Dissertations / Theses: 'Hepatitis C Victoria Epidemiology'

1

Sweeting, Michael John. "Statistical modelling in hepatitis C epidemiology." Thesis, University of Cambridge, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.612187.

Full text

APA, Harvard, Vancouver, ISO, and other styles

2

Aisyah, Dewi Nur. "Assessing the epidemiology of hepatitis C to inform public health strategies towards hepatitis C elimination." Thesis, University College London (University of London), 2018. http://discovery.ucl.ac.uk/10058645/.

Full text

Abstract:

Background: Major advances in hepatitis C virus (HCV) treatment suggest that HCV might be eliminated in the future. In this thesis, I have undertaken a series of studies (systematic review, secondary analysis of existing cohort study, modelling) to investigate factors that are likely to impact on the feasibility of achieving HCV elimination. Overarching Aim: To improve our understanding of the epidemiology and natural history of hepatitis C in order to inform public health strategies working towards HCV elimination. Methods: Systematic review and meta-analysis assessing HCV spontaneous clearance rate and its predictors (Chapters 2&3). Prevalence surveys to assess the burden of and risk factors for HCV in Guernsey (Chapter 4) and in vulnerable populations in London (Chapter 5). Development of a mathematical model to estimate the required scale-up of DAA treatment that would be required to eliminate HCV in PWID in London by 2030 (Chapter 6). Findings: • HCV prevalence was high in people screened in homeless centres, a prison and drug treatment centres. Increased case finding is needed in these settings. • 35% of patients spontaneously clear HCV by 12 months - it may be appropriate to have a year observation before instigating treatment for recently infected patients in low and middle-income countries with low healthcare budgets. • A wide range of risk factors predict spontaneous clearance. Notably drug users and those with HIV are less likely to spontaneously clear than other groups. Thus, early treatment for high risk groups is recommended for those who are less likely to achieve clearance and pose a higher risk of onward transmission. • IL28B rs8103142, IL28B rs12979860, and IL28B rs8099917 are important host genetics predictors of clearance. • Treatment prioritisation with "watch and wait" approach is probably more appropriate to be implemented for developing and less developed countries, where large number of HCV patients were infected by iatrogenic transmission and usually those settings have limited DAAs drugs supply. However, for developed countries such as UK, treatment prioritisation is probably less relevant as the majority of HCV infection came from PWID and DAA's treatment are available. • The modelling suggests that elimination of HCV in PWID in London by 2030 would require 46% annual treatment coverage of those infected - this represents a major scale up from current activity. Retreatment of treatment failures lowers the coverage needed to 29.5%. The model is highly sensitive to: SVR (Sustained Virologic Response - suggesting need to support adherence and prevent resistance) and injecting duration (suggesting the need for drug treatment services). Conclusion: Hepatitis C elimination would require substantial additional investment to raise treatment coverage and prevent transmission through injecting drug use. My work has identified a number of approaches would could support efforts to achieve this goal.

APA, Harvard, Vancouver, ISO, and other styles

3

Mohsen, Abdul Hadi. "The epidemiology of hepatitis C and HCV-HIV coinfection." Thesis, King's College London (University of London), 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.424448.

Full text

APA, Harvard, Vancouver, ISO, and other styles

4

Corrado, Rachel E. "Distribution of Hepatitis C Testing in Philadelphia, 2012-2014." Master's thesis, Temple University Libraries, 2015. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/312884.

Full text

Abstract:

Epidemiology
M.S.
Background: Hepatitis C virus (HCV) is a widespread problem in the United States, but the disease's low screening rates mean that reported cases account for only a fraction of the population's antibody prevalence. In reality, chronic HCV is the most common chronic blood-borne infection in the country. While newer infections may be completely asymptomatic, the virus can lead to serious complications in the liver down the line, including hepatic fibrosis, cirrhosis, and hepatocellular carcinoma (HCC). Because HCV is a reportable disease, the Philadelphia Department of Public Health (PDPH) hepatitis surveillance registry has records of all of the positive tests performed in the city. Negative test results are not readily available, however, making it difficult to create an accurate picture of who is being tested for HCV. Our study used negative results collected from reference laboratories throughout the city to fill in many of the gaps and determine which neighborhoods were not sufficiently screening at-risk populations. Methods: Our dataset included approximately 100,000 individuals, a little over 90% of whom were HCV negative. Negative test results were obtained from Quest and Lab Corp, two of the major reference laboratories in the area that account for approximately 80% of all of the results of tests performed in Philadelphia. The screening data were then combined with records from the PDPH hepatitis surveillance registry. ArcGIS geographic information software was used to create maps out of neighborhood and census tract data, providing a visual representation of HCV screening distribution in Philadelphia. We also explored differences in demographic characteristics and testing facility information by test result. The data included anyone in the past 2 years who had undergone an antibody (Ab) or RNA test for HCV. Results: We found that census tract poverty rate was positively associated with HCV screening rate. Also, the majority of testing occurred in either hospital networks or private practices. There were significantly more males testing positive for HCV, despite the fact that many more females were tested overall. Similarly, the "baby boomer" age range (50-69) had the highest proportion of HCV positive test results, yet those aged 30-49 had the highest HCV testing rates. Conclusions: Negative test results for reportable diseases are rarely utilized, but can be extremely useful in identifying problem areas and focusing testing resources. Because so many people with HCV go undiagnosed, it is especially important that populations requiring additional attention be recognized and screened.
Temple University--Theses

APA, Harvard, Vancouver, ISO, and other styles

5

Polis, Suzanne Public Health &amp Community Medicine Faculty of Medicine UNSW. "Hepatitis B and hepatitis C virus in an antenatal population : an epidemiological study." Awarded by:University of New South Wales. School of Public Health and Community Medicine, 2005. http://handle.unsw.edu.au/1959.4/22035.

Full text

Abstract:

Although Australian epidemiology of HBV and HCV has been well described for populations groups at higher risk, but the information available for groups generally considered to be lower risk is much more limited. An understanding of the prevalence of these infections and their risk factors in antenatal women is important to guide testing policy and practice. A study was therefore conducted of the epidemiology of hepatitis B and hepatitis C infection in women. In addition, women were asked about their experience with antenatal testing. A total of 516 women participated in the survey, of these 479 (95%) women had been tested for HCV antibodies .The prevalence of HCV antibodies was 4% overall, and 2% among women who were unaware of their HCV status prior to their antenatal test. A history of injecting drug use and residing with a HCV positive person were significantly associated with HCV infection in multivariate analyses. HBV testing was conducted in 468 (99.6%) of women, and the overall prevalence was 2%. Risk factors identified were birthplace in countries of South East Asia. Women were asked about their perception of antenatal testing and pre-test information. Nearly a third (143, 30.5%) of women who had been tested for HCV infection either said that they did not know whether they had been tested, or said that they had declined testing. The corresponding proportion for HBV infection was 28.8% (135). Over 65% and 66% of women said that had not received any information about testing for HCV and HBV respectively. The finding that virtually all antenatal women were being tested for HCV was in contrast to government and non-government organisation policies of ???selective??? screening in place during the study period. Of concern was the substantial proportion of women who were tested despite reporting that they had declined their clinician???s offer to test for HCV and HBV, and the large number of women who reported an absence of pre-test information. Women who said they had received information reported the delivery and quality of information varied according to the antenatal clinician group, but perceived the overall quality as poor.

APA, Harvard, Vancouver, ISO, and other styles

6

Halasz, Robert. "Epidemiology and clinical importance of GB virus C/hepatitis G virus /." Stockholm, 2000. http://diss.kib.ki.se/2000/91-628-3997-7/.

Full text

APA, Harvard, Vancouver, ISO, and other styles

7

Thein, Hla-Hla Public Health &amp Community Medicine Faculty of Medicine UNSW. "Measuring the health burden of hepatitis C at an individual and population level in Australia." Awarded by:University of New South Wales. School of Public Health and Community Medicine, 2006. http://handle.unsw.edu.au/1959.4/24967.

Full text

Abstract:

This thesis examines the effect of hepatitis C virus infection (HCV) on health-related quality of life (HRQOL) to define burden of disease at individual and population levels. A systematic review of HCV HRQOL studies was undertaken with translation of Short Form-36 (SF-36) Health Survey data into community-weighted health state utilities using three different methods. Derived estimates of health utilities were 0.87 for HCV treatment-induced sustained virological response (SVR); 0.81 for pre-cirrhosis; 0.76 for compensated cirrhosis; 0.69 for decompensated cirrhosis; 0.67 for hepatocellular carcinoma (HCC); and 0.77 for liver transplant. The HCV health state utilities varied considerably from expert estimates, with relatively lower estimates for early liver disease and higher estimates for advanced liver disease, but were comparable to direct patient-elicited utilities. A study utilising data from population-based health surveys incorporating HCV screening among prisoners at Australian correctional centres in 1996 and 2001 showed no measurable effect of HCV on HRQOL, including that attributable to HCV viraemia. Compared to uninfected Australian norms, prisoners had lower HRQOL irrespective of HCV status. Several non-HCV factors such as age, co-morbidity, severity of depressive symptoms, and medical care utilization influenced HRQOL. A prospective study of health outcomes among HCV monoinfected and HIV/HCV coinfected individuals conducted at Sydney tertiary level hepatitis clinics between 2003 and 2005 found similar cognitive function, mood, and HRQOL patterns in these two HCV groups in the context of pegylated interferon (PEG-IFN) alfa-2a and ribavirin therapy. The HCV groups had similar levels of pre-treatment HRQOL impairment, further on-treatment deterioration, and posttreatment improvements. SVR was associated with significant HRQOL improvements, but mental HRQOL improvement was also seen in individuals not achieving an SVR. The impact of HCV treatment uptake on HCV-related burden of disease at a population level in Australia was examined using a mathematical model. The model estimated that in 2004, there were ~181,500 cases of chronic HCV infection, 7,020 with HCV-related cirrhosis, and annual incidence of 238 cases of HCV-related liver failure and 70 cases of HCV-related HCC. Compared to no treatment, current treatment levels (~1% of HCV-infected individuals per annum) would reduce projected HCV-related cirrhosis and advanced liver disease numbers by ~30% at 2020 and a gain of ~122,200 Quality-Adjusted Life Years (QALYs). Even with a five-fold increase from current treatment levels, advanced liver disease numbers will continue to increase through 2020 but will be reduced by ~55% and a gain of ~483,200 QALYs.

APA, Harvard, Vancouver, ISO, and other styles

8

Judd, Ali. "Epidemiology of hepatitis C virus infection in injecting drug users in London." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.411031.

Full text

APA, Harvard, Vancouver, ISO, and other styles

9

Tucker, Timothy Johan Paul. "Epidemiology, molecular characterisation and tropism of the Hepatitis G Virus / GBV-C." Doctoral thesis, University of Cape Town, 1999. http://hdl.handle.net/11427/25669.

Full text

Abstract:

The hepatitis G virus and GBV-C are recently discovered variants of the same virus belonging to the family Flavivirus (HGV/GBV-C). Although initially thought to be a hepatitis virus, it has been shown to have no association with liver disease. No work has been performed on the prevalence or molecular characteristics of HGV/GBV-C in southern Africa. In addition, although it is clear that the liver is not the primary site of replication, there is no data on the sites of HGV/GBV-C replication in normal subjects. Thus, this study aimed to assess the prevalence of HGV/GBV-C carriage in the urban and rural adult Black communities of the Western and Eastern Cape Provinces of South Africa, and compare it to the prevalence of serological markers of the hepatitis viruses A-E. In addition, this study aimed to assess the molecular features of South African HGV/GBV-C isolates and demonstrate the organs where viral replication was present. The mean prevalences of antibodies to hepatitis A lgG, hepatitis B surface antigen and antibodies to hepatitis B surface antigen were 98%, 4.3% and 61.1 % respectively. The mean prevalence of antibodies to hepatitis C was 1.8%. No significant differences in prevalence were shown between the urban and rural regions for these viruses. The mean anti-hepatitis E prevalence varied from 5.8% to 19.1 % in the different regions. Those living in mud houses without access to chlorinated tap water had a significantly higher prevalence of antihepatitis E. No anti-hepatitis D positive samples were isolated. The overall prevalence of HGV/GBV-C was 26.9%, with rural communities having a significantly lower prevalence than urban communities. A significant relationship was observed between HGV/GBV-C infection with the use of illicit drugs, female gender, younger age and past blood transfusions. Phylogenetic analysis demonstrated a novel fourth South African HGV/GBV-C genotype, distinct from the previously described genotypes 1-3. In addition, certain isolates showed a major deletion in the highly conserved 5' non-coding region of HGV/GBV-C. Analysis of 23 tissue biopsies from infected cadavers suggested that the spleen and bone marrow were the primary sites of HGV/GBVC replication.

