Risk Factors and Outcome among a Large Patient Cohort with Community-Acquired Acute Hepatitis C in Italy

Santantonio, T.; Medda, Emanuela; Ferrari, Carlo; Fabris, Paolo; Castaldo, Giuseppe; Massari, Marco; Babudieri, Sergio; Toti, M; Francavilla, Ruggiero; Ancarani, F.; Antonucci, Giorgio; Scotto, Gaetano; Marco, Vito Di; Pastore, Giuseppe; Stroffolini, Tommaso

doi:10.1086/507640

Cited by 107 publications

(105 citation statements)

References 17 publications

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“…Symptomatic patients may exhibit jaundice but more often will com- plain of fatigue, nausea, abdominal pain, or flulike symptoms. In a study with a surprisingly high rate of symptoms (68%), Santantonio et al 28 noted jaundice in 57% and alanine aminotransferase (ALT) levels greater than 20 times the upper limit of normal in 73%. 28 Seventy-three of the 203 subjects (36%) had spontaneous viral clearance-80% within 3 months of disease onset.…”

Section: Natural History Of Acute Hcvmentioning

confidence: 99%

“…In a study with a surprisingly high rate of symptoms (68%), Santantonio et al 28 noted jaundice in 57% and alanine aminotransferase (ALT) levels greater than 20 times the upper limit of normal in 73%. 28 Seventy-three of the 203 subjects (36%) had spontaneous viral clearance-80% within 3 months of disease onset. Although symptomatic infection was not associated with clearance in this study, it has nonetheless been postulated that symptomatic patients have a higher rate of spontaneous clearance than asymptomatic patients.…”

Section: Natural History Of Acute Hcvmentioning

confidence: 99%

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Acute hepatitis C virus infection: A chronic problem

et al. 2008

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S ince the discovery of the hepatitis C virus (HCV) in the late 1980s, there has been an explosion of information regarding its natural history, treatment, and replication cycle. Nonetheless, there are still relatively few data regarding acute HCV infection. By convention, the term acute hepatitis refers to the presence of clinical signs or symptoms of hepatitis for a period of 6 months or fewer after the presumed time of HCV exposure. Early studies of posttransfusion patients who developed non-A, non-B hepatitis provide a clinical picture of early infection. 1 Following the availability of specific serologic and virologic tests, most such patients were shown to have acute HCV infection. After acute infection, HCV RNA may become detectable in the serum/plasma in as little as 2 weeks ( Fig. 1). Several weeks later, a high percentage of patients experience an increase in serum aminotransferase levels consistent with the development of acute hepatocellular injury. In the majority of cases, patients develop mild constitutional symptoms, including abdominal pain, nausea, vomiting, anorexia, and fatigue. During this acute infection, serum aminotransferases often peak below 1000 IU/mL and may return to normal levels. A minority develops sufficient elevations in bilirubin to lead to overt jaundice or the development of dark urine. Unless the clinical suspicion is high, few patients will be tested for HCV RNA or HCV antibody seroconversion. However, in the majority-but not all-of infected patients, HCV RNA persists, and a chronic disease state develops.The reasons for the general lack of data regarding acute HCV infection are multifactorial and include (1) the relatively high percentage of asymptomatic or unrecognized early infections, (2) the lack of large-scale identification of chronic carriers in the general population who serve as a reservoir for infection, and (3) the decreased number of acute infections that occur in controlled clinical settings such as that of blood transfusions. These factors and the lack of nonprimate animal models necessitate reliance on retrospective studies in chronic carriers, the use of limited historical collections of banked sera, and the extrapolation of outcomes based on small disease outbreaks in unique settings (for example, transmission from a physician to a patient in the operating room setting or following parenteral exposure in healthcare workers). Moreover, there exist only a limited number of population cohorts that continue to experience high rates of HCV transmission (for example, Egypt); nonetheless, there is a growing body of information regarding the clinical presentation, natural history, and treatment outcomes of acute HCV infection.In this article, we review the current information regarding our understanding of the epidemiology, virology, and immunology of HCV with a particular emphasis on acute HCV infection. In addition, we review recent data related to interferon-based treatment intervention and propose an algorithm for the diagnosis and management of acute HCV inf...

