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The epidemiology of hepatitis C in a UK health regional population of 5.12 million
  1. A H Mohsen,
  2. Trent HCV Study Group
  1. Royal Hallamshire Hospital, Sheffield, UK
  1. Dr M W McKendrick, Department of Infection and Tropical Medicine, Royal Hallamshire Hospital, Sheffield S10 2JF, UK.mike.mckendrick{at}csuh.nhs.uk

Abstract

BACKGROUND The epidemiology and natural history of hepatitis C virus (HCV) infection in the UK are uncertain. Previous reports are from small or selected populations such as blood donors or tertiary referral centres.

AIMS To study the epidemiology and natural history of HCV infection.

METHODS Prospective study incorporating five centres within the Trent region. Patients were managed and followed up according to a commonly agreed protocol.

SUBJECTS A total of 1128 HCV positive patients. Patients with haemophilia, human immunodeficiency virus, and chronic renal failure were excluded.

RESULTS Between September 1991 and December 1998, 2546 anti-HCV positive patients were identified of whom 1128 (44%) were enrolled in the cohort. A risk factor(s) for infection was identified in 93.4% of patients who completed the questionnaire; 81% of patients were HCV RNA positive. A total of 397 initial liver biopsies were scored by a single pathologist. These showed a correlation between high alcohol intake and fibrosis score. Multivariate analysis showed fibrosis to be associated with age over 40, past evidence of hepatitis B virus infection, and higher necroinflammatory grade but not with sex, viral genotype, maximum known alcohol intake, estimated duration of infection, or mode of transmission. Twelve (7.8%) of 153 patients who received interferon therapy had sustained serum virus clearance. Sixty six patients have died during the follow up period, 31 with a liver related cause of death. This represents a considerable excess over the expected death rate for a cohort of this age and sex distribution.

CONCLUSIONS HCV infection is an emerging health problem in the Trent region. Identifying risk factors for infection and disease severity will enhance understanding and facilitate improved intervention. An excess mortality in infected individuals is already evident in this unselected cohort.

  • hepatitis C
  • epidemiology
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Footnotes

  • Trent HCV Study Group (see appendix for details)

  • Abbreviations used in this paper:
    HCV
    hepatitis C virus
    HBV
    hepatitis B virus
    RT-PCR
    reverse transcriptase-polymerase chain reaction
    IDU
    injecting drug user
    HIV
    human immunodeficiency virus
    anti-HBc
    antibody to hepatitis B core antigen
    HBsAg
    hepatitis B surface antigen
    NBA
    National Blood Authority

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