摘要:

Summary.The route of transmission of hepatitis C virus is still controversial. Parenteral exposure via blood or blood products leads to infection in the majority of cases, and the majority of intravenous drug users become infected by repetitive exposure to contaminated injection equipment. The risk of infection from a single need lipstick injury is 5–15% and may depend on the size of the innoculum. Other parenteral routes of transmission may include traditional healing practices and the use of contaminated medical equipment.Transmission is less common within a family but the prevalence of hepatitis C viral antibodies is higher in family members and sexual partners of carriers than in the general population. There are some well‐documented instances of acute hepatitis C occurring after a defined sexual exposure. Vertical transmission is rare unless the mother has high levels of circulating HCV RNA as may occur in those also infected with HIV. The detection of hepatitis C in saliva and the higher than expected prevalence of infection in dentists may point to the possibility of transmission by salivary contamination. There remain large numbers of hepatitis C carriers in whom no route of infection can be identif

ISSN:1352-0504    

DOI:10.1111/j.1365-2893.1995.tb00016.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Summary.There is an increasing need for a practical assay to measure HCV RNA to assess the viral burden in chronic hepatitis C virus (HCV) infection as viral load relates to transmission and therapeutic response. This study evaluates branched DNA (bDNA) signal amplification, a technique that avoids many of the pitfalls of polymerase chain reaction (PCR). The bDNA assay uses a microtitre well format and a series of capture, target and amplification probes that bind RNA to the well and then successively bind oligonucleotides to the RNA and branched DNA molecules to the oligonucleotides. Enzyme‐labelled probes are bound to the arms of the bDNA and light output from a chemiluminescent substrate is directly proportional to the amount of starting HCV RNA. Appropriate standards provide direct quantitation. Whereas PCR amplifies the HCV genome, bDNA amplifies the hybridization signal.In testing a standardized, coded panel, bDNA showed 100% specificity and detected five of six sera proven to transmit hepatitis C to the chimpanzee; PCR detected all six infectious sera. Serial samples were measured in two acute and five chronic cases of transfusion‐associated hepatitis and in three commercial seroconversion panels. In acute cases, 107–108molecular equivalents per ml (eq per ml) of HCV RNA were detected prior to peak alanine aminotransferase (ALT) activity and then rapidly declined to non‐detectable levels. Similar levels of HCV RNA were observed early in the course of two patients who progressed to chronic hepatitis; the chronic course was characterized by diminished, fluctuating and sometimes non‐detectable levels of HCV RNA. In two chronic cases, HCV RNA was not detected, or only transiently detected by bDNA, but was present when assayed by PCR. In one chronic case, the periodicity of HCV RNA levels closely paralleled the fluctuations of ALT suggesting a relationship between viral replication and subsequent hepatocellular injury. In testing 50 blood donors whose anti‐HCV reactivity was confirmed by a recombinant immunoblot assay (RIBA), HCV RNA was detected by bDNA in 41 (81%), while PCR was positive in 45 (90%); the overall concordance between bDNA and PCR in 100 anti‐HCV enzyme immunoassays (EIA) reactive donor samples was 96%. Lastly, bDNA showed the loss of HCV RNA in six out of six evaluable patients who had complete biochemical responses to interferon; five out of six non‐responders also showed appreciable declines in HCV RNA level, but in only two did HCV RNA drop below the detection limit; these two cases remained PCR positive. Seventeen placebo‐treated patients did not lose HCV RNA by either bDNA or PCR. Hence the bDNA assay is a practical means to measure HCV RNA in a variety of clinical settings. Although it is not as sensitive as PCR, it has greater specificity, is directly quantitative, and can be used in any routine laboratory that can perform microwell EIAs. This simplified quantitation may be of particular benefit in evaluating the probability of HCV transmission and the response to a

