RESUMEN
BACKGROUND: Hepatitis C is a viral infection that leads to chronic liver disease, resulting in significant morbidity and mortality. OBJECTIVES: To describe the demographic characteristics and clinical presentation of patients with chronic hepatitis C infection. The aspartate aminotransferase-to-platelet ratio index (APRI) and the fibrosis index based on 4 factors (FIB-4) were assessed for prediction of liver fibrosis. METHODS: We retrospectively reviewed 87 records of patients who presented to the liver clinic at Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa, from January 2007 to December 2016. Patients' records were reviewed and analysed using SPSS statistical software version 24. Convenience sampling was used. RESULTS: The patients' mean (standard deviation (SD)) age was 52.6 (12.3) years. Fifty-four percent were female. Hepatitis C virus genotype 5 was exclusively found in blacks (p<0.001), constituting 60.3% of infections in this ethnic group and 48.7% in the cohort, followed by genotype 1 (21.8%), genotype 3 (15.4%), genotype 4 (10.3%) and mixed-genotype infections (3.8%). Genotype 5 patients were older (mean (SD) age 56.7 (9.8) years) than genotype 1 (46.3 (11.4) years) and genotype 3 (42 (9.8) years) (p=0.002 and p<0.001, respectively). The receiver operating characteristic curve for METAVIR F0 v. APRI (cut-off <0.7) showed a moderate correlation, with an area under the curve (AUC) of 0.349 (p=0.002), sensitivity of 78.8%, specificity of 70.6% and a negative predictive value (NPV) of 63.2%. METAVIR F4 v. APRI (cut-off ≥1.5) showed an AUC of 0.881 (p=0.001) with sensitivity of 85.7%, specificity of 93% and a positive predictive value (PPV) of 67%. METAVIR F0 v. FIB-4 (cut-off <1.45) showed a moderate correlation, with an AUC of 0.332 (p=0.021), sensitivity of 78.3%, specificity of 53.8% and an NPV of 73.7%. METAVIR F4 v. FIB-4 (cut-off >3.25) had a strong correlation, with an AUC of 0.952 (p<0.001), sensitivity of 63.6%, specificity of 100% and a PPV of 100%. Early virological response (EVR) was found to predict sustained virological response (SVR) to therapy (odds ratio 27.8; 95% confidence interval 2.8 - 274.3; p=0.004). CONCLUSIONS: Compared with other genotypes, genotype 5 was predominant in our cohort, particularly in older age groups. Moreover, APRI and FIB-4 scores correlated significantly with advanced fibrosis in HCV patients. Finally, EVR during therapy was found to determine SVR.
Asunto(s)
Hepacivirus/genética , Hepatitis C Crónica/complicaciones , Hepatitis C Crónica/tratamiento farmacológico , Cirrosis Hepática/diagnóstico , Adulto , Anciano , Antivirales/uso terapéutico , Área Bajo la Curva , Aspartato Aminotransferasas/sangre , Comorbilidad , Quimioterapia Combinada , Femenino , Genotipo , Hepatitis C Crónica/sangre , Hepatitis C Crónica/virología , Humanos , Interferón-alfa/uso terapéutico , Cirrosis Hepática/sangre , Cirrosis Hepática/patología , Cirrosis Hepática/virología , Masculino , Persona de Mediana Edad , Recuento de Plaquetas , Polietilenglicoles/uso terapéutico , Curva ROC , Proteínas Recombinantes/uso terapéutico , Estudios Retrospectivos , Ribavirina/uso terapéutico , Factores de Riesgo , Sudáfrica , Respuesta Virológica Sostenida , Centros de Atención TerciariaRESUMEN
A cross-sectional study was carried out to investigate the prevalence and risk factors for severe anaemia among schoolchildren in New Halfa, eastern Sudan. After taking age and gender, haemoglobin (Hb) levels were measured and all children were screened for malaria and intestinal parasitic infections, including schistosomiasis. Six hundred and forty (230 boys, 410 girls) schoolchildren aged 8-18 years were enrolled. The mean (SD) of the haemoglobin was 9.6 (1.7) mg/dl. One hundred and eleven (17.3%) and 33 (5.2%) children had Schistosoma mansoni infection and Hymenolepis nana infection, respectively. Five hundred and eighty (90.6%) of these children had anaemia (Hb < 12 g/dl), and 103 (16.0%) of them had severe anaemia (Hb < 8 g/dl). Girls (OR = 2.5, 95% CI = 1.1-5.3; P = 0.01) were at higher risk for severe anaemia in univariate and multivariate analyses. Schistosoma mansoni infections were associated with severe anaemia in univariate analyses only. Thus, there was a high prevalence of severe anaemia among these children. This needs to be investigated in more depth in the future, and more attention should be paid to the health of adolescent girls.