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The spectrum of undiagnosed hepatitis C virus infection in a US HIV clinic

Taylor, Lynn E; Foont, Julie A; DeLong, Allison K; Wurcel, Alysse; Linas, Benjamin P; Chapman, Stacey; Maynard, Michaela A; Cu-Uvin, Susan; Mayer, Kenneth H
United States guidelines endorse one-time HCV antibody screening at HIV diagnosis. Rescreening HCV-seronegative patients on a regular basis is still not policy, although HIV-infected persons have reasonably substantial HCV incidence. We evaluated routine risk factor-independent HCV antibody re-testing in a Rhode Island HIV clinic. We instituted annual HCV antibody testing for HCV-seronegative patients who had not been rescreened in a year or more. Testing based on clinical suspicion continued. We conducted a chart review of new antibody-positive cases in the first year of rescreening, July 2006 to June 2007. Of 245 rescreened patients, 11 (4.5%) seroconverted. Five (45%) were female. Median time between last negative and first positive result was 32 months (range 8-98 months). Six (55%) had documented risk factors and 6 (55%) elevated ALT (> 45 IU/L) between antibody tests; none prompted re-testing. One seroconverter died of hepatocellular carcinoma 3.7 years after HCV diagnosis. A twelfth was rescreened for suspected acute HCV based on ALT of 515 IU/L. He had newly detectable HCV RNA then seroconversion, and achieved SVR following 6 months of treatment in the acute phase for genotype 1 infection. Incident HCV is not uncommon among HIV-infected patients in care. Rescreening identified undiagnosed HCV in this population. HCV RNA should be checked promptly in HCV-seronegative persons with ALT elevation. We observed consequences of late diagnosis (hepatocellular carcinoma) and benefits of early diagnosis (cure with treatment of acute HCV). Adding annual rescreening to the Ryan White Program would facilitate earlier identification of undiagnosed HCV and create an instant widespread surveillance system, providing HCV incidence data.
PMID: 24428794
ISSN: 1087-2914
CID: 909772

Hepatitis C virus and alcohol

Siu, Larry; Foont, Julie; Wands, Jack R
This review will focus on the prevalence of hepatitis c virus (HCV) infection in alcoholics with and without liver disease. Evidence will be presented to demonstrate that ethanol and chronic HCV infection synergistically accelerate liver injury. Some of the major postulated mechanisms responsible for disease progression include high rates of apoptosis, lipid peroxidation, and generation of free radicals and reactive oxygen species with reduced antioxidant capacity of the liver. Acquisition and persistence of HCV infection may be due to the adverse effects of ethanol on humoral and cellular immune responses to HCV. Dendritic cells (DC) appear to be one of the major targets for ethanol's action and DC dysfunction impairs the ability of the host to generate viral specific cluster of differentiation 4 (CD4+) and cluster of differentiation 8 (CD8+) immune responses. There is a relationship between increased alcohol intake and decreased response to interferon (IFN) therapy, which may be reversed by abstinence. Clinical studies are needed to optimize treatment responses in alcoholic patients with chronic HCV infection.
PMID: 19387918
ISSN: 0272-8087
CID: 548992

Spontaneous clearance of hepatitis C virus after liver transplantation in two patients coinfected with hepatitis C virus and human immunodeficiency virus [Case Report]

Bhagat, Vishal; Foont, Julie A; Schiff, Eugene R; Regev, Arie
Spontaneous resolution of chronic hepatitis C virus (HCV) infection is exceedingly rare and poorly understood. As HCV and human immunodeficiency virus (HIV) have shared routes of transmission, HCV coinfection is estimated to affect 15%-30% of the HIV-positive population. We report 2 patients with HCV-HIV coinfection who underwent orthotopic liver transplantation at our center and had spontaneous clearance of their chronic HCV infection after transplantation without any anti-HCV treatment. Both patients showed no evidence of HCV recurrence for more than 3 years despite long-term immunosuppressant therapy. Spontaneous clearance of chronic HCV infection can occur in HIV-HCV-coinfected patients after liver transplantation. The mechanism of this phenomenon remains unclear.
PMID: 18161776
ISSN: 1527-6465
CID: 548972

Avoid the tragedy of hepatitis B reactivation in immunosuppressed patients [Comment]

Foont, Julie A; Schiff, Eugene R
PMID: 17262070
ISSN: 1743-4378
CID: 548982

Knowledge and attitudes regarding vaccination against hepatitis A and B in patients with chronic hepatitis C virus infection: A comparison of Family Medicine and internal medicine physicians in the United States [Meeting Abstract]

Foont, JA; Chaudhan, S; Tenner, CT; Weinshel, EH; Bini, EJ
ISSN: 0884-8734
CID: 56290

Barriers to vaccination against hepatitis a and hepatitis B in patients with chronic hepatitis C virus infection: A national survey of family medicine and internal medicine physicians [Meeting Abstract]

Foont, JA; Chauchari, S; Tenner, CT; Weinshel, E; Bini, EJ
ISSN: 0884-8734
CID: 56291