ISSN:1352-0504    

DOI:10.1111/j.1365-2893.1995.tb00017.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Summary.To examine the role of acute hepatitis A and B infection in the aetiology of chronic fatigue syndrome and psychiatric morbidity we studied 40 patients with acute viral hepatitis A or B consecutively admitted to an infectious diseases unit and studied at least 6 months after recovery. Liver function tests (LFT) had returned to normal in each case. Forty‐seven patients with other infectious diseases, of which 12 were presumed viral, admitted immediately after each hepatitis patient during the same period acted as controls. The main outcome measures were scores on a fatigue and muscle pain questionnaire, general health questionnaire (GHQ12) and supplementary questions. The hepatitis cases scored significantly higher fatigue scores, GHQ‐12 scores and muscle pain scores. Length of time since recovery from illness, age and sex were not confounding factors. Hepatitis cases were also less energetic, had greater weight change, had altered alcohol tolerance, had less exercise tolerance and felt less fit than the control group and compared with their premorbid state. Hence fatigue is more common after recovery in patients hospitalized for hepatitis A and B up to 30 months post‐infection compared with matched controls hospitalized for other infectious diseases. Hepatitis A and B infection is a risk factor for post‐infection fatigue, intermittent fatigue, as well as for psychiatric mo

ISSN:1352-0504    

DOI:10.1111/j.1365-2893.1995.tb00018.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Summary.The presence of anti‐hepatitis C virus (HCV) antibodies frequently indicates both persistent infection and infectivity. Consequently, blood donors found to be anti‐HCV positive, are excluded from the donor pool. The aim of this study was to compare age, sex and ethnic differences in the prevalence of anti‐HCV antibodies with that of hepatitis B surface antigen (HBsAg) among immigrant and Israeli‐born blood donors. Anti‐HCV antibodies were assayed by a second‐generation enzyme‐immunoassay (EIA) and HBsAg by a standard EIA in a sample of 136 977 blood donors in Israel during 1992. The overall age‐adjusted prevalence of anti‐HCV antibodies was 0.66% in men and 0.55% in women, and for HBsAg, 0.85% and 0.44%, respectively. There was a significant increase in the prevalence of anti‐HCV antibody with age, and significant differences by country of birth, with the highest prevalence found among those born in the former USSR and eastern Europe. This contrasted with the findings for the prevalence of HBsAg, where the highest rates were among those born in northern Africa. Among Israeli‐born donors, differences in the prevalence of anti‐HCV antibodies by parental country of origin were minimal and much less than for HBsAg. Hence the prevalence of anti‐HCV antibodies in Israel is strongly associated with age and country of birth but not with country of origin. There is little evidence of substantial vertical or intra familial transmission o

ISSN:1352-0504    

DOI:10.1111/j.1365-2893.1995.tb00019.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Summary.Between July 1988 and July 1989, sera from 1223 persons resident in the Valencia area of Spain were tested for antibodies against the hepatitis A virus. Sixty‐five per cent of serum samples were positive for anti‐HAV (95% confidence interval = 62.4–67.6). The prevalence of anti‐HAV increased significantly with age (odds ratio 50 years = 69.8; 95% confidence interval = 26.5–183.4) and previous history of hepatitis A (odds ratio = 2.1; 95% confidence interval = 1.4–3.2). Prevalence decreased with higher educational level (odds ratio, university studies = 0.2; 95% confidence interval = 0.1–0.5). Overall, there has been a reduction of anti‐HAV prevalence reflecting the decreasing exposure of the Spanish population to hepatitis A virus in recent years, particularly in the younger generations. The age of infection has increased, increasing the probability of future epidemics in groups previously protected by immunity acquired in early childhood. This new epidemiological pattern has strong public health implications, and universal childhood vaccination together with measures directed to improve sanitation may be the best public health strategy to protect

