Background/Aims: In 2002, the first reported outbreak of hepatitis A virus (HAV) infection involving mostly intravenous drug users (IDU) occurred in Italy. We attempted a thorough evaluation of the outbreak, including...Background/Aims: In 2002, the first reported outbreak of hepatitis A virus (HAV) infection involving mostly intravenous drug users (IDU) occurred in Italy. We attempted a thorough evaluation of the outbreak, including epidemiological, clinical and virological analyses. Methods: We conducted an epidemiological investigation, including a case-control study, to identify the source and themodes of HAV transmission. Hepatitis B and C (HCV) viruses and human immunodeficiency vir us (HIV) coinfections were clinically analysed. Sequence analysis of the VP1/2A junction of the HAV isolates was also performed. Results: Of the 47 symptomatic cases, 35 were IDUs. The only associated risk factor was contact (not related to injecting practices) with a jaundiced person (odds ratio: 5.8; 95%confidence i nterval: 1.3-29.9). Of the cases, 58%were anti-HCV positive and 4.7%anti-HI V positive. Three individuals died of acute liver failure: 2 were HCV-coinfecte d alcohol abusers, with underlying liver cirrhosis; 1 was HCV/HIV-coinfected. H AV-RNA was found in 15 of the 24 tested patients: genotype IB (8 cases) and III A (7 cases) were detected. Conclusions: HAV was probably transmitted through the fecal-oral route, although parenteral transmission cannot be excluded. The hig h fatality ratewas probably due to severe underlying liver damage. The occurrenc e of this outbreak highlights the need for routine HAV vaccination for IDUs.展开更多
Persons chronically infected with hepatitisCvirus (HCV), some of whom may be coinfected with HIV and human T-lymphotropic virus type II (HTLV-II), are at high risk for end-stage liver disease (ESLD). We evaluated whet...Persons chronically infected with hepatitisCvirus (HCV), some of whom may be coinfected with HIV and human T-lymphotropic virus type II (HTLV-II), are at high risk for end-stage liver disease (ESLD). We evaluated whether ESLD death was associated with premorbid HCV RNA level or specific HCV protein antibodies among persons with or without HIV/HTLVII coinfection in a cohort of 6,570 injection drug users who enrolled in 9 US cities between 1987 and 1991. We compared 84 ESLD descendents and 305 randomly selected cohort participants with detectable HCV RNA, stratified by sex, race, HIV, and HTLV-II strata. Relative hazard (RH) of ESLD death was derived from the proportional hazard model. Risk of ESLD death was unrelated to the intensity of antibodies against the HCV c- 22(p), c- 33(p), c- 100(p), and NS5 proteins, individually or combined, but it increased with HCV RNA level (RHadj = 2.26 per log10 IU/mL, 95% CI: 1.45- 5.92). The association between HCV RNA level and ESLD death remained significant after adjustment for alcohol consumption (RHadj = 2.57 per log10 IU/mL, 95% CI: 1.50- 8.10). Deaths from AIDS (n = 45) and other causes (n = 43) were unrelated to HCV RNA (RHadj = 1.14 and 1.29 per log10 IU/mL, respectively). HIV infection was not associated with ESLD risk in multivariate analyses adjusted for HCV RNA. Men had an increased risk of ESLD death in unadjusted analyses (RH = 1.92, 95% CI: 1.15- 3.56) but not in multivariate analysis (RHadj = 0.98, 95% CI: 0.48- 2.88). Non-black patients were at increased risk for ESLD death (RHadj = 2.76, 95% CI: 1.49- 10.09). In conclusion, HCV RNA level is a predictor of ESLD death among persons with chronic HCV infection.展开更多
文摘Background/Aims: In 2002, the first reported outbreak of hepatitis A virus (HAV) infection involving mostly intravenous drug users (IDU) occurred in Italy. We attempted a thorough evaluation of the outbreak, including epidemiological, clinical and virological analyses. Methods: We conducted an epidemiological investigation, including a case-control study, to identify the source and themodes of HAV transmission. Hepatitis B and C (HCV) viruses and human immunodeficiency vir us (HIV) coinfections were clinically analysed. Sequence analysis of the VP1/2A junction of the HAV isolates was also performed. Results: Of the 47 symptomatic cases, 35 were IDUs. The only associated risk factor was contact (not related to injecting practices) with a jaundiced person (odds ratio: 5.8; 95%confidence i nterval: 1.3-29.9). Of the cases, 58%were anti-HCV positive and 4.7%anti-HI V positive. Three individuals died of acute liver failure: 2 were HCV-coinfecte d alcohol abusers, with underlying liver cirrhosis; 1 was HCV/HIV-coinfected. H AV-RNA was found in 15 of the 24 tested patients: genotype IB (8 cases) and III A (7 cases) were detected. Conclusions: HAV was probably transmitted through the fecal-oral route, although parenteral transmission cannot be excluded. The hig h fatality ratewas probably due to severe underlying liver damage. The occurrenc e of this outbreak highlights the need for routine HAV vaccination for IDUs.
文摘Persons chronically infected with hepatitisCvirus (HCV), some of whom may be coinfected with HIV and human T-lymphotropic virus type II (HTLV-II), are at high risk for end-stage liver disease (ESLD). We evaluated whether ESLD death was associated with premorbid HCV RNA level or specific HCV protein antibodies among persons with or without HIV/HTLVII coinfection in a cohort of 6,570 injection drug users who enrolled in 9 US cities between 1987 and 1991. We compared 84 ESLD descendents and 305 randomly selected cohort participants with detectable HCV RNA, stratified by sex, race, HIV, and HTLV-II strata. Relative hazard (RH) of ESLD death was derived from the proportional hazard model. Risk of ESLD death was unrelated to the intensity of antibodies against the HCV c- 22(p), c- 33(p), c- 100(p), and NS5 proteins, individually or combined, but it increased with HCV RNA level (RHadj = 2.26 per log10 IU/mL, 95% CI: 1.45- 5.92). The association between HCV RNA level and ESLD death remained significant after adjustment for alcohol consumption (RHadj = 2.57 per log10 IU/mL, 95% CI: 1.50- 8.10). Deaths from AIDS (n = 45) and other causes (n = 43) were unrelated to HCV RNA (RHadj = 1.14 and 1.29 per log10 IU/mL, respectively). HIV infection was not associated with ESLD risk in multivariate analyses adjusted for HCV RNA. Men had an increased risk of ESLD death in unadjusted analyses (RH = 1.92, 95% CI: 1.15- 3.56) but not in multivariate analysis (RHadj = 0.98, 95% CI: 0.48- 2.88). Non-black patients were at increased risk for ESLD death (RHadj = 2.76, 95% CI: 1.49- 10.09). In conclusion, HCV RNA level is a predictor of ESLD death among persons with chronic HCV infection.
