Influence of alcohol use, race, and viral coinfections on spontaneous HCV clearance in a US veteran population

Piasecki, Barbara; Reddy, K. Rajender; Bellamy, Scarlett; Porter, Steven B.; Weinrieb, Robert M.; Stieritz, Donald D.; Chang, Kyong–Mi

doi:10.1002/hep.20384

Cited by 34 publications

(36 citation statements)

References 41 publications

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“…Coinfection with HBV was associated with a higher likelihood of spontaneous clearance of HCV which is consistent with previous findings in specific high-risk cohorts. 11,17 The study on PWIDs by Grebely et al 3 also reported similar trend but HBV did not reach statistical significance, which may be due to very small number of cases with viral clearance (n=9). Previous research suggested that HBV superinfection may suppress the pre-existing HCV infections.…”

Section: Discussionmentioning

confidence: 86%

“…Variables based on a priori hypotheses 17,31,32 and those significant at 0.10 in the univariate analysis were included in the multivariable models, and adjusted odds ratios (aOR) are reported with 95% CI. To avoid nonidentification problem, we did not include age, birth cohort and HCV diagnosis year in the same adjusted model.…”

Section: Discussionmentioning

confidence: 99%

“…[14][15][16] However, epidemiological research that studied the factors associated with spontaneous clearance of HCV has not examined the role of primary T-cell deficiency on viral clearance. 3,11,12,17,18 Concurrent infection with hepatitis B virus (HBV) has also been suggested to be associated with spontaneous clearance of HCV in specific group of population such as hemophiliacs, 12,19 and people who inject drugs (PWID). 3 Most studies on spontaneous clearance were of relatively small size and were conducted in specific high-risk population cohort such as PWID, hemophiliacs or men who have sex with men (MSM).…”

Section: Introductionmentioning

confidence: 99%

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Role of primary T‐cell immunodeficiency and hepatitis B coinfection on spontaneous clearance of hepatitis C: The BC Hepatitis Testers Cohort

Islam

Krajden

Gilbert

et al. 2016

Journal of Viral Hepatitis

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T-cell host immune response against hepatitis C virus (HCV) has been suggested to play an important role in determining HCV infection outcome. However, data from human studies are not available. This study examined the effect of primary T-cell deficiency along with other factors on the spontaneous clearance of HCV in a large population-based cohort in British Columbia, Canada. The BC Hepatitis Testers Cohort includes all individuals tested for HCV in BC in 1990-2013 linked with data on their medical visits, hospitalizations and prescription drugs. HCV-positive individuals with at least one valid HCV PCR test on/after HCV diagnosis (n=46 783) were included in this study. To examine factors associated with the spontaneous clearance of HCV, multivariable logistic regression was fitted on the full sample, and Cox proportional hazards model on the HCV seroconverters. Spontaneous clearance was observed in 25.1% (n=11 737) of those tested for HCV. After adjusting for potential confounders, the odds of spontaneous clearance of HCV was lower in people with primary T-cell immunodeficiency (adjusted odds ratio [aOR]: 0.55, 95% CI: 0.32-0.94), and higher in females (aOR: 1.61, 95% CI: 1.54-1.68) and in those coinfected with HBV (aOR: 2.31, 95% CI: 1.93-2.77). Similar results were observed in HCV seroconverters except HBV coinfection was not significant. In conclusion, primary T-cell immunodeficiency is associated with a lower spontaneous clearance of HCV while female sex and coinfection with HBV are associated with a higher spontaneous clearance.

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Role of primary T‐cell immunodeficiency and hepatitis B coinfection on spontaneous clearance of hepatitis C: The BC Hepatitis Testers Cohort

Islam

Krajden

Gilbert

et al. 2016

Journal of Viral Hepatitis

View full text Add to dashboard Cite

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“…Several other investigators have reported higher clearance rates of acute HCV infection among subjects who were co-infected with HBV. 16,17,23,[26][27][28] The reason for the higher HCV clearance rates among co-infected subjects is not known. One hypothesis is that co-infection might lead to direct interference at the intracellular level in the hepatocyte.…”

Section: Resultsmentioning

confidence: 99%

HBV/HCV co‐infection is associated with a high level of HCV spontaneous clearance among drug users and blood donors in China

Xiong

Xiao

Wang

et al. 2016

Journal of Viral Hepatitis

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Understanding the biology of spontaneous clearance of hepatitis C virus (HCV) infection could lead to improved strategies to prevent the sequelae associated with chronic HCV infection. Chronic infections with hepatitis virus are very common in China, but the factors associated with spontaneous clearance of HCV have not been adequately studied. We evaluated the spontaneous clearance of HCV among 1918 drug users and 1526 HCV-seropositive blood donors in Guangzhou, China. Among participants who were co-infected with hepatitis B virus (HBV), 41.38% of drug users and 39.47% of blood donors had cleared their HCV infection without antiviral therapy compared to 9.41% of drug users and 16.73% of blood donors who were mono-infected with a single virus (P<.01). The proportion of subjects who had cleared their HCV infection was significantly greater in the co-infected subjects whose serum HBV DNA was greater than 2000IU/mL than those with lower levels. A multiple logistic regression analysis found female gender, IL28B rs8099917 TT genotype, HBV co-infection and blood donors (vs drug users) associated with increased spontaneous clearance of HCV infection. Although acute HCV infections are common in China, the incidence of chronic HCV may be reduced among the high prevalence of chronic HBV and IL28B genotypes associated with spontaneous clearance of HCV in Chinese populations.

