TRANSMISSION OF HEPATITIS C VIRUS (HCV)

Mother-to-child transmission. DM Gibb and colleagues reviewed data from HCV-infected women and their infants (491 mother-child pairs) to examine the effect of risk factors on the vertical transmission rate. Coinfection with human immunodeficiency virus (HIV) was present in 5% (22) of the women, and the HCV transmission rate was higher in the HIV-positive vs. HIV-negative mothers (18.4% vs. 6.4%). Elective cesarean section prior to membrane rupture was associated with a lower rate of HCV transmission compared to vaginal delivery or emergency cesarean section (0% vs. 7.4%; p=0.04). The sensitivity of HCV RNA was only 22% prior to 1 month of age but rose to 97% thereafter. HCV antibody became negative in 50% of uninfected children by 8 months and in 95% by 13 months of age. The low sensitivity of HCV RNA in the first month after birth and lower transmission rate with elective cesarean section suggests that HCV infection occurs at the time of delivery. (Gibb DM, et al. Lancet 2000;356:904-907)

Transmission during medical care. R. Stefan Ross and coworkers provide evidence that an anesthesiology assistant contracted HCV from a patient with chronic hepatitis C and subsequently transmitted HCV to 5 other patients during the incubation stage of his disease. The assistant had been HCV-negative 8 weeks prior to the operation on the index patient. He had a weeping wound on his right hand during the period of time that he administered anesthesia and did not wear surgical gloves. The assistant and the 6 patients were all positive for serum HCV RNA. Genotyping revealed HCV genotype 1a in all 6 cases, and sequence analysis of HCV hypervariable region 1 demonstrated that the assistant and patients were infected with the same HCV isolate. Spread of HCV could likely have been prevented if universal precautions had been taken. (Ross RS, et al. N Engl J Med 2000;343:1851-1854)

HCV infection in the Nile Delta. Mostafa Habib and colleagues conducted a study in which one half of the households of a rural village in the Nile Delta were tested for anti-HCV and interviewed (3,999 subjects). They found 24.7% of this population to be anti-HCV positive. The prevalence of anti-HCV positivity increased with age: >50% of those older than 35 years of age compared to only 9.3% of those £20 years of age were anti-HCV positive. Other risk factors for HCV infection among subjects older than 20 years of age identified by multivariate analysis included male gender, marriage, injection treatment for schistosomiasis, blood transfusion, invasive medical procedure, receipt of injections from informal health care providers, and cesarean section or abortion. These data are now being used in rural prevention programs in Egypt. (Habib M, et al. Hepatology 2001;33:248-253)

Primary Biliary Cirrhosis (PBC)

Epidemiology. W. Ray Kim and associates performed an epidemiological study of the incidence and prevalence of PBC in a U.S. community (Olmstead County, Minnesota) and examined the validity of the Mayo natural history model for PBC in these unselected patients. The age-adjusted incidence of PBC was 2.7 cases per 100,000 person-years, and the age- and sex-adjusted prevalence was 40.2 cases per 100,000 persons. The actual 7-year survival was 65% compared to the 61% predicted by the Mayo model. These data indicate that a larger number of people have PBC than previously estimated and that the Mayo natural history model for PBC accurately predicted survival in this population. (Kim WR, et al. Gastroenterology 2000;119:1631-1636)

Risk factors. Arti Parikh-Patel et al. conducted a survey of 241 PBC patients, 261 of their siblings, and 141 friends without PBC. The survey revealed elevated adjusted odds ratios for PBC patients compared to friends for other autoimmune diseases, smoking, tonsillectomy, and urinary tract infections. Smoking may influence a Th1 response, and the higher rate of urinary tract infection raises the possibility of an infectious etiology for PBC and molecular mimicry. (Parikh-Patel A, et al. Hepatology 2001; 33: 16-21)

Transplantation. Raquel Garcia and colleagues retrospectively reviewed data from 400 PBC patients who underwent orthotopic liver transplantation (OLT) at a single center between 1983 and 1999. The actuarial survival at 1, 5, and 10 years was 83%, 78%, and 67%, respectively. Recurrent PBC was found in 17% of patients at a mean time of 36 months. Although recurrence is common, OLT is an effective treatment for patients with advanced PBC. (Garcia RFL, et al. Hepatology 2001;33:22-27)

Alcoholic Hepatitis

Pentoxifylline (PTX) therapy. Evangelos Akriviadis and coworkers conducted a randomized trial of PTX (400 mg orally 3 times daily) vs. placebo in patients with severe alcoholic hepatitis (n=101). Mortality during the index hospitalization was greater in the placebo group compared to the PTX treatment group (46.1% vs. 24.5%; p=0.037). Furthermore, hepatorenal syndrome more frequently caused death in placebo patients than patients treated with PTX (p=0.009). The results of this trial demonstrate that PTX therapy improves short-term survival in patients with severe alcoholic hepatitis, primarily by decreasing the risk of hepatorenal syndrome. (Akriviadis E, et al. Gastroenterology 2000;119:1637-1648)

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