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Disease Outcomes in a Cohort of Women Infected by Hepatitis C-Contaminated anti-D Immunoglobulin During 1970s
Journal of Hepatology ( IF 25.7 ) Pub Date : 2017-12-01 , DOI: 10.1016/j.jhep.2017.07.034
Patricia Garvey , Niamh Murphy , Paula Flanagan , Aline Brennan , Garry Courtney , Orla Crosbie , John Crowe , John Hegarty , John Lee , Margaret McIver , Carol McNulty , Frank Murray , Niamh Nolan , Cliona O'Farrelly , Stephen Stewart , Michele Tait , Suzanne Norris , Lelia Thornton

BACKGROUND & AIM In the mid-1990s, a group of Rh negative women was diagnosed with hepatitis C virus (HCV) genotype 1b infection, following administration of contaminated anti-D immunoglobulin in 1977-79. We aimed to describe their disease history and estimate the effect of selected host and treatment factors on disease progression. METHODS We conducted a cohort study on the women infected with HCV. Information was collected from records at seven HCV treatment centres on demographics, treatment and health outcomes up to the 31st December 2013. We calculated cumulative incidence, case fatality, and sub hazard ratios (SHR) for disease progression using competing risks regression. RESULTS Six hundred and eighty-two patients were included in the study. Among the chronically infected patients (n=374), 35% completed interferon-based antiviral treatment; 42% of whom had a sustained virological response. At the end of 2013, 19%, 1.9%, and 4.9% of chronically infected patients had developed cirrhosis, hepatocellular carcinoma, and liver-related death, respectively, compared with 10%, 0.8%, and 2.4% at the end of 2008. At the end of 2013, 321 (86%) of the chronically infected patients remained alive, 247 (77%) of whom were still chronically infected. Factors associated with increased cirrhosis rates included high alcohol intake (aSHR=4.9 [2.5-9.5]) and diabetes mellitus (aSHR=5.0 [2.9-8.8]). CONCLUSIONS Development of liver-related outcomes accelerated with time, with the risk of cirrhosis, hepatocellular carcinoma, and liver-related death doubling in the last five years of follow-up, particularly in women with high alcohol consumption and diabetes mellitus. We recommend that patients with chronic HCV infection be advised of the additive harmful effect of alcohol, and that data be collected on this cohort after a further five years to analyse the effect of subsequent antiviral treatment during this rapidly evolving period in HCV treatment history. LAY SUMMARY In the mid-1990s, a group of women were diagnosed with chronic hepatitis C virus (HCV) infection following receipt of contaminated anti-D immunoglobulin between 1977 and 1979 in Ireland. Seventy-two (19%) developed cirrhosis and 18 had died from liver-related causes (5%) after 36years of infection. Disease progression accelerated in the last five years of follow-up, particularly in women with diabetes mellitus and high alcohol consumption. We recommend that patients with chronic HCV infection be advised of the additive harmful effect of high alcohol consumption.

中文翻译:

1970 年代一组感染丙型肝炎抗 D 免疫球蛋白的妇女的疾病结果

背景与目的 在 1990 年代中期,一组 Rh 阴性女性在 1977-79 年服用受污染的抗 D 免疫球蛋白后被诊断出患有丙型肝炎病毒 (HCV) 基因型 1b 感染。我们旨在描述他们的病史,并估计选定的宿主和治疗因素对疾病进展的影响。方法 我们对感染 HCV 的女性进行了队列研究。截至 2013 年 12 月 31 日,从七个 HCV 治疗中心的记录中收集了有关人口统计学、治疗和健康结果的记录。我们使用竞争风险回归计算了疾病进展的累积发病率、病死率和亚风险比 (SHR)。结果 研究中包括 682 名患者。在慢性感染患者中(n=374),35% 完成基于干扰素的抗病毒治疗;其中 42% 的人有持续的病毒学反应。2013 年底,19%、1.9% 和 4.9% 的慢性感染患者发展为肝硬化、肝细胞癌和肝脏相关死亡,而 2008 年底分别为 10%、0.8% 和 2.4% . 2013 年底,321 名(86%)慢性感染患者仍然存活,其中 247 名(77%)仍处于慢性感染状态。与肝硬化率增加相关的因素包括高酒精摄入量 (aSHR=4.9 [2.5-9.5]) 和糖尿病 (aSHR=5.0 [2.9-8.8])。结论 肝脏相关结局的发展随着时间的推移而加速,在过去五年的随访中,肝硬化、肝细胞癌和肝脏相关死亡的风险翻了一番,尤其是在饮酒量大和患有糖尿病的女性中。我们建议慢性 HCV 感染患者被告知酒精的附加有害影响,并在 5 年后收集该队列的数据,以分析在 HCV 治疗史的这一快速发展时期内后续抗病毒治疗的效果。概述 在 1990 年代中期,一组妇女在 1977 年至 1979 年期间在爱尔兰接受受污染的抗 D 免疫球蛋白后被诊断出患有慢性丙型肝炎病毒 (HCV) 感染。72 人 (19%) 在感染 36 年后发展为肝硬化,18 人死于肝脏相关原因 (5%)。在过去五年的随访中,疾病进展加速,特别是在患有糖尿病和大量饮酒的女性中。
更新日期:2017-12-01
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