APA, Harvard, Vancouver, ISO, and other styles

10

Markov, Peter V. "Molecular epidemiology, evolution and adaptation of hepatitis C virus to population immunity." Thesis, University of Oxford, 2011. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.711633.

Full text

APA, Harvard, Vancouver, ISO, and other styles

11

Thaikruea, Lakkana. "Epidemiology of hepatitis C virus infection among blood donors in northern Thailand." Available to US Hopkins community, 2003. http://wwwlib.umi.com/dissertations/dlnow/3080779.

Full text

APA, Harvard, Vancouver, ISO, and other styles

12

Thorburn, Douglas. "Hepatitis C infection in the west of Scotland : epidemiology, treatment and disease progression." Thesis, University of Glasgow, 2001. http://theses.gla.ac.uk/5374/.

Full text

Abstract:

After the discovery of and development of diagnostic tests for hepatitis A and B it became apparent that a parenterally transmissible agent was responsible for cases of non-A non-B hepatitis. It was not until 1989, a further fifteen years later, that the agent responsible for most cases, the hepatitis C virus (HCV), was identified. This virus was initially thought to cause a mild self-limiting hepatitis. With the introduction of serological screening tests for HCV, it was soon apparent that it caused a chronic asymptomatic hepatitis which could be accompanied by significant fibrosis and sometimes cirrhosis and hepatocellular carcinoma. Epidemiological studies have since revealed that up to eighty percent of those infected develop chronic infection and that in the developed world hepatitis C virus infection is widespread. An estimated 0.5% of the UK population and 1.8% of the population in the USA are infected. It is now accepted that HCV can cause an asymptomatic indolent infection that can progress over decades with the development of cirrhosis. Hepatitis C infection is now established as the single most common condition referred to hepatologists and the leading indication for hepatic transplantation in Europe and the USA.Since the discovery of the hepatitis C virus much research has focussed on the epidemiology, natural history and treatment of the condition. The first chapter provides an overview of HCV and places in context the research contained in this thesis. In western countries the role of the healthcare setting in transmitting hepatitis C virus is poorly understood. We performed a large retrospective serological survey of hepatitis C virus infection in healthcare workers from theWest of Scotland. This revealed the overall prevalence of HCY infection in healthcare workers to be low regardless of involvement in exposure-prone procedures. This indicates that the risk of acquisition of hepatitis C virus infection by healthcare workers in an area with a large HCY infected intravenous drug using population is small and that the risk posed to patients by contact with the HCY infected healthcare workers is also low. Liver biopsy is the gold standard for assessing the extent of liver injury and determining prognosis in chronic hepatitis C. Non-invasive markers of liver injury have proved disappointing such that serial liver biopsies are required to monitor disease progression. In this thesis the hepatocellular enzyme a-glutathione stransferase is studied as a non-invasive marker of liver injury and as a means of assessing response to treatment with a - interferon. Disappointingly a-glutathione s-transferase performed poorly as a non-invasive marker of liver injury but showed some promise as a marker of response to interferon therapy. Three chapters of this thesis then focus on factors that may influence the natural history of chronic hepatitis C virus infection and in particular account for the variable rates of progression of liver fibrosis observed in chronic HCY. The role of iron and polymorphisms in the haemochromatosis gene (HFE) were studied. Carriage of HFE mutations was not related to the serum and liver markers of iron accumulation or the progression of liver fibrosis. Elevated liver iron concentrations were rarely observed, occurring in patients with more severe liver disease, and whether this was the cause or result of hepatocellular injury was unclear. Carriage of genetic polymorphisms in the renin-angiotensin system, which are associated with increased systemic renin-angiotensin system activity, were studied. This novel study was designed to explore whether these polymorphisms, known to influence the progression of renal and cardiac fibrosis in a number of cardiovascular diseases, influenced the progression of liver fibrosis in chronic HCY. In this study no association between these functional renin-angiotensin polymorphisms and the progression of liver fibrosis was observed. Hepatitis G virus infection was sought in a cohort of hepatitis C virus infected blood donors to investigate whether coinfection with this virus influenced the severity of hepatitis C virus related liver injury. Although hepatitis G virus co-infection was frequently observed it did not effect the severity of liver injury assessed biochemically and histologically. The factors that account for the variable rates of progression of chronic hepatitis C virus infection remain to be elucidated. Finally in this thesis the role of a - interferon therapy in the management of asymptomatic blood donors found to have hepatitis C virus infection at blood donation is studied. Most patients detected in this manner have only mild hepatitis with minimal fibrosis and little data exists as to whether they are appropriate candidates for treatment. In a randomised crossover study these patients were observed to tolerate a. - interferon therapy and have comparable response rates to other patient groups with chronic hepatitis C infection. These patients appear to be suitable candidates for treatment, although more data are required to establish what the prognosis is for these individuals if chronic HCV is left untreated.

APA, Harvard, Vancouver, ISO, and other styles

13

Gao, Zhanhai School of Mathematics UNSW. "Modelling Human Immunodeficiency Virus and Hepatitis C Virus Epidemics in Australia." Awarded by:University of New South Wales. School of Mathematics, 2001. http://handle.unsw.edu.au/1959.4/18187.

Full text

Abstract:

This thesis is concerned with the mathematical modelling for human immunodeficiency virus (HIV) and hepatitis C virus (HCV) epidemics in Australia. There are two parts to this thesis. Part I is aimed at modelling the transmission of HIV and HCV via needle sharing among injecting drug users (IDUs). The dynamical model of an epidemic through needle sharing among IDUs is derived. This model reveals the correlation between needle sharing and the epidemic prevalence among IDUs. The simulations of HIV and HCV prevalence and incidence among IDUs in Australia are made with this model. The comparison of simulated results with literature estimates shows that the modelled results are consistent with the literature estimates. The effects of needle sharing and cleaning on HIV and HCV prevalence and incidence among IDUs in Australia are evaluated. Part II is devoted to modelling the spread of HIV in the general community in Australia. A mathematical model is formulated to assess the epidemiological consequences of injecting drug use and sexual transmission in Australia. The effects of highly active antiretroviral therapies (HAART) on the HIV epidemic are included. The modelled results are in broad agreement with the literature estimates and observed data. The long-term effects of HAART are also discussed.

APA, Harvard, Vancouver, ISO, and other styles

14

Chen, Yang. "An Epidemiological Study of Hepatitis C Virus Infection Among U.S. Population." Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etd/3105.

Full text

Abstract:

Hepatitis C virus (HCV) infection is the most common blood-borne infection in the United States (U.S.). The largest increases of incidence for HCV infection are reported in the Appalachian region. This study aimed to 1) examine the prevalence and trends of HCV infection in the U.S. from 1999 to 2012; 2) investigate barriers to HCV infection treatment in Northeast Tennessee and the U.S.; and 3) study characteristics and risk factors for HIV-infection and HCV-infection in Northeast Tennessee. In the U.S., data were obtained from the National Health and Nutrition Examination Survey (NHANES) 1999-2012 to study the prevalence of HCV infection and barriers to treatment. In Northeast Tennessee, hepatitis C and HIV/AIDS data were obtained from National Electronic Disease Surveillance System (NEDSS) and enhanced HIV/AIDS Reporting System (eHARS). Descriptive statistics and multiple logistic regression models were used for analysis. Odds ratios (OR) and 95% confidence intervals (CI) were reported. There was an estimated 3.8 million people having HCV antibody in the U.S. in 2012. No significant change was found in the prevalence of HCV infection during 1999 – 2012. The leading barrier to the treatment was cost issues in the U.S. (50.0%) and Northeast Tennessee (25.0%), respectively. HCV patients without symptoms in Northeast Tennessee were more likely to be untreated (OR: 3.08, 95% CI: 1.10-8.60) and patients without health insurance in the U.S. were more likely to be untreated than their counterparts (OR: 3.38, 95% CI: 1.14-10.05). The incidence of acute hepatitis C peaked in 2012-2013 in Northeast Tennessee, while the incidence of HIV/AIDS increased by 100% from 2013 to 2015. More injection drug users (IDUs) and less men who have sex with men (MSM) were observed in patients with HCV infection than in those with HIV infection (IDUs: 50.63% vs.16.38% p

APA, Harvard, Vancouver, ISO, and other styles

15

Zoran, Dakić. "Značaj primene definicije slučaja za unapređenje epidemiološkog nadzora nad hepatitisima B i C." Phd thesis, Univerzitet u Novom Sadu, Medicinski fakultet u Novom Sadu, 2017. http://www.cris.uns.ac.rs/record.jsf?recordId=100362&source=NDLTD&language=en.

Full text

Abstract:

Adekvatni nadzor nad zaraznim bolestima predstavlja aktuelni izazov ne samo kod nas već i u razvijenim zemljama. Savremeni epidemiološki nadzor nad zaraznim bolestima zasniva se na odgovarajućim definicijama slučaja. Njihova osnovna funkcija je olakšavanje prepoznavanja određenih bolesti i njihovo registrovanje na jednoobrazan način. Definisanje slučajeva zaraznih bolesti nije jednostavno, jer uključuje kliničke, epidemiološke i laboratorijske parametre, uz istovremeno očekivanje visoke senzitivnosti i specifičnosti. Ciljevi istraživanja su bili da se utvrdi primenljivost definicija slučaja hepatitisa B i C na Klinici za infektivne bolesti Kliničkog centra Vojvodine, te da se utvrdi senzitivnost i specifičnost primenjenih definicija slučaja hepatitisa B i C. Uz postojeći dijagnostički algoritam Klinike za infektivne bolesti Kliničkog centra Vojvodine, uvedena su tri seta definicija hepatitisa B i C: Evropskog centra za prevenciju i kontrolu bolesti (ECDC) iz 2008. i 2012.godine kao i američkih Centara za kontrolu bolesti (CDC) iz 2012. godine. Istraživanje je sprovedeno na Klinici za infektivne bolesti Kliničkog centra Vojvodine i tokom 12 meseci, u skladu sa predloženim definicijama slučaja, identifikovano je 150 ispitanika obolelih od hepatitisa B i C. Utvrđene su sledeće činjenice: preporučene definicije slučaja su primenljive u Republici Srbiji za laboratorijske i kliničke kriterijume, dok uključivanje epidemiološke povezanosti u definicije slučaja ima malo praktičnog značaja za prijavljivanje hepatitisa; definicije slučaja koje uključuju i obavezno prisustvo kliničkih kriterijuma (najčešće definicije verovatnog slučaja) imaju nisku senzitivnost, a visoku specifičnost, kao posledica prisustva infekcije i u odsustvu bilo kakvih kliničkih manifestacija; definicije slučaja koje se zasnivaju samo na laboratorijskim kriterijumima imaju maksimalnu senzitivnost i specifičnost.
Adequate surveillance of communicable diseases is the actual challenge, not only in our country but also in developed countries. Modern epidemiological surveillance of communicable diseases is based on the appropriate case definitions. Their main purpose of them is to facilitate the recognition of certain diseases and their registration in a uniform manner. Case definition of communicable diseases is not easy, because it involves clinical, epidemiological and laboratory parameters, along with the expectated high sensitivity and specificity.The objectives of the study were to determine the applicability of the casedefinitions for hepatitis B and C in the Clinic for Infectious Diseases of the Clinical Center of Vojvodina and to determine the sensitivity and specificity of the applied definition of cases of hepatitis B and C. In addition to existing diagnostic algorithm of the Clinic for Infectious Diseases, three sets of hepatitis B and C case definitions were introduced: the European Centre for Disease Prevention and Control in 2008 and 2012 as well as the US Centers for Disease Control in 2012. The study was conducted at the Clinic for Infectious Diseases Clinical Center of Vojvodina over 12 months, and in accordance with the proposed case definitions, 150 patients suffering from hepatitis B and C were identified. We found following facts: recommended case definitions are applicable in the Republic of Serbia for laboratory and clinical criteria, while the inclusion of epidemiological connection between the case definition has little practical significance for reporting hepatitis; case definitions that include the obligatory presence of clinical criteria (most common definition of probable cases) have low sensitivity and high specificity, as a result of the presence of infection in the absence of any clinical manifestations; case definitions that are based solely on laboratory criteria showed maximum sensitivity and specificity.

APA, Harvard, Vancouver, ISO, and other styles

16

Hood, Robert Baltasar. "Hepatitis C virus and maternal and child health in the United States." The Ohio State University, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=osu1587213372856517.

Full text

APA, Harvard, Vancouver, ISO, and other styles

17

Hamour, Naylah. "Estimating and comparing the burden of chronic Hepatitis C in the immigrant and the non-immigrant population in Québec." Thesis, McGill University, 2012. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=110736.

Full text

Abstract:

Background: Immigrants have higher mortality from chronic viral hepatitis and hepatocellular carcinoma as compared to those born in Canada. Approximately 20% of this burden is likely due to hepatitis C (HCV). Despite this disparity there are no screening programs to detect chronic HCV in immigrants after arrival in Canada. This is partly due to a lack of population-based data describing the burden of chronic HCV in immigrants.Methods: To fill this gap, we created a case series of all cases of chronic hepatitis C reported from 1991-2008 in Québec through linking the MADO (Québec Reportable Disease) database to 5 other Québec administrative databases; the MICC (Québec Landed Immigrants), the RAMQ (Québec provincial health insurance and physician billing) and the hospitalization databases. Reported rates were estimated using the reported number of cases in immigrants and non-immigrants during the study period. Québec census data from 1991, 1996, 2001, and 2006 (stratified by immigrant and non-immigrant status) was used for the denominator. Rates, rate ratios, and 95% CIS were calculated using the Poisson distribution. Proportions of cases with chronic hepatitis C associated complications were calculated and compared in immigrants and non-immigrants. Results: A total of 20,459 cases of chronic hepatitis C (1,980 immigrants and 18,479 non-immigrants) were reported between 1998-2007. Cases from 1991-1997 were excluded due to incomplete laboratory reporting during this period. Immigrant cases were older (mean age 47.1 vs. 43.1 years, p < 0.0001) and were less likely to be male (53.1% vs. 68.2%, p <0.0001). The overall rate of chronic hepatitis C was similar for immigrants and non-immigrants [rates/100,000 (95%CI) were 25.2 (24.1-26.4) vs. 27.8 (27.4-28.2), rate ratio= 0.91]. Immigrants from several world regions however had higher rates of chronic hepatitis C as compared to the non-immigrant population; Eastern Europe/Central Asia [77.6 (68.2-87.0) rate ratio = 2.8], Sub-Saharan Africa [60.2 (51.5-68.8), rate ratio = 2.2], South Asia [48.1 (41.5-54.7), rate ratio = 1.7]. Immigrants had a higher proportion of compensated cirrhosis (15.1% vs. 12.9%, p= 0.007) and hepatocellular carcinoma (1.2% vs. 0.6%, p= 0.005) compared to non-immigrantsConclusions: Immigrants from several world regions are at increased risk for chronic hepatitis C, have a higher proportion of hepatitis C related complications and are diagnosed a mean of > 8 years after arrival in Canada. Many immigrants would therefore benefit from early screening and appropriately timed treatment for chronic hepatitis C to decrease associated morbidity and mortality.
Introduction : Les immigrants ont un plus haut taux de mortalité causée par l'hépatite virale chronique et le carcinome hépatocellulaire comparativement aux individus nés au Canada. Approximativement 20% de ce fardeau serait dû au virus de l'hépatite C (VHC). En dépit de cette disparité, il n'existe aucun programme de dépistage du VHC chez les immigrants à leur arrivée au Canada. Ceci est en partie dû au manque de données basées sur des populations décrivant le fardeau du VHC chronique chez les immigrants. Méthodes : Afin de pourvoir à ce manque, nous avons créé une série de cas de tous les cas d'hépatite C chronique rapportés entre 1991-2008 au Québec en reliant la base de données MADO (Maladies à Déclaration Obligatoire du Québec) à cinq autres bases de données administratives québécoises; le MICC (immigrants arrivés au Québec), la RAMQ (assurance maladie provinciale du Québec et facturation des médecins) et les bases de données d'hospitalisation. Les taux rapportés ont été estimés en utilisant le nombre de cas rapportés chez les immigrants et les non immigrants durant la période d'étude. Les données de recensements de 1991, 1996, 2001 et 2006 (stratifiées en statut d'immigrant ou non immigrant) ont été utilisées comme dénominateur. Les taux d'incidences (TI), TI relatifs et les IC 95% ont été calculés avec la distribution de Poisson. La proportion de cas avec complications associées à l'hépatite C chronique a été calculée et comparée chez les immigrants et non immigrants. Résultats : Un total de 20 459 cas d'hépatite C chronique (1 980 immigrants et 18 479 non immigrants) ont été rapportés entre 1998-2007. Les cas datant de 1991 à 1997 ont été exclus dû au manque d'information complète de méthodes de laboratoire durant cette période. Les cas d'immigrants étaient plus âgés (âge moyen de 47.1 vs 43.1 années, p<0.0001) et moins probables chez les hommes (53.1% vs 68.2%, p <0.0001). Le TI d'hépatite C chronique était similaire entre immigrants et non immigrants [TI/100 000 (IC 95%) étaient de 25.1 (24.1-26.4) vs 27.8 (27.4-28.2), TI relatif = 0.91]. Les immigrants de plusieurs régions du monde, cependant, avaient un TI plus élevé d'hépatite C chronique comparativement aux non immigrants : l'Europe de l'Est/l'Asie centrale [77.6 (68.2-87.0), TI relatif = 1.7], l'Afrique subsaharienne [60.2 (51.5-68.8), TI relatif = 2.2], l'Asie du Sud [48.1 (41.5-54.7), TI relatif = 1.7]. Les immigrants avaient une proportion plus élevée de cirrhose compensée (15.1% vs 12.9%, p = 0.007) et de carcinome hépatocellulaire (1.2% vs 0.6%, p = 0.005) comparativement aux non immigrants. Conclusions : Les immigrants de plusieurs régions du monde sont à un risque plus élevé d'hépatite C chronique, ont une proportion plus élevée de complications liées à l'hépatite C et reçoivent un diagnostic en moyenne >8 ans après leur arrivée au Canada. Beaucoup d'immigrants bénéficieraient donc du dépistage et du traitement précoces pour l'hépatite C afin de diminuer la morbidité et la mortalité qui y sont associées.

APA, Harvard, Vancouver, ISO, and other styles

18

Elom, Hilary, and Shimin Zheng. "The distribution of hepatitis c virus genotypes in US population. Data from NHANES 2006-2016." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/asrf/2018/schedule/116.

Full text

Abstract:

Background: Unlike other non-hepatitis c viral infection, hepatitis c viral infection is a non-vaccine preventable disease. Thus, effective treatment is an important part in the prevention of complication of chronic hepatitis c infection. The viral genotype plays a significant role in the choice of treatment regimen. Aim: the purpose of this study is to estimate the prevalence of hepatitis c viral infection and the distribution of viral genotype in the US population. Methods: Diagnosis of Hepatitis C viral infection was made by assaying the blood specimen collected from the study participants using Ampiclor monitor (Roche Diagnostic System, Inc Branchburg NJ), and genotype determined from the NS5b region. The data is from NHANSE 2006-2016. SAS v 9.4 software was used to perform the analysis. Results: Of the 356 participants (2006-2016) who tested positive to Hepatitis C virus-RNA, 205 persons had genotype 1a, 1b (n=66), other forms of genotype 1 (n=1), genotype 2(n=41), genotype 3 (n=30), genotype 4 (n=1), genotype 6(n=1), undetermined genotype (n=8). Based on weighted analysis of person infected with genotype 1, 2, 3; genotype 1 was highest across all ages and gender (78.2%). Of 271 participants infected with genotype 1, there were 5.09% Mexican Americans, 3.94% other Hispanics, 56.58% non-Hispanic whites, 28.74% non-Hispanic black, and 5.65% other races including multiracial population. Subjects aged 50 years or above was 27.7% less likely being infected with HCV genotype 1 vs 2 and 3, compared with younger individuals (adjusted Odds Ratio (95% confidence interval) (aOR): 0.72 (0.72-0.73)). Non-Hispanic black were about 13 times (aOR: 13.1 (13.0-13.2)) as likely to be infected with genotype 1 vs 2 and 3 as non-Hispanic white. Conclusion: Hepatitis C virus genotype 1 is predominant among those infected with hepatitis c virus in the US population. Improvement in therapy targeting genotype 1 is essential to reduce the burden and complication of chronic hepatitis C in the United States.

APA, Harvard, Vancouver, ISO, and other styles

19

Bruchfeld, Annette. "Hepatitis C in chronic kidney disease and kidney transplantation : with special reference to epidemiology and treatment /." Stockholm, 2003. http://diss.kib.ki.se/2003/91-7349-701-0/.

Full text

APA, Harvard, Vancouver, ISO, and other styles

20

Danta, Mark. "Acute hepatitis C infection in HIV co-infection : epidemiology, natural history and the host-viral responses." Thesis, University College London (University of London), 2006. http://discovery.ucl.ac.uk/1445482/.

Full text

Abstract:

Aim: To analyse the epidemiological, clinical and immunological aspects of a recent epidemic of acute HCV in HIV co-infected individuals.;Methods: The epidemiology was characterised using combined molecular and clinical studies. A phylogenetic analysis of the E1/E2 region of the HCV genome was performed to determine HCV transmission. Transmission risk factors were then explored in a multicentre case-control study. Data was collected on the early clinical course of HCV in HIV. Longitudinal cell-mediated responses to HCV and HCV evolution were studied with PBMCs and serum collected during the acute phase.;Results: The studies revealed significant differences in the epidemiology, natural history, cell-mediated responses and HCV evolution between acute HCV with and without HIV. The seven clusters demonstrated in the molecular study is strong evidence for common source transmission. The case-control study identified permucosal factors, including high-risk mucosally traumatic sexual and drug practices, were significantly associated with the recent transmission of HCV. HCV persistence was the outcome in the vast majority of HIV co-infected individuals and these rates are significantly higher than those for HCV mono-infection. The CD4 T-cell responses lacked the magnitude and breadth of response for control of HCV. The virological data supported this, revealing quasispecies evolution that appeared not to be driven by immune pressure.;Conclusions: The phylogenetic clusters cross both HCV genotype and subtype implying that the HCV transmission is not due to a specific viral change, but that patient and/or environmental factors are responsible for the recent infections. Permucosal rather than parenteral behavioural risk factors are associated with this transmission. The immuno-deficient state associated with HIV results in very low spontaneous clearance of HCV and the vast majority of these patients become persistently infected. In order to mitigate this important and ongoing epidemic, these factors need to be the focus of a concerted effort on the part of public health specialist, clinicians and HIV-positive individuals themselves.

APA, Harvard, Vancouver, ISO, and other styles

21

Bruen, Brian Keith. "Assessing the Past, Present, and Future of Treatment of Hepatitis C in the D.C. Medicaid Population." Thesis, The George Washington University, 2019. http://pqdtopen.proquest.com/#viewpdf?dispub=13812577.

Full text

Abstract:

Starting in late 2013, new direct-acting antiviral medicines (DAAs) offered the chance of a cure for chronic hepatitis C virus (HCV) infection. In clinical trials, DAAs helped more than 90% of patients achieve sustained viral response (SVR), commonly considered to be a cure that will stop progression of related liver disease and prevent transmission of the virus to others. Prices for these medicines are now around $20,000 per treatment after discounts from manufacturers, due to competition.