ISSN:1352-0504    

DOI:10.1111/j.1365-2893.1995.tb00020.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Summary.To assess the prevalence of hepatitis 8 virus (H5V) in northern India, 204 adult patients with acute and chronic liver disease who were positive for hepatitis B virus (HBV) markers were screened for anti‐H8V antibody by enzyme‐linked immunosorbent assay (ELISA). Anti‐H8V antibodies were positive in 29 (14.2%) patients. The incidence of H8V infection was higher (21.4%) in patients with chronic liver disease when compared with those with acute viral hepatitis (10.7%) (P<0.05). HδV antibodies were positive in 16.6% of patients with fulminant hepatic failure (FHF) and in 25% of cases with hepatocellular carcinoma. Co‐infections were significantly higher in acute hepatitis (80%), while super infections predominated (66.7%) in chronic liver disease (P<0.05). Our data show that HδV is endemic in northern India and should be considered a major healt

ISSN:1352-0504    

DOI:10.1111/j.1365-2893.1995.tb00021.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Summary.Non‐responders to 6‐months treatment with recombinant interferon (rIFN)‐α, 3 MU thrice weekly (primary non‐responders) were treated for 6 further months with the same therapy or with a double dose of rIFN‐α or with a different type of IFN (L‐IFN). 112 primary non‐responders were randomly enrolled into four groups of 28 patients each over a period of 4 years and were followed up for 6 months: group A continued the same dose of rIFN‐α, group B was treated with the same rIFN‐α but received a double dose (6 MU thrice weekly), group C received L‐IFN, 3 MU thrice weekly, and group D stopped IFN therapy and did not receive any treatment. Patients were examined at monthly intervals and response was defined as a complete normalization of alanine amino transferase (ALT). The four groups were homogeneous as to age, sex, duration of the disease, probable source of infection, histological diagnosis, ALT and γ glutamyl transferase (γGT) levels. No patient discontinued therapy for side‐effects. Further treatment with rIFN‐α 3MU thrice weekly (group A) induced normalization of ALT levels in four patients (14%); treatment with double‐dosed rIFN‐α (group B) induced normalization of liver enzymes in six cases (21%); a different type of interferon (L‐IFN) (group C) achieved normalization of serum ALT in five patients (18%). None of 28 primary non‐responders who did not receive any treatment (group D) showed normalization of ALT levels. None of the patients was anti‐HCV negative at the end of the study and no statistically significant difference was noted between responders and non‐responders to the second course of IFN therapy as to age, sex, duration of the disease, ALT and γGT levels at the end of the trial. Overall at the end of the study the primary non‐responders with normal levels of ALT were 15/112 (13%), with a therapeutic advantage of 7%. No statistically significant difference in the response rate was found among patients who continued IFN therapy, but prolongation of rIFN‐α treatment at doubl

ISSN:1352-0504    

DOI:10.1111/j.1365-2893.1995.tb00022.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Summary.Patients with autoimmune chronic active hepatitis (AICAH) often have very high titres of antibodies to rubella and/or measles virus. In the present study a young girl at the clinical onset of AICAH exhibited very high titres of antibodies against influenza viruses A and B, parainfluenza viruses, rubella virus and varicella‐zoster virus. The titres normalized over 2 months except for rubella and varicella‐zoster antibodies. Strong reactivities were seen against the rubella structural proteins E1, E2 and C in Western blot but IgM antibodies were not demonstrated. Total IgG was increased with normal ratios of subclasses. The IgG1 was the dominant antibody to E1 and E2, while IgG4 dominated the anti‐C response. There was no significant shift in subclass reactivities over one year from onset. The polymerase chain reaction (PCR), using a nested primer set, was negative for rubella virus RNA in a liver biopsy obtained at the clinical onset and in peripheral blood mononuclear cells (PBMC) 1 year later. Co‐cultivation experiments using PBMC and permissive cell lines were also negative for rubella virus. Hence, in the very early phase of AICAH there may be a transiently enhanced antibody response to various unrelated

ISSN:1352-0504    

DOI:10.1111/j.1365-2893.1995.tb00023.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY