Objective: To describe the epidemiology of infection with hepatitis C virus (HCV) among injecting drug users (IDUs) in Victoria.Design and subjects: Subjects were current 'DUs from a wide spectrum of age, sex and social background, enrolled in a prospective study of injecting drug use. They were contacted by peer workers through their social networks and through community agencies and prisons, and were regularly followed for interview and blood collection in the field. Sera were tested for presence of antibody to HCV (anti-HCV), for the presence of HCV RNA directly in serum, and for measures of liver function. The results were correlated with demographic variables.Setting: Rural and metropolitan Victoria. Main outcome measures: Presence of anti-HCV and demonstration of HCV RNA.Results: Two-thirds (68%, 206/303) of the current cohort of 'DUs were seropositive for HCV, risk being particularly associated with duration of injecting, and independently for men with opiate use and prison history, and for women with a history of methadone therapy. HCV RNA was detected in 48% (76/160) by polymerase chain reaction (PCR); 61% (741122) of these subjects were HCV seropositive and 5% (2/38) seronegative. Of 32 HCV seronegative subjects followed for a mean period of 291 days, five seroconverted to HCV, an incidence of 20 infections per 100 person-years. Those who seroconverted were older, more likely to be male, had been injecting longer, more often reported opiate use, and were more likely to be based in the country. Serum liver enzyme levels were higher and more likely to be abnormal in HCV seropositive than seronegative subjects, and were highest in those seropositive subjects in whom HCV RNA was detected.Conclusions: This population of IDUs has a very high rate of exposure to HCV, related to duration of injecting and independently to opiate use and prison history, perhaps reflecting increased risk in particular social networks. There is evidence of high rates of carriage of HCV, of continuing transmission of HCV, and of ongoing liver disease among these IDUs. If these IDUs are at all representative of alliDUs in Australia, we estimate that 80 000 current and former IDUs may be at risk of chronic liver disease from HCV, and that 8000-10 000 new infections may be occurring each year. Two subjects who were seronegative had HCV RNA detectable in sera. These data have important implications for screening programs and document the need for further measures to prevent spread of bloodborne viruses including HIV among IDUs. (Med J Aust 1993; 159: 237-241) T he hepatitisC virus (HCY)is the recently discovered and characterised cause of most parenterallyacquired non-A non-S hepatitis.' It is transmitted efficiently by the percutaneous inoculationof contaminated blood, and less efficiently sexually." The availability of sensitive antibody assays has allowed the descriptive epidemiology of HCV infection to begin, but without convenient assays to detect the presenceof virus, the significanceand specificity of the antibody assays have ...
Rubella virus (RV) infection induces a variety of morphological changes in the host cell including the modification of lysosomes to produce "replication complexes" and the alteration of mitochondrial morphology and distribution. The morphogenesis of RV was further characterized with particular emphasis on the localization of RV core particles. Thin-section electron microscopy (TSEM) studies indicated that RV core-like particles, measuring approximately 33 nm in diameter, were found associated with RV replication complexes. Immunogold-labeling electron microscopy (EM) using monoclonal antibodies to RV capsid proteins confirmed that these particles were viral cores. RV core particles were also detected in association with mitochondria as observed by TSEM and immunogold-labeling EM using monoclonal antibodies to capsid or polyclonal antibodies to RV virions. The results of this study indicate that the localization of RV core particles in relation to replication complexes is similar to that found for the alphaviruses. However, the association of RV core particles with mitochondria appears unique within the family Togaviridae.
Objective: To identify independent patient, disease and viral characteristics that predict a sustained biochemical or viral response to interferon alfa therapy in patients with chronic hepatitis C.Design: Comparison of interferon responders and non-responders by univariate and multivariate analysis. Setting:The hepatitis clinic of the Alfred Hospital, Melbourne (a tertiary referral hospital), between July 1989 and June 1994.Subjects: All patients with chronic hepatitis C who were treated with interferon alfa (IFN-a; 3 million IU, three times a week or more) for at least 12 weeks. Outcome measures:Patient demographic and epidemiologic characteristics, pretreatment serum alanine aminotransferase (ALT) and y-glutamyl transpeptidase (GGT) levels, histological grading of hepatic steatosis, necroinflammatory activity and fibrosis, serum hepatitis C virus (HCV) RNA titres and genotype and post-treatment serum ALT levels and presence of HCV RNA.Results: Of 58 patients, 13 (22%) had a sustained (six months or longer) biochemical response to IFN-a therapy, including 12 (21%) with a sustained viral response. Univariate analysis showed that young patients with a normal serum GGT level, grade 0-1 steatosis and fibrosis, low viral titre and infection with genotypes 3a and 2a were more likely to have a sustained response. Infection with genotypes other than 1a and 1b was the only independent variable associated with both a sustained biochemical and viral response. After adjusting for genotype, a hepatic fibrosis grade of 0-1 was also independently associated with viral response. This logistic regression model accurately predicted the virological response in 80% of cases. Conclusion:In Australian patients with chronic hepatitis C, a sustained viral response to IFN-a therapy is most likely in those infected with a genotype other than 1a or 1b and with minimal hepatic fibrosis.
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