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“…This assumption of similarity betweeen chronics and resolvers in terms of adverse health behaviors is supported by studies examining the determinants of spontaneous resolution. (37)(38)(39)(40) We further performed an auxillary analysis to assess the ongoing risk of hospitalization for acute alcohol intoxication, acute drug intoxication, and hospitalization for violence-related injury (i.e., admissions that reflect *Where the liver-mortality rate in resolvers exceeds that of chronic, the attributable fraction was taken to be zero; † this figure is indicative of the average number of deaths attributable to chronic infection; ‡ calculated through dividing the total number of liver deaths attributable to CHC by the total number of liver deaths occuring with CHC infection; § "CI" refers to a credible interval, as opposed to a confidence interval.…”

Section: Validity Of Using Spontaneous Resolvers As a Benchmark Groupmentioning

confidence: 99%

Liver mortality attributable to chronic hepatitis C virus infection in Denmark and Scotland—Using spontaneous resolvers as the benchmark comparator

et al. 2016

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Liver mortality among individuals with chronic hepatitis C (CHC) infection is common, but the relative contribution of CHC per se versus adverse health behaviors is uncertain. We explored data on spontaneous resolvers of hepatitis C virus (HCV) as a benchmark group to uncover the independent contribution of CHC on liver mortality. Using national HCV diagnosis and mortality registers from Denmark and Scotland, we calculated the liver mortality rate (LMR) for persons diagnosed with CHC infection (LMR chronic ) and spontaneously resolved infection (LMR resolved ), according to subgroups defined by age, sex, and drug use. Through these mortality rates, we determined subgroup-specific attributable fractions (AFs), defined as (LMR chronic -LMR resolved )/LMR chronic , and then calculated the total attributable fraction (TAF) as a weighted average of these AFs. Thus, the TAF represents the overall fraction (where 0.00 5 not attributable at all; and 1.00 5 entirely attributable) of liver mortality attributable to CHC in the diagnosed population. Our cohort comprised 7,005 and 21,729 persons diagnosed with HCV antibodies in Denmark and Scotland, respectively. Mean follow-up duration was 6.3-6.9 years. The TAF increased stepwise with age. It was lowest for death occurring at <45 years of age (0.21 in Denmark; 0.26 in Scotland), higher for death occurring at 45-59 years (0.69 in Denmark; 0.69 in Scotland), and highest for death at 601years (0.92 in Denmark; 0.75 in Scotland). Overall, the TAF was 0.66 (95% confidence interval [CI]: 0.55-0.78) in Denmark and 0.55 (95% CI: 0.44-0.66) in Scotland. Conclusions: In Denmark and Scotland, the majority of liver death in the CHC-diagnosed population can be attributed to CHC-nevertheless, an appreciable fraction cannot, cautioning that liver mortality in this population is a compound problem that can be reduced, but not solved, through antiviral therapy alone. (HEPATOLOGY 2016;63:1506-1516 P ersons with chronic hepatitis C (CHC) infection exhibit rates of liver mortality that are between 17 and 36 times greater than the general population. (1)(2)(3)(4)(5)(6) A prerequisite to an effective public health response is a complete understanding of the factors driving this phenomenon. Although CHC is an established cause of liver failure and liver cancer, we cannot assume that all liver deaths occurring in the CHC infected population are de facto attributable to CHC. To judge the CHC contribution, we need to uncover the benchmark mortality rate; in other words, the rate of liver mortality that this population would exhibit in the absence of CHC. This is a challenging task; CHC infection is inextricably linked to high rates of injecting drug

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Influence of alcohol use, race, and viral coinfections on spontaneous HCV clearance in a US veteran population

Cited by 34 publications

References 41 publications

Role of primary T‐cell immunodeficiency and hepatitis B coinfection on spontaneous clearance of hepatitis C: The BC Hepatitis Testers Cohort

Role of primary T‐cell immunodeficiency and hepatitis B coinfection on spontaneous clearance of hepatitis C: The BC Hepatitis Testers Cohort

HBV/HCV co‐infection is associated with a high level of HCV spontaneous clearance among drug users and blood donors in China

Liver mortality attributable to chronic hepatitis C virus infection in Denmark and Scotland—Using spontaneous resolvers as the benchmark comparator

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