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Section: Natural History Of Acute Hcvmentioning

confidence: 99%

Section: Natural History Of Acute Hcvmentioning

confidence: 99%

Acute hepatitis C virus infection: A chronic problem

et al. 2008

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“…It would be advantageous to identify these people prior to therapy. Spontaneous loss of HCV-RNA from serum occurs within 3 months of infection (Gerlach et al, 2003;Santantonio et al, 2005), so delaying treatment of individuals to target only those who remain HCV-RNA positive is feasible (Santantonio et al, 2006). For the strategy of delayed treatment to be possible, it would be helpful to identify factors, host or viral, that predict spontaneous loss of HCV-RNA from serum.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous loss of hepatitis C virus RNA from serum is associated with genotype 1 and younger age at exposure

Rolfe

Curran

Alexander

et al. 2011

Journal of Medical Virology

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A variety of factors have been associated with spontaneous loss of hepatitis C virus (HCV)‐RNA from serum, including infecting HCV type, although results are conflicting. This study aimed to investigate further whether infecting HCV type was linked to spontaneous loss of HCV‐RNA. Serum samples from 321 untreated HCV antibody positive patients presenting at the Hepatology clinic at Addenbrooke's Hospital, Cambridge between 2004 and 2007 were tested. These individuals were classified either as HCV antibody and HCV‐RNA positive (viremic, n = 219) or HCV antibody positive and repeatedly HCV‐RNA negative (non‐viremic, n = 102). Infecting HCV type was identified by genotyping (viremic) or serotyping (non‐viremic). Binomial regression analysis investigated the independent effect of HCV type on spontaneous loss of HCV‐RNA from serum by comparing the two groups. Ninety‐one percent of patients were found to be either genotype 1 or genotype 3. The prevalence of type 1 infection was greater among non‐viremic (64.5%) than viremic individuals (45%). After controlling for the effects of potential confounding factors, multivariable analyses showed that individuals with type 1 infections were more likely to be non‐viremic than genotype 3 infections (RR = 2.07; 95% CI: 1.25, 3.43; P = 0.005). Individuals infected at an older age were also less likely to become HCV‐RNA negative spontaneously (RR = 0.42 comparing those infected at ≥20 years of age against those infected at <20 years of age, 95% CI: 0.25, 0.72; P = 0.002). In conclusion, the results suggest that HCV genotype 1 infections are more likely than genotype 3 infections to become spontaneously non‐viremic, as are infections acquired at younger age. J. Med. Virol. 83:1338–1344, 2011. © 2011 Wiley‐Liss, Inc.

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“…However, what we do know about the epidemiology of acute hepatitis C is that intravenous drug and surgical/accidental exposure have been identified as the most common route of HCV transmission in most studies conducted in Western populations ( Figure 1). Indeed, intravenous drug use accounted for about 25% to 54% of acute cases of hepatitis C in studies conducted in the US and throughout Europe [4][5][6][7] . In the United States alone, almost half of all HCV-positive patients aged 20 to 59 years report a history of injection drug use [8] .…”

mentioning

confidence: 99%

“…Transfusion-related acute hepatitis C is relatively rare; however, blood transfusion prior to 1992 remains a significant risk factor for hepatitis C infection throughout the world [8] . Sexual contact is another important route of transmission (risk factor 4% to 25%) [4][5][6] . Individuals with 20 or more lifetime sexual partners are at significant risk for hepatitis C in Western Countries; those participating in high risk sexual behavior are particularly susceptible because of an association with herpes simplex-type 2 infection [2,8] .…”

mentioning

confidence: 99%

Acute hepatitis C: Prospects and challenges

Kamal

2007

WJG

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More than 170 million people worldwide have chronic hepatitis C. Acute hepatitis C is rarely diagnosed because it is commonly asymptomatic. Most infected patients are unaware of their condition until the symptoms of chronic infection manifest. Treatment of acute hepatitis C is something of a paradox because spontaneous resolution is possible and many patients do not have symptoms. However, several factors provide a rationale for treating patients who have acute hepatitis C. Compared with acute hepatitis C, chronic hepatitis C is associated with a worse prognosis, the need for more intensive treatment, longer treatment duration, and a decrease in successful treatment outcomes. Conversely, early intervention is associated with improved viral eradication, using a regimen that is better tolerated, less expensive, more convenient, and of shorter duration than the currently approved combination therapies for chronic hepatitis C.

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Risk Factors and Outcome among a Large Patient Cohort with Community-Acquired Acute Hepatitis C in Italy

Cited by 107 publications

References 17 publications

Acute hepatitis C virus infection: A chronic problem

Acute hepatitis C virus infection: A chronic problem

Spontaneous loss of hepatitis C virus RNA from serum is associated with genotype 1 and younger age at exposure

Acute hepatitis C: Prospects and challenges

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