In late 2016, the medical director for D.C. Medicaid asked what it would take to eradicate hepatitis C in the city. This dissertation focused on that question for Medicaid alone, to inform policy discussions and identify next steps. I profiled beneficiaries with chronic HCV infection based on medical claims from 2014-2016; interviewed medical providers and policymakers to learn more about their decision-making processes and to identify opportunities to expand treatment, as well as potential barriers; and created an Excel-based Markov model that estimates outcomes and costs under different scenarios.

Only 799 individuals, about 10% of the D.C. Medicaid beneficiaries identified as having chronic HCV infection, received treatment with DAAs in 2014-2016. Providers and policymakers are committed to treating this population, but treatment rates remained low through 2018. I estimate that roughly 80% of Medicaid beneficiaries with chronic HCV had not been treated at the start of 2019.

Beneficiaries with chronic HCV infection often have other physical, mental, and behavioral health conditions that might keep them from seeking treatment for an often-asymptomatic HCV infection. They often miss scheduled appointments and/or are lost to follow-up. Most live east of the Anacostia River, where there are fewer providers. Even if they engage in care, government or health plan policies might discourage or prevent individuals with low levels of liver damage from getting prior authorization for treatment.

Broader use of DAAs in D.C. Medicaid will allow more people to achieve SVR, potentially decreasing future healthcare costs for some and saving lives. A moderate (50%) increase in treatment rates among those with low liver damage could enable about 300 additional patients to achieve SVR over 10 years, at a net cost of $6.1 million. A 50% increase in treatment rates among those with moderate liver damage could enable more than 500 additional patients to achieve SVR over 10 years, keep more than 160 from severe liver damage, and avoid 19 early deaths. The net cost of the second scenario is $6.5 million, a smaller increase per person achieving SVR because curing those with moderate liver damage is more likely to avoid high healthcare costs.

The District must weigh the upfront costs of expanding use of DAAs against uncertain long-term benefits and inherent budget limitations. I recommend that D.C. develop a more complete profile of Medicaid beneficiaries with HCV infection; work toward universal screening and sustained monitoring of at-risk populations; collaborate with key stakeholders to develop policies, practices, and tools to engage beneficiaries in care; and reduce prior authorization requirements that might deter or prevent treatment when beneficiaries and health care providers are ready.

APA, Harvard, Vancouver, ISO, and other styles

22

Iles, James C. "The molecular epidemiology of HCV and related viruses in Africa." Thesis, University of Oxford, 2014. http://ora.ox.ac.uk/objects/uuid:8eb2d243-9918-48d5-acec-0886c8d3b254.

Full text

Abstract:

Hepatitis C virus (HCV) causes severe illness in millions of people worldwide, but the epidemic strains responsible for most infections arose within the past hundred years and represent only a small part of total HCV diversity. In this thesis I combine laboratory and computational methods to study HCV in Africa. I aim to characterize its current genetic diversity and its historical transmission prior to the global HCV epidemic. In Chapter 2 I begin by screening samples from the Democratic Republic of the Congo (DRC) for HCV and the related human pegivirus. I find high HCV sequence diversity, including a putative new subtype, and find significantly higher HCV prevalence in those born before 1950. Chapter 3 continues this screening, and combines the sequences obtained with those from online databases. Using molcular clock methods I estimate that genotype 4 originated in central Africa around 1733, and that multiple lineages, including subtype 4a which dominates the HCV epidemic in Egypt, have moved to north Africa since ~1850. In Chapter 4 I analyse sequences sampled from an elderly population in Kinshasa to estimate HCV’s transmission history there during the 20th century. The results indicate a rapid increase in HCV transmission between 1950 and 1970 in multiple independent lineages. Possible causes of this increase are discussed. This study population also exhibits high HCV genetic diversity, including the second genotype 7 sample discovered to date. Finally, Chapter 5 uses a range of sequencing techniques, including RNAseq, to characterise two putative HCV recombinants from Cameroon. I confirm that both sequences are recombinants, and generate a full genome sequence for one. I also develop new tools to distinguish between dual infection and recombination in next-generation sequencing data, and discuss how recombination might affect HCV diversity and treatment.

APA, Harvard, Vancouver, ISO, and other styles

23

Yeung, Man Wah. "Overcoming Hepatitis C: changes in quality of life, healthcare use and substance use in HIV-coinfected patients after antiviral therapy." Thesis, McGill University, 2014. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=121533.

Full text

Abstract:

Background: In chronic hepatitis C virus (HCV) mono-infection and HIV/ HCV co-infection, the goal of antiviral treatment is a sustained virologic response (SVR). Some clinical benefits of SVR have been identified among HIV co-infected patients. However, endpoints beyond liver-related outcomes have not been well documented in co-infected patients who often have concurrent problems. We examined changes in health-related quality of life (HRQOL), health service use and substance over time among patients treated for HCV, in particular SVR-achievers and non-responders. Methods: HIV/ HCV co-infected patients with detectable HCV RNA were selected from the Canadian Co-infection Cohort and followed every six months. HRQOL was self-reported using the EuroQOL-5D visual analogue scale from 0 to 100 (worst to best health). Incidence rate ratios (IRR) for health service utilization and proportion of current users for substance use were determined. Linear and negative binomial regressions were used to model the effects of SVR on HRQOL and healthcare utilization respectively. Results:Of 1002 chronic HCV patients, 169 (17%) received treatment— 65 (38%) achieved SVR, 46 (27%) did not, 35 (21%) had ongoing treatment and 23 (14%) had unknown treatment response. EuroQOL scores improved in SVR-achievers after treatment (median (Q1, Q3): from 71 (60, 80) to 80 (70, 95.8)), but not in non-achievers (median (Q1, Q3): from 70 (48, 80) to 68 (50, 80)). Overall, SVR-achievers used fewer health services than non-achievers, particularly emergency visits and hospitalizations (IRR (95% CI): 0.36 (0.1, 1.0) and 0.17 (0.0, 0.5), respectively). One exception was walk-in clinic visits (IRR: 3.26 (95% CI: 1.3, 10.6)). Achieving SVR was associated with markedly decreased in-patient service use (IRR: 0.21 (95% CI: 0.07, 0.64). All Patients reduced tobacco smoking and illicit drug use behaviours, but alcohol consumption increased post-treatment among all patients (percentage reporting consumption: from 49% pre-treatment to 64% post-treatment in SVR-achievers; from 44% to 61% in non-achievers).Conclusions: HCV treatment and SVR can have a range of effects on HRQOL, healthcare use and substance use in HIV/ HCV co-infection. Longer follow-up is required to determine the duration of health benefits.
Contexte:Pour les patients infectés par le virus de l'hépatite C (VHC), l'objectif du traitement antiviral est d'atteindre une réponse virologique soutenue (RVS) qui procure des avantages en santé mesurables par rapport à la mono-infection en VHC. Cependant, l'existence de tels avantages pour les patients co-infectés par le VIH qui ont des problèmes de santé supplémentaires n'est pas claire. Nous avons examiné les changements de la qualité liée à la santé de la vie (QVLS), l'utilisation des services de santé et l'utilisation de substances au cours du temps chez les patients traités pour le VHC, en particulier les répondeurs et les non-répondeurs au traitement, dans la cohorte de co-infection VIH/VHC canadienne. Méthodes: Des patients co-infectés VIH/VHC avec ARN positif du VHC (avec ou sans traitement anti-VHC antérieur) ont été sélectionnés à partir de la Cohorte canadienne de coïnfection VIH-VCH et suivis aux six mois. Les patients se sont auto-évalués de 0 à 100 (du pire au meilleur état de santé) pour la QVLS en utilisant l'échelle visuelle analogique du questionnaire EuroQol-5D. Nous avons examiné les scores médians QVLS, les ratios des taux d'incidence des services de santé et la fréquence de consommation de drogues avant et après le traitement anti-VHC. Par ailleurs, nous avons utilisé la régression linéaire pour examiner l'effet de la RVS sur le changement en pourcentage de QVLS. Une régression binomiale négative a permis de modéliser la relation entre la RVS et la fréquence des services de santé utilisés. Résultats: À partir des 1002 patients VHC chroniques, 169 (17%) ont reçu un traitement - 65 (38%) ont atteint la RVS, 46 (27%) n'ont pas attient la RVS, 35 (21%) ont reçu un traitement continu et 23 (14%) avaient des résultats inconnus. Pour les répondeurs au traitement, les scores EuroQOL se sont améliorés après le traitement (médiane des scores: 71 à 80). Les non-répondeurs n'ont démontré aucune amélioration au cours du temps (scores médians: ≤ 70). Globalement, l'utilisation des services de santé était plus faible pour les répondeurs au traitement que pour les non-répondeurs., particulièrement pour les visites à l'urgence et les hospitalisations (ratios des taux d'incidence à six mois (post-traitement: 0,36 et 0,17, respectivement). À l'exception des visites aux cliniques sans rendez-vous (ratios des taux d'incidence à six mois post-traitement: 3,26). L'atteinte de la RVS a diminué de manière significative la fréquence des visites des patients hospitalisés. Les patients ont réduit leur consommation de tabac et les comportements de consommation de drogues illicites, mais la consommation d'alcool post-traitement a augmenté chez tous les patients (de 49% à 64% chez les répondeurs et de 44% à 61% chez les non-répondeurs). Conclusions: La RVS peut avoir des effets multidimensionnels sur la QVLS, l'utilisation des soins de santé et l'utilisation de substances. Un meilleur état de santé a été noté et moins de services de santé ont été utilisés par les répondeurs au traitement. L'augmentation de la consommation d'alcool après la RVS nécessite une investigation plus approfondie puisqu'elle pourrait contrecarrer les avantages du traitement anti-VHC. Un suivi plus long est nécessaire pour déterminer la durabilité des avantages pour la santé de la RVS dans la co-infection.

APA, Harvard, Vancouver, ISO, and other styles

24

Cheng, Pui-sai. "Evaluation and comparison of genotyping assays for molecular epidemiological study of HCV in Hong Kong /." View the Table of Contents & Abstract, 2007. http://sunzi.lib.hku.hk/hkuto/record/B38297231.

Full text

APA, Harvard, Vancouver, ISO, and other styles

25

Cheng, Pui-sai, and 鄭佩茜. "Evaluation and comparison of genotyping assays for molecular epidemiological study of HCV in Hong Kong." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2007. http://hub.hku.hk/bib/B45011126.

Full text

APA, Harvard, Vancouver, ISO, and other styles

26

Potter, Martin. "Estimating variations between health care centres in the uptake of Hepatitis C Virus (HCV) treatment in HIV-HCV co-infected patients." Thesis, McGill University, 2013. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=114160.

