler signal was found in only 4 out of 36(1 I%) lesions at 1 day after TAE, it was demonstrable in 23 lesions (64%) 2 weeks later. We also carried out histopathological examination for 27 lesions at 2 weeks after TAE. Residual viable HCC was found in 1! out of 14 (78%) with arterial Doppler signal, in contrast of 4 of 13 lesions (31%) without color Doppler signal. Conclusion: Viable HCCs were frequently found in the lesions in which residual color signals were positive. Lesions with color Doppler signals required additional treatment. Color Doppler ultrasound may be a useful tool to evaluate residual tumor after TAE.