Full text

Abstract:

The effect of Health Care Centres on uptake of Hepatitis C Virus (HCV) treatment in HIV-HCV co-infected patientsBackgroundThe purpose of the study was to investigate the effect of health care centres on HCV treatment uptake after adjusting for case-mix variables. Methods Using data from the Canadian Co-infection Cohort, we modelled time to HCV treatment uptake using a Bayesian survival analysis model with random intercepts for each of the 16 cohort centres. To take into account variability in patient populations served at each centre (case-mix), models were adjusted for age, gender, ethnicity, HCV genotype; and at cohort enrolment, duration of HCV infection, receipt of combination antiretroviral therapy, history of psychiatric illness ,CD4 cell count, and self-reports of homelessness, use of intravenous drugs, and current use of alcohol. Variation between centres in treatment uptake was estimated and centres ranked according to their rate of starting patients on HCV treatment. Results Among 996 cohort participants, 390 were excluded (past HCV treatment n=170, spontaneous clearance n=50, contribution of only enrolment data n=160 and missing baseline CD4 cell count n=10). Of the remaining 606 participants, 122 started HCV treatment. Patients with more favourable HCV genotypes (2 or 3) were more likely to initiate treatment. Two centres more frequently initiated patients on HCV treatment while one centre did so less often. Conclusions After adjustment for case-mix, there was still appreciable variation in treatment uptake between centres. Determining the factors associated with higher HCV treatment rates at two centres may be informative for improving wider access to HCV treatment for co-infected persons.
Objectif: L'objectif de cette étude mieux est de déterminer l'impact que les centres de sante ont sur l'initiation de traitement à l'infection du VHC chez les patients ayant une coïnfection par le VIH, suite à un ajustement des caractéristiques « case-mix ». Méthode: Utilisant les données obtenues de la Cohorte Canadienne de Co-Infection, des analyses de survie, via une méthode bayésienne, furent entamées avec des interceptes aléatoires pour chacun des 16 centres. Afin de prendre en considération les variations entre les centres, les modèles furent ajustés pour les variables « case-mix » : l'âge, genre, ethnicité, génotype VHC; et a l'admission dans la cohorte, durée de l'infection au VHC, prise d'antirétroviraux, antécédents de maladies psychiatriques, taux de CD4, itinérance, usage de drogue intraveineuse, et usage d'alcool. Les différences entre les centres de sante sur les taux d'initiations au traitement du VHC furent déterminées, et les centres furent classés selon leur taux d'initiation de traitement. Résultats: Parmi les 996 participants de la cohorte, 390 furent exclus (traitement du VHC dans le passé n=170, éradication spontanée n=50, contribution d'une seule donnée n= 160, valeur de CD4 manquante n=10). Sur les 606 participants restants, 122 ont débuté un traitement. Les participants ayant un génotype favorable (2 ou 3) étaient plus prédisposés à débuter un traitement. Les participants de deux centres avaient un taux plus élevé de traitement au VHC, tandis qu'un centre avait un taux d'initiation au traitement inférieur. Conclusions: Apres ajustement des variables « case-mix », il demeure une variation appréciable entre les divers centres de santé sur les taux d'initiation au traitement de l'infection au VHC. Déterminer les facteurs associés aux deux centres ayant le plus haut taux d'initiation au traitement pourrait donner une piste permettant d'augmenter l'accessibilité au traitement du VHC pour les gens ayant une coïnfection VIH-VHC.

APA, Harvard, Vancouver, ISO, and other styles

27

Buchanan, Ryan Malcolm. "The social and genetic epidemiology of Hepatitis C in an isolated network of people who inject drugs." Thesis, University of Southampton, 2017. https://eprints.soton.ac.uk/417993/.

Full text

Abstract:

Background and Aims: Hepatitis C (HCV) causes liver cirrhosis, liver cancer and is a leading cause of death worldwide. In the UK the commonest risk factor for HCV is current or previous injecting drug use but many cases are undiagnosed and many known cases are disengaged from treatment services. The Isle of Wight (IOW) is a deprived, rural and geographically isolated population but suffers from the same obstacles to HCV care as larger nearby mainland populations. The overall aim of this thesis is to understand the burden of HCV in people who inject drugs (PWID) on the IOW and how their social network could be utilised in an HCV elimination strategy. Method: A sequential mixed method research design was used. Qualitative methods informed the design of a quantitative survey, which recruited PWID via respondent driven sampling (RDS) for a social network questionnaire and HCV bio-behavioural survey. This was used to estimate the population prevalence of HCV and the total population size of PWID on the IOW. Data from the social network survey were combined with a phylogenetic analysis of HCV RNA positive cases and qualitative narratives to give a representation of the HCV transmission network in PWID. This network was then used in an individualbased model (IBM) testing different treatment strategies. Results: Sixty-nine PWID participated in the HCV bio-behavioural and social network surveys. The estimated prevalence of HCV was 29% (95% CI 13.3-44%) and the estimated total population size was 262 individuals. The social network survey described 179 PWID, connected together into a cohesive network component via injecting partnerships. Phylogenetic analysis indicated that a number of these partnerships had led to the transmission of HCV and that genotype 3a virus had been transmitted between PWID living on the IOW. In the IBM the preferential treatment of well-connected PWID, via injecting and social relationships, led to significantly fewer new infections of HCV than treating at random (9.56 vs. 6.58 P < 0.01 and 9.56 vs. 7.84 p=0.011 respectively). Conclusion: The burden of HCV in PWID on the IOW is lower than expected and existing case-finding initiatives are effective. The qualitative and quantitative results indicate that PWID are linked together in a dense network and the treatment of well-connected nodes within this network may be an effective treatment as prevention strategy for the elimination of HCV on the IOW.

APA, Harvard, Vancouver, ISO, and other styles

28

Camargo, Alessandra Rodrigues de. "Líquen plano oral associado a Hepatite C." Universidade de São Paulo, 2010. http://www.teses.usp.br/teses/disponiveis/23/23139/tde-20032015-154058/.

Full text

Abstract:

O presente estudo teve como objetivo verificar a associação entre o líquen plano oral (LPO) e a infecção de hepatite C (HCV) crônica em duas populações distintas do município de São Paulo. Foram avaliados um total de 308 pacientes distribuídos em dois grupos de estudo: grupo HCV composto por 275 pacientes (132 homens e 143 mulheres; idade média = 49,8 anos) com infecção de HCV crônica; e o grupo LPO composto por 33 pacientes (10 homens e 23 mulheres; idade média = 52,9 anos) com LPO. No grupo HCV o diagnóstico da infecção crônica foi estabelecido através de sorologia para anti-HCV (MEIA, kit AxSYM® HCV version 3.0, Abbott Laboratories, North Chicago, Illinois) confirmado pela pesquisa de RNA-HCV através do teste PCR qualitativo (Cobas Amplicor HCV MonitorTM test, version 2.0, Roche Diagnostic Systems, NJ, USA). No grupo LPO o diagnóstico para lesões orais seguiu critérios estabelecidos pela World Health Organization (WHO) em 1978 e posteriormente modificados por van der Meij e van der Waal em 2003. Como critérios de exclusão para o grupo HCV pacientes que fizeram uso de interferon e/ou ribavirina por um período menor que 6 meses foram excluídos do estudo, assim como pacientes que encontravam-se em terapia antiviral para HCV. Neste grupo a presença de co-infecções - HIV, HBV, HTLV - também foi desconsiderada. No grupo LPO pacientes com diagnóstico clínico sugestivo de reação liquenóide por uso a drogas (RLD) e reação liquenóide por contato (RLC) foram excluídos da amostra, assim como pacientes tratados local ou sistemicamente para LPO por um período menor que 6 meses. Casos com achados histopatológicos de displasia liquenóide também foram desconsiderados. Para análise dos resultados duas comparações foram efetuadas: (1) no grupo HCV a prevalência de LPO foi determinada e comparada com a prevalência de LPO em nossa instituição (grupo controle); (2) no grupo LPO a prevalência da infecção de HCV foi determinada e comparada com a prevalência da infecção de HCV na população de São Paulo. A prevalência de LPO em pacientes com HCV crônica (grupo HCV) foi de 2,18% e de 1,54% no grupo controle (P = 0,39). A prevalência de HCV crônica em pacientes com diagnóstico de LPO (grupo LPO) foi de 3,03% e de 1,42% na população em geral (P = 0,39). Nenhuma diferença estatisticamente significante foi verificada quando os grupos foram comparados. Em nossa análise não foi verificada associação entre o LPO e a infecção de HCV crônica, nas duas populações avaliadas no município de São Paulo.
The objective of the present study was to verify the association between oral lichen planus (OLP) and chronic hepatitis C virus infection (HCV) in two distinct populations in the municipality of São Paulo. A total of 308 patients were evaluated distributed in two study groups: group HCV, comprising 275 patients (132 men and 143 women; average age = 49.8 years old) with chronic HCV infection; and group OLP, comprising 33 patients (10 men and 23 women; average age = 52.9 years old) with OLP. In group HCV, the diagnosis of chronic infection was established through serology for anti-HCV (MEIA, kit AxSYM® HCV version 3.0, Abbott Laboratories, North Chicago, Illinois) confirmed by RNA-HCV research through qualitative PCR testing (Cobas Amplicor HCV MonitorTM test, version 2.0, Roche Diagnostic Systems, NJ, USA). In group OLP, the diagnosis of oral lesions followed the criteria established by the World Health Organization (WHO) in 1978 and later modified by van der Meij and van der Waal in 2003. As exclusion criteria for group HCV, patients that made use of interferon and/or ribavirin for a period below 6 months were excluded from the study, as well patients that were under antiviral treatment for HCV. In this group the presence of co-infections - HIV, HBV, HTLV - was also discarded. In group OLP, patients with clinical diagnosis suggestive of drug-induced lichenoid reactions (DLR) and oral lichenoid lesions related to dental materials (LLDM) were excluded from the sample, as well as patients treated locally or systemically for OLP for a period below 6 months. Cases with histopathological findings of lichenoid dysplasia were also discarded. For result analysis, two comparisons were conducted: (1) in group HCV, OLP prevalence was determined and compared to OLP prevalence in our institution (control group); (2) in group OLP, the prevalence of HCV infection was determined and compared to the prevalence of HCV infection in the São Paulo population. OLP prevalence in patients with Chronic HCV (group HCV) was 2.18% and 1.54% in the control group (P = 0.39). Chronic HCV prevalence in patients with a diagnosis of OLP (group OLP) was 3.03% and 1.42% in the general population (P = 0.39). No statistically significant difference was verified when groups were compared. Our study did not verify an association between OLP and chronic HCV infection in the two populations assessed in the municipality of São Paulo.

APA, Harvard, Vancouver, ISO, and other styles

29

Luna, Alexandre La. "Busca de fatores genéticos associados à resposta ao tratamento do HCV genótipo 3." Universidade de São Paulo, 2012. http://www.teses.usp.br/teses/disponiveis/42/42135/tde-09112012-105715/.

Full text

Abstract:

Recentemente estudos demonstraram que os SNPs (polimorfismos de base única) rs8099917 e rs12979860 localizados próximos ao gene da IL28B explicam a variação de resposta à infecção e tratamento do paciente contra o genótipo 1 do HCV, porém não para o genótipo 3 deste vírus. Este trabalho encontrou associação significativa entre resposta à infecção devida ao genótipo 3 pelo tratamento (PEG-INF e RBV) e o polimorfismo rs8099917 em uma amostra da população de Santos - SP. Para o polimorfismo rs12979860, esta associação somente foi encontrada ao se parear indivíduos para sexo, idade e grau de fibrose hepática, demonstrando a importância da retirada de efeitos de estratificação neste tipo de análise. Estes resultados se confirmam ao se agregar dados de uma população proveniente da Bahia em uma meta-análise. Além disso, fez-se um estudo GWAS a fim de se conhecer outras variações genéticas envolvidas nessa resposta. Esta análise indicou a existência de alguns SNPs candidatos com sugestão de associação, dentre eles a tiroglobulina, relacionada aos hormônios da tireóide.
Recently, studies have shown that SNPs (single nucleotide polymorphisms) rs8099917 and rs12979860, located near the gene IL28B explain the changes in the response to infection and treatment of a patient against the HCV genotype 1, but not for the genotype 3 of the virus. This study found a significant association between response to infection due to treatment by genotype 3 (PEG-INF and RBV) and the rs8099917 polymorphism in a population sample from Santos - SP. To the rs12979860 polymorphism, this association was only found when individuals are paired for sex, age and degree of hepatic fibrosis, demonstrating the importance of the withdrawal effects of stratification in this type of analysis. These results confirm the aggregate data from a population of Bahia in a meta-analysis. In addition, a GWAS was made in order to search other genetic variations involved in this response. This analysis indicated the existence of some candidate SNPs with suggestion of association, including thyroglobulin, thyroid hormones related to.

APA, Harvard, Vancouver, ISO, and other styles

30

Ciaccia, Maria Celia Cunha. "Aspectos epidemiológicos, sorológicos e moleculares das hepatites A, B e C em crianças e adolescentes matriculados em creches e escolas do ensino infantil e fundamental da rede municipal na cidade de Santos." Universidade de São Paulo, 2012. http://www.teses.usp.br/teses/disponiveis/5/5141/tde-14012013-120337/.

Full text

Abstract:

As hepatites virais continuam sendo uma preocupação em nível de saúde pública no Brasil e no Mundo, tanto pelo número de indivíduos atingidos, como pela possibilidade de complicação das formas agudas e crônicas. Segundo a Organização Mundial de Saúde (OMS), 170 milhões de pessoas são portadoras crônicas de hepatite C e 350 milhões portadoras crônicas de hepatite B. No Brasil, a estimativa de portadores de hepatite B crônica é de aproximadamente 600 mil pessoas e de hepatite C crônica, 1,5 milhão. Quanto à hepatite aguda A foram confirmados no país, em 2010, 5943 casos. O objetivo deste estudo foi conhecer a prevalência de marcadores sorológicos dos vírus das hepatites A, B e C em crianças e adolescentes matriculados em creches e escolas de ensino infantil e fundamental da rede municipal na cidade de Santos; conhecer os aspectos moleculares dos vírus das hepatites B e C, identificando o genótipo dos dois agentes e estudar modo de aquisição nos casos com sorologias positivas. Tratou-se de um estudo transversal realizado no período de 28 de Junho a 14 de Dezembro de 2007 onde foram coletadas 4680 amostras de sangue colhidas através de punção capilar e ao mesmo tempo aplicado um questionário nos familiares das crianças e adolescentes. Os exames sorológicos foram realizados utilizando a técnica de ELISA. O estudo molecular foi realizado pela técnica de reação em cadeia de polimerase \"in House\". A idade da população estudada variou de 7 meses a 18 anos e 1 m. A prevalência geral do anti-HVA IgG reagente foi de 9,7% e desses 74,6% foi anti-HVA IgM reagente. A prevalência de anti-HVA IgG foi maior entre as crianças mais velhas, meninas, aquelas que brincavam em córregos, sem esgoto em sua moradia, de pais com baixa instrução, de baixa renda familiar e aquelas que não eram moradoras da Orla. A prevalência de anti-HVA IgM, não foi diferente entre as diferentes categorias, exceção feita à faixa etária (pico no primeiros anos e posterior queda) e morro e Zona Noroeste foi mais baixa. A prevalência geral do anti-HBc reagente foi de 0,1%, do AgHBs de 0,02% e do anti-HVC foi de 0,02%. Conclui-se que a prevalência geral em crianças dos marcadores sorológicos para hepatites A, B e C na cidade de Santos foi baixa, quando comparada com os dados de literatura. Apesar dos nossos dados confirmarem uma mudança no perfil epidemiológico da hepatite A, as medidas preventivas atuais quanto ao saneamento, grau de instrução, habitação, ainda permanece com uma deficiência em Santos, cidade balneária com o maior porto do Brasil. A vacinação para hepatite B foi altamente eficaz com a baixa prevalência encontrada dos marcadores sorológicos. A utilização do papel de filtro em estudos epidemiológicos para hepatite A foi eficaz. Entretanto para o vírus da hepatite C ainda necessita de estudos comparativos utilizando sangue venoso, uma vez que a prevalência de crianças infectadas com hepatite C foi muito baixa na cidade de Santos.
Viral hepatitis are still a concern in the public health level in Brazil and around the Word, due both to the number of affected subjects and the possibility of complication in the acute and chronic forms. According to the World Health organization (WHO), 170 million people are chronic carriers of hepatitis C and 350 million chronic carriers of hepatitis B. In Brasil, the estimate of people with chronic hepatitis B is approximately 600 thousand people and chronic hepatitis C, 1,5 million. It has been confirmed in the country, in 2010, 5943 cases of acute hepatitis A. The The aim of this study was to learn the prevalence of serological markers of hepatitis A, B and C virus in children and teenagers enrolled at the municipal education network in the city of Santos, to learn molecular aspects of hepatitis B and C, identifying the genotype of the two agents and to study the acquisition mode in cases with positive serology. Cross-sectional study carried out over the period from June 28 to December 14, 2007, in which 4680 fingerprick blood samples were collected; at the same time, a survey questionnaire was applied to the family members of the children and teenagers. The serological tests were performed using the ELISA technique. The molecular analysis was performed using the technique of polymerase chain reaction \"in House\". Age of the population studied ranged from 7 months to 18 years and 1 month. . The general prevalence of serological markers anti-HAV IgG reagent was 9.7% and between them 74,7% was anti-HAV IgM reagent. There was higher prevalence among older children, females, those who used to play in streams near their home, the absence of a sewage system in home, parents with low education, low household income and among those who did not live in the seashore. The prevalence of anti-HAV IgM was not different between the categories, except for the age (peak in the early years and subsequent fall) and lower on the Hills and Northweast Zone. The general prevalence of anti-HBc reagent was 0,1%, AgHBs was 0,02% and anti-HCV was 0,02%. It is concluded that, in children, the general prevalence of serological markers for hepatitis A, B and C in the city of Santos was low when compared with literature data. Although our data confirm a change in the epidemiological profile of hepatitis A, the current preventive measures regarding sanitation, education level and housing still remain with a deficiency in Santos, the coastal city with the largest harbor in Brazil. Vaccination for hepatitis B was highly effective because it found a low prevalence of serological markers. The use of filter paper in epidemiological studies for hepatitis A was effective. However for the vírus of hepatitis C still requires comparative studies using venous blood because the prevalence of infected children was very low in the city of Santos.

APA, Harvard, Vancouver, ISO, and other styles

31

Blair, Carol S. "Hepatitis C and G in south east Scotland : studies in epidemiology, progression of disease and quality of life." Thesis, University of Edinburgh, 2005. http://hdl.handle.net/1842/29209.

Full text

Abstract:

Hepatitis C is now a global health problem with an estimated 170 million people infected worldwide. It is known to be the cause of the majority of cases of non-A, non-B hepatitis. It is known to be progressive with at least 20% of patients developing cirrhosis over 20 years. What is less clear is whether all infected people will eventually develop complications and whether certain factors are important in progression of this disease. The aims of this thesis were to: Study the epidemiology and natural history of HCV infection in our population of HCV infected patients in South East Scotland; Investigate the factors important in progression of chronic HCV infection and also the effects of chronic HCV infection on quality of life; and Examine another novel flavivirus, HGV, in Scottish blood donors. A database of all patients with chronic HCV referred to our hospital was set up. Data was gathered prospectively and analysed with regards to demographic variables and factors related to progression of disease. The importance of HLA status in development and severity of disease was also examined. Finally the impact of chronic HCV infection on QOL was assessed in a subgroup of this population. In a separate population the prevalence, natural history, clinical significance and risk factors for transmission of HGV were assessed. 262 patients were included in the database. Various demographic variables were recorded. Nearly 20% had cirrhosis on biopsy. Factors important in progression were age at infection, male sex and alcohol consumption. When HLA status and progression were examined certain antigens were found to protect against development of chronic disease, significant inflammation and cirrhosis. Quality of life was found to be significantly impaired across all domains of life in patients with chronic HCV infection. HGV is common amongst Scottish blood donors but is not associated with significant symptoms or liver disease. A risk factor for infection was not identified in the majority of infected donors.

APA, Harvard, Vancouver, ISO, and other styles

32

Wittchen, Hans-Ulrich, Sabine M. Apelt, Bettina Christl, Katja A. Hagenau, Alexandra Groß, Jens Klotsche, and Michael Soyka. "Die Versorgungspraxis der Substitutionstherapie Opiatabhängiger (COBRA)." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2012. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-97958.

Full text

Abstract:

Hintergrund: Die Datenlage zur Substitutionstherapie Opiatabhängiger ist defizitär. Vor diesem markant defizitären Erkenntnishintergrund erscheint es sinnvoll und notwendig, eine versorgungsepidemiologische Studie zur aktuellen Versorgungslage opiatabhängiger Substitutionspatienten durchzuführen, um offene Fragen zu klären. Hierfür haben wir ein mehrstufiges Forschungsprojekt unter dem Akronym COBRA initiiert. COBRA steht für "Cost-Benefit and Risk Appraisal of Substitution Treatments" und signalisiert, dass wir uns in umfassender Weise um eine Evaluation der Risiken, Vor- und Nachteile verschiedener Interventionsstrategien und Modalitäten in der Substitutions- und Versorgungspraxis Opiatabhängiger in Deutschland bemühen. Zielsetzungen des COBRA-Projekts sind: • Die Charakterisierung von bestehenden Einrichtungsformen und -modellen; • Die Charakterisierung von: – Merkmalen opiatabhängiger Patienten in diesen Einrichtungen (Schwere, Dauer/ Stadium, Komorbidität, Delinquenz, Desintegration etc.), – der Diagnostik sowie den Indikations- und Allokationsentscheidungen in der Versorgungsrealität sowie – den eingesetzten Interventionsmethoden (Substitutionsmittel, Therapie komorbider Störungen, psychotherapeutische und soziale Interventionen) • Die Ermittlung von Problemen der Substitutionstherapie bei verschiedenen Risikogruppen (z.B. Hepatitis-C- und HIVPatienten) • Die Beschreibung des Kurzzeitverlaufs und Outcomes hinsichtlich verschiedener klinischer und sozialer Kriterien Methodik: Die Studie teilt sich in einen deskriptiv-klinisch-epidemiologischen und einen analytisch-evaluativen Teil. Der deskriptive Teil soll zunächst darüber Auskunft geben, wie viele und welche Arten von Substitutionseinrichtungen in Deutschland wie viele Opiatabhängige erreichen und behandeln. Auf dieser Grundlage soll dann im evaluativen Teil an möglichst repräsentativen Einrichtungen und Patienten beurteilt werden, wie und mit welchen Methoden welche Arten von Patienten und Problemlagen versorgt werden. Durch Abgleich mit den wissenschaftlichen Bewertungsmaßstäben können daraus Defizite, Probleme und mögliche verbesserte Allokationsstrategien abgeleitet werden. Ergebnisse: Es werden erste Vorstudienbefunde und Ihre Design- Konsequenzen vorgestellt und diskutiert
In the present paper, we will describe aims, methods, and design along with selected pre-study findings of an epidemiological study in a nationally representative sample of substitution doctors (N = 381) and their patients (n = 2500) in Germany. The project has three major components: (a) Pre-study: We sent mailed questionnaires to a sample of over 1000 substitution doctors to describe qualification and setting characteristics, treatment profiles and attitudes of substitution doctors in Germany. (b) Cross-sectional study: With a two-step epidemiological design (target day assessment of the patients, clinical appraisals by the doctors), our main aims were (1) to determine the number of opiate addicts treated by methadone or buprenorphine or other substitution drugs; (2) to find predictors and correlates for treatment, taking into account doctors, patients, and system variables; and (3) to evaluate cross-sectional differences between groups with regard to clinical presentation (comorbidity), clinical course, acceptance/compliance, critical incidences, and social integration. (c) Furthermore, the study includes a prospective-longitudinal cohort study of a total of 1000 patients sampled from this data base. The cohort will be followed-up over a period of three months to investigate whether buprenorphine patients have a more favorable course and outcome in terms of clinical, psychosocial, pharmaco-economic, and related measures. Selected pre-study findings are summarized, highlightening that current registers include a considerable proportion of doctors and a considerable heterogeneity of setting characteristics in terms of the number of patients, choice of substitution drugs and involvement in hepatitis- C treatment

APA, Harvard, Vancouver, ISO, and other styles

33

Bangah, Ramesh. "The State of Needle Exchange Programs in Sweden and Hepatitis C Virus Incidence." Thesis, Södertörns högskola, Miljövetenskap, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:sh:diva-40833.

Full text

Abstract:

Hepatitis C virus (HCV) affects up to 45,000 people in Sweden today. Although it is a very treatable disease, the prevalence of HCV is extremely high within the population of people who inject drugs (PWID). This study examines the direct effect of needle exchange programs (NEPs) on HCV rates in Sweden. Previous research has shown that NEPs reduce the transmission of other blood-borne diseases among PWID. Using an interrupted time series (ITS) analysis, this study investigates if there are statistically significant differences between HCV rates in Swedish counties before and after the implementation of NEPs. The study also investigates via linear regression to see if there is a relationship between sterile injecting equipment (needles and syringes) dispensed and HCV rates in the counties where NEPs exist. While there has been a steady decrease in HCV rates across the country as a whole, the ITS analyses show no statistically significant differences in HCV rates due to the opening of NEPs. Because of the relatively recent introduction of NEPs in Sweden, more data points post-intervention may be needed before we can truly see the effect they have on regional HCV rates. There is also no relationship between the number of needles and syringes dispensed and county HCV rates. However, Sweden falls far short of the 300 syringes/needles per user per year recommendation of the World Health Organization at this time. Standardized data collection and further research can help answer these questions more clearly.

APA, Harvard, Vancouver, ISO, and other styles

34

Duberg, Ann-Sofi. "Hepatitis C virus infection a nationwide study of associated morbidity and mortality /." Doctoral thesis, Örebro : Örebro universitet, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-7835.

Full text

APA, Harvard, Vancouver, ISO, and other styles

35

Araújo, Lyriane Apolinário de. "Investigação epidemiológica e molecular da infecção pelo vírus da hepatite C em assentados nos estados de Goiás e Mato Grosso do Sul, Brasil." Universidade Federal de Goiás, 2014. http://repositorio.bc.ufg.br/tede/handle/tede/5281.

Full text

Abstract:

Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2016-03-03T13:03:40Z No. of bitstreams: 2 Dissertação - Lyruane Apolinário de Araújo - 2014.pdf: 2072768 bytes, checksum: 9626c7f70ff133cd2e05e4d0d4a2de6c (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5)
Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2016-03-03T13:05:30Z (GMT) No. of bitstreams: 2 Dissertação - Lyruane Apolinário de Araújo - 2014.pdf: 2072768 bytes, checksum: 9626c7f70ff133cd2e05e4d0d4a2de6c (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5)
Made available in DSpace on 2016-03-03T13:05:30Z (GMT). No. of bitstreams: 2 Dissertação - Lyruane Apolinário de Araújo - 2014.pdf: 2072768 bytes, checksum: 9626c7f70ff133cd2e05e4d0d4a2de6c (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2014-02-25
Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq
Fundação de Amparo à Pesquisa do Estado de Goiás - FAPEG
The hepatitis C virus (HCV) infection is considered one of the main causes of chronic liver disease, being responsible for great disease burden to the Health Systems Worldwide. According to the World Health Organization, there are approximately 150 million people chronically infected by the HCV in the world. There are only a few studies that have evaluated the HCV occurrence in people that live in settlements, and most of these families are composed by a large number of individuals that have little formal education, that live under poor environmental and sanitation conditions, beyond also usually have no access to adequate health care, due primarily to the difficulties in reaching the health service systems, but also because of the poor quality of the health services. Therefore, the aim of this study was to estimate the prevalence of HCV infection, to analyze the characteristics of the population associated with the infection and to identify the HCV genotypes/subtypes in individuals that live in settlements in the States of Goiás and Mato Grosso do Sul, Central Brazil. The population was consittued by 921 individuals. They were all interviewed and one blood (serum) sample from each person was collected. All sera samples were screened for anti-HCV using an Enzyme Linked Immunosorbent Assay (ELISA). All ELISA positive samples were submitted to RNA extraction and tested by Polymerase Chain Reaction (PCR). All PCR positive samples were further genotyped using the Line Probe Assay (LiPA). The mean age of the population was 39 years old, composed mainly by Caucasian married women, with a low level of formal education, and low family income. Of the 921 samples, four were anti-HCV positive, resulting in an overall prevalence of 0.43% (CI 95%: 0.14-1.19). The viral RNA was detected in all anti-HCV positive samples and the genotyping revealed the presence of the genotype 1, subtype 1a. The HCV infected individuals reported as risk caracteristics for HCV infection: sharing sharp personal hygiene objects, history of surgical intervention, blood transfusions before to 1993, sex without protection, history of sexually transmitted disease and imprisonment. This study showed a low prevalence of HCV infection in this population. This study showed a low prevalence of HCV infection in this population. However, epidemiological investigations are important to verify the circulation of the virus , especially in settled populations, which are often on the margins of public health services.
A infecção pelo vírus da hepatite C (HCV) tem assumido uma grande relevância entre as causas de doença hepática crônica, constituindo um sério agravo de saúde. A Organização Mundial de Saúde estima que existam cerca de 150 milhões de pessoas cronicamente infectadas pelo HCV no mundo. Existem poucos estudos sobre a ocorrência do HCV em indivíduos que vivem em assentamentos, sendo que a maioria das famílias são numerosas, possuem baixa escolaridade e renda familiar, além de não receberem assistência adequada a saúde, principalmente, pela dificuldade do acesso aos serviços de saúde e pela qualidade dos mesmos. Este estudo teve como objetivos estimar a prevalência da infecção pelo HCV, analisar as características de risco relatadas pelos indivíduos infectados e identificar os genótipos/subtipos deste vírus em população assentada nos Estados de Goiás e Mato Grosso do Sul, Brasil Central. A população foi constituída por 921 indivíduos, provenientes de assentamentos de Goiás e Mato Grosso do Sul. Todos foram entrevistados e uma amostra de sangue (soro) foi coletada de cada participante. Os soros foram triados para detecção de anti-HCV por ELISA, e as amostras reativas para esse marcador foram submetidas à detecção do RNA viral pela reação em cadeia pela polimerase (PCR). As amostras RNA-HCV positivas foram genotipadas pelo método Line Probe Assay (LiPA). A média de idade da população foi de 39 anos, com predomínio de mulheres, casadas, brancas, com níveis baixos de educação formal e renda familiar. Quatro amostras foram anti-HCV reagentes, resultando em uma prevalência de 0,43% (IC 95%: 0,14-1,19). O RNA viral foi detectado em todas as amostras anti-HCV reagentes e a genotipagem revelou a presença do genótipo 1, subtipo 1a. Os indivíduos infectados pelo HCV relataram como características de risco pela infecção pelo HCV: compartilhamento de objetos cortantes de higiene pessoal, procedimento cirúrgico, transfusão de sangue antes de 1993, não uso de preservativo, histórico de doença sexualmente transmissível (DST) e antecedente de prisão. Este estudo evidenciou uma prevalência baixa da infecção pelo HCV na população estudada. Contudo, investigações epidemiológicas são importantes para verificar a circulação desse vírus, principalmente em populações assentadas, que muitas vezes ficam às margens dos serviços públicos de saúde.

APA, Harvard, Vancouver, ISO, and other styles

36

Mouton, Marlize National Centre in HIV Social Research Faculty of Arts &amp Social Sciences UNSW. ""More than a liver" - the role of the social work practitioner in hepatitis C treatment centres." Publisher:University of New South Wales. National Centre in HIV Social Research, 2008. http://handle.unsw.edu.au/1959.4/41466.

Full text

Abstract:

Hepatitis C is a fast growing infectious disease in Australia and is often associated with related psycho-social and mental health problems. The conventional treatment process for hepatitis C is challenging due to a number of reasons. This study explored social workers perceptions of the contribution of their role in hepatitis C treatment centres in relation to the treatment experience of patients. The roles that social workers fulfill, their contribution to the multidisciplinary team and towards a culturally competent service, were explored. Furthermore the knowledge, skills and values required for providing a competent service in a hepatitis C treatment setting was explored. The broad theoretical frameworks that inform social work practice were considered, especially the biopsycho-social model, the strengths perspective, the critically reflexive approach and communications theory. This qualitative study used a semi-structured interview method for data collection. Ten social workers in hepatitis C treatment clinics participated in the study. The findings highlight the needs of patients and how social worker participants described helping to address and meet these needs by employing their knowledge, skills and values through their social work roles and interventions in a team context in a multicultural and multi-faceted work environment. A major challenge that social workers described was to keep patients on treatment despite debilitating side effects that diminish patients' motivation to complete treatment. A shortcoming in the service was described to be the limited psychiatric support available at many treatment centres. The findings lead to a number of recommendations to improve social work services in hepatitis C treatment settings. More research was recommended in areas such as motivational techniques, psychiatric support, and effective group work strategies. The need for increased funding for social work positions in the hepatitis C field was also highlighted. It is anticipated that findings of this study can be applied to hepatitis C treatment in broader settings such as prisons, drug and alcohol settings and general practice. This research will contribute to literature in the field of hepatitis C treatment models and in the field of social work practice in hepatitis C contexts.

APA, Harvard, Vancouver, ISO, and other styles

37

Neto, Gaspar Lisboa. "Influência da infecção pregressa pelo vírus da hepatite B em portadores de hepatite C crônica: análise histológica." Universidade de São Paulo, 2009. http://www.teses.usp.br/teses/disponiveis/5/5134/tde-02072009-095040/.

Full text

Abstract:

INTRODUÇÃO: Os vírus das hepatites B (VHB) e C (VHC) são os principais causadores de hepatopatia crônica em todo mundo. Ambos compartilham vias semelhantes de transmissão. Em pacientes portadores crônicos de VHC com sorologia compatível com infecção pregressa pelo VHB (anti-HBcAg[+] e HBsAg [-]), o VHB DNA residual tem sido detectado por técnicas de biologia molecular altamente sensíveis no soro, em células linfomononucleares de sangue periférico e em hepatócitos (como cccDNA), de forma que o anti-HBcAg tem sido associado a pior prognóstico, tanto histológico quanto terapêutico. OBJETIVOS: Analisar a associação entre infecção pregressa pelo VHB nos portadores crônicos do VHC e o dano histológico hepático, além das características epidemiológicas, clínicas e laboratoriais destes pacientes em região de baixa prevalência para o VHB. MÉTODOS: A prevalência do anti-HBcAg foi avaliada em 574 pacientes portadores crônicos de VHC atendidos durante o ano de 2006 no ambulatório de Hepatites Virais do DMIP-HC FMUSP. Deste grupo, foram selecionados 215 pacientes (98 de 112 com anti-HBcAg[+] e 117 de 462 monoinfectados pelo VHC) para análise comparativa. Ainda, 145 indivíduos foram submetidos à análise estatística multivariada, por metodologia de Regressão Logística sequencial, para identificação de possíveis preditores de fibrose avançada. RESULTADOS: Foram avaliados 98 pacientes com marcadores sorológicos de infecção pregressa pelo VHB. Quarenta e seis indivíduos (47%) possuíam o anti-HBcAg de forma isolada. O principal fator de risco relacionado à infecção viral foi hemotransfusão (31,6%). Contudo, a freqüência de UDI foi maior no grupo com infecção pregressa pelo VHB, em relação aos 117 indivíduos monoinfectados pelo VHC (p<0,05). Não houve diferença estatisticamente significativa quanto ao estadiamento (p=0,40) ou à graduação necroinflamatória histológica (APP, p=0,70) entre esses dois grupos. O tempo de infecção e a taxa de progressão de fibrose também foram semelhantes (p=0,99 e p=0,61, respectivamente). A presença do anti-HBcAg não foi considerada preditora de fibrose hepática avançada (p=0,11), porém identificamos como variáveis independentes o tabagismo acentuado (OR 4,40; IC95%: 1,30-14,87), aumento da ALT (OR 1,01; IC95%: 1,00-1,03), de gamagt (OR 1,01; IC95%: 1,00-1,01) e leucopenia (OR 7,75; IC95%: 2,13-28,23). CONCLUSÃO: A prevalência de infecção pregressa pelo VHB em portadores de infecção crônica pelo VHC foi de 20%, sendo este valor compatível com outros estudos realizados em regiões de endemicidade semelhante. A freqüência do marcador anti-HBcAg isolado foi alta neste grupo, refletindo uma possível supressão da imunidade humoral contra o VHB frente a resposta dirigida ao VHC. A infecção pregressa pelo VHB não parece acentuar ou acelerar o dano histológico hepático no nosso meio.
INTRODUCTION: Hepatitis B (HBV) and C (HCV) virus are the main causers of chronic hepatic disease worldwide. Both viruses share similar transmission routes. In chronic HCV infected patients with serological markers of resolved HBV infection (anti-HBcAg [+] and HBsAg [-]), residual HBV-DNA has been detected through highly sensible techniques in serum, PBMC and hepatocytes (as cccDNA). In fact, anti-HBcAg has been associated with worse prognoses, severe histological liver damage and less sustained virological response to HCV treatment. OBJECTIVE: Assess the relationship between previous HBV infection (anti-HBcAg [+]; HBsAg [-]) in patients with chronic hepatitis C (HCV) and histological damage, considering epidemiological, clinical and laboratorial characteristics of this group in a region of low prevalence for HBV. METHODS: Anti-HBcAg prevalence was evaluated in 574 patients seen during a period of one year in a tertiary center (University of Sao Paulo General Hospital, Sao Paulo, Brazil). Of this group, 215 subjects addressed selection criteria and have been selected for evaluation (98 of 112 carriers of anti-HBcAg and 117 of 462 infected only by HCV). 145 individuals have undergone analysis for identification of predictors of advanced fibrosis through univariate and multivariate stepwise logistic regression. RESULTS: Nineteen-eight subjects with serological markers of previous HBV infection were evaluated. Forty-six (47%) patients had anti-HBcAg in isolated form. The main risk factor for infection was blood transfusion (31,6%). However, the IDU frequency was greater in this group (p<0.05). There was no difference regarding histological staging (fibrosis ranging from 0 to 4, p=0.40) or grading (portal inflammation, p=0.70) compared with subjects infected only by HCV with no markers of HBV infection. The rate of fibrosis progression (in units per year) and the infection length was similar in these two groups (p=0,61 and p=0,99, respectively). Anti-HBcAg was not considered a predictor for advanced fibrosis (p=0.11). However, we identified tobacco smoking (OR 4.40; CI 95%: 1.30-14.87), increased ALT (OR 1.01; CI 95%: 1.00-1.03), increased -gt (OR 1.01; CI 95%: 1.00-1.01) and leucopenia (OR 7.75; CI 95%: 2.13-28.23) as independent variables. CONCLUSION: The prevalence of resolved HBV infection in subjects with chronic hepatitis C was 20%. This result was equivalent to other studies carried out in regions of similar endemicity. The frequency of the isolated anti-HBcAg was higher in this group, reflecting a possible suppression of the humoral immunity against HBV caused by an active immune response directed to HCV. Former and resolved HBV infection does not seem to increase or accelerate histological damage in our geographical area.

APA, Harvard, Vancouver, ISO, and other styles

38

Wittchen, Hans-Ulrich, Sabine M. Apelt, Bettina Christl, Katja A. Hagenau, Alexandra Groß, Jens Klotsche, and Michael Soyka. "Die Versorgungspraxis der Substitutionstherapie Opiatabhängiger (COBRA)." ecomed verlagsgesellschaft AG & Co. KG, 2004. https://tud.qucosa.de/id/qucosa%3A26181.

Full text

Abstract:

Hintergrund: Die Datenlage zur Substitutionstherapie Opiatabhängiger ist defizitär. Vor diesem markant defizitären Erkenntnishintergrund erscheint es sinnvoll und notwendig, eine versorgungsepidemiologische Studie zur aktuellen Versorgungslage opiatabhängiger Substitutionspatienten durchzuführen, um offene Fragen zu klären. Hierfür haben wir ein mehrstufiges Forschungsprojekt unter dem Akronym COBRA initiiert. COBRA steht für "Cost-Benefit and Risk Appraisal of Substitution Treatments" und signalisiert, dass wir uns in umfassender Weise um eine Evaluation der Risiken, Vor- und Nachteile verschiedener Interventionsstrategien und Modalitäten in der Substitutions- und Versorgungspraxis Opiatabhängiger in Deutschland bemühen. Zielsetzungen des COBRA-Projekts sind: • Die Charakterisierung von bestehenden Einrichtungsformen und -modellen; • Die Charakterisierung von: – Merkmalen opiatabhängiger Patienten in diesen Einrichtungen (Schwere, Dauer/ Stadium, Komorbidität, Delinquenz, Desintegration etc.), – der Diagnostik sowie den Indikations- und Allokationsentscheidungen in der Versorgungsrealität sowie – den eingesetzten Interventionsmethoden (Substitutionsmittel, Therapie komorbider Störungen, psychotherapeutische und soziale Interventionen) • Die Ermittlung von Problemen der Substitutionstherapie bei verschiedenen Risikogruppen (z.B. Hepatitis-C- und HIVPatienten) • Die Beschreibung des Kurzzeitverlaufs und Outcomes hinsichtlich verschiedener klinischer und sozialer Kriterien Methodik: Die Studie teilt sich in einen deskriptiv-klinisch-epidemiologischen und einen analytisch-evaluativen Teil. Der deskriptive Teil soll zunächst darüber Auskunft geben, wie viele und welche Arten von Substitutionseinrichtungen in Deutschland wie viele Opiatabhängige erreichen und behandeln. Auf dieser Grundlage soll dann im evaluativen Teil an möglichst repräsentativen Einrichtungen und Patienten beurteilt werden, wie und mit welchen Methoden welche Arten von Patienten und Problemlagen versorgt werden. Durch Abgleich mit den wissenschaftlichen Bewertungsmaßstäben können daraus Defizite, Probleme und mögliche verbesserte Allokationsstrategien abgeleitet werden. Ergebnisse: Es werden erste Vorstudienbefunde und Ihre Design- Konsequenzen vorgestellt und diskutiert.
In the present paper, we will describe aims, methods, and design along with selected pre-study findings of an epidemiological study in a nationally representative sample of substitution doctors (N = 381) and their patients (n = 2500) in Germany. The project has three major components: (a) Pre-study: We sent mailed questionnaires to a sample of over 1000 substitution doctors to describe qualification and setting characteristics, treatment profiles and attitudes of substitution doctors in Germany. (b) Cross-sectional study: With a two-step epidemiological design (target day assessment of the patients, clinical appraisals by the doctors), our main aims were (1) to determine the number of opiate addicts treated by methadone or buprenorphine or other substitution drugs; (2) to find predictors and correlates for treatment, taking into account doctors, patients, and system variables; and (3) to evaluate cross-sectional differences between groups with regard to clinical presentation (comorbidity), clinical course, acceptance/compliance, critical incidences, and social integration. (c) Furthermore, the study includes a prospective-longitudinal cohort study of a total of 1000 patients sampled from this data base. The cohort will be followed-up over a period of three months to investigate whether buprenorphine patients have a more favorable course and outcome in terms of clinical, psychosocial, pharmaco-economic, and related measures. Selected pre-study findings are summarized, highlightening that current registers include a considerable proportion of doctors and a considerable heterogeneity of setting characteristics in terms of the number of patients, choice of substitution drugs and involvement in hepatitis- C treatment.

APA, Harvard, Vancouver, ISO, and other styles

39

Dearlove, Bethany Lorna. "Genome evolution and epidemiology of human pathogens." Thesis, University of Oxford, 2013. http://ora.ox.ac.uk/objects/uuid:af385d35-ca1a-4f4c-ae1a-0ad954cab928.

Full text

Abstract:

Understanding the transmission dynamics of infectious diseases is important to well-informed public health policy, responsive infection control and individual patient management. The on-going revolution in whole-genome sequencing provides unprecedented resolution for detecting evidence of recent transmission and characterising population-level transmission dynamics. In this thesis, I develop and apply evolutionary approaches to investigating transmission, focusing on three globally important pathogens. Hepatitis C virus (HCV) is a major cause of liver disease affecting 150 million people and killing 350,000 annually. I conducted a meta-analysis of twentieth-century HCV epidemics, finding that the age of the epidemic can be predicted by genetic diversity. Using the coalescent, I fitted classic susceptible-infected (SI), susceptible-infected-susceptible (SIS) and susceptible-infected-recovered (SIR) epidemiological models. Most epidemics showed signatures of SI dynamics, but three, from Argentina, Hong Kong and Thailand, revealed complex SIR dynamics. Norovirus is the leading viral cause of diarrhoea, estimated to cost the NHS around £115 million annually. I analysed whole norovirus genomes via a stochastic transmission model, finding that up to 86% of hospital infection was attributable to transmission from another patient in the hospital. In contrast, the rate of new introductions to hospital by infected patients was extremely low (<0.0001%), underlining the importance of ward management during outbreaks. Campylobacter is the most commonly identified cause of bacterial gastroenteritis worldwide. I developed a zoonotic transmission model based on phylogeography approaches to test whether three strains previously associated with multiple host species were in fact aggregates of strongly host-restricted sub-strains, or genuine generalists. Members of the same strain isolated from different host species were often more closely related than those isolated from the same host species. I estimated 419, 389 and 31 zoonotic transmissions in ST-21, ST-45 and ST-828 respectively, strongly supporting the hypothesis that these strains are adapted to a generalist lifestyle.

APA, Harvard, Vancouver, ISO, and other styles

40

Mora, Monica Viviana Alvarado. "Estudos sobre infecções pelos vírus da hepatite B (HBV), hepatite C (HCV), hepatite delta (HDV) e vírus GB-C (GBV-C) em diferentes regiões da América do Sul." Universidade de São Paulo, 2011. http://www.teses.usp.br/teses/disponiveis/5/5147/tde-13012012-082814/.

Full text

Abstract:

As hepatites virais estão entre as mais importantes pandemias mundiais da atualidade. Existem várias causas de hepatite, entre elas, o vírus da hepatite B (HBV), o vírus da hepatite C (HCV) e o vírus da Hepatite Delta (HDV). Da mesma forma, o vírus GB-C (GBV-C) é importante na coinfecção com outros vírus, como o HIV. Nesse estudo, várias regiões da América do Sul foram analisadas. Na Colômbia, os estados do Amazonas e Magdalena foram encontradas como regiões hiperendêmicas para HBV. O genótipo F3 (75%) foi o mais prevalente. Determinou-se que o subgenótipo F3 é o mais antigo dos subgenótipos F. No estado de Chocó, encontrou-se o subgenótipo A1 (52,1%) como o mais prevalente. Surpreendentemente, nesse mesmo estado foram encontrados nove casos autóctones de infecção pelo genótipo E (39,1%). Para o HCV, em Bogotá, encontrou-se o subtipo 1b (82,8%) como o mais prevalente. Da mesma forma, estimou-se que esse subtipo foi introduzido por volta de 1950 e se propagou exponencialmente entre 1970 a 1990. O HDV foi identificado em casos de hepatite fulminante do estado de Amazonas, todos classificados como genótipo 3. Se determinou que o HDV/3 se espalhou exponencialmente a partir de 1950 a 1970 na América do Sul e depois desta época, esta infecção deixou de aumentar, provavelmente devido a introdução de vacinação contra o HBV. GBV-C foi procurado em doadores de sangue colombianos infectados com HCV e/ou HBV de Bogotá e em povos indígenas com infecção pelo HBV no Amazonas. A análise filogenética revelou a presença do genótipo 2a como o mais prevalente entre os doadores de sangue e o 3 nos povos indígenas estudados. A presença do genótipo 3 na população indígena foi previamente relatada na região de Santa Marta, na Colômbia e nos povos indígenas da Venezuela e da Bolívia. No Chile, foi realizado um estudo com 21 pacientes cronicamente infectados pelo HBV sem tratamento antiviral prévio. Todas as sequências obtidas eram do subgenótipo F1b e se agrupavam em quatro diferentes grupos, sugerindo que diferentes linhagens desse subgenótipo estão circulando no Chile. No Brasil, no estado de Rondônia, para o HCV, encontramos o subtipo 1b (50,0%) como o mais frequente. Esse foi o primeiro relato sobre os genótipos do HCV neste estado. Para o HBV, o subgenótipo A1 (37,0%) foi o mais frequente. Os resultados do estado de Rondônia são consistentes com outros estudos no Brasil, mostrando a presença de vários genótipos do HBV, refletindo a origem mista da população Brasileira. Estudando o estado do Maranhão, avaliamos a frequência da infecção pelo HBV e seus genótipos. Foram encontradas 4 sequencias genótipo A1 que agruparam com outras sequências reportadas do Brasil. Em outro estudo, caracterizamos os subgenótipos do HBV em 68 pacientes com hepatite crônica B em Pernambuco, encontrando 78,7% de presença do subgenótipo A1. Finalmente, em um estudo realizado com amostras da cidade de São Paulo, encontramos um caso de HBV genótipo C em um brasileiro nativo, sendo essa a primeira sequência completa do genoma de HBV/C2 notificados no Brasil
Viral hepatitis are among the major pandemics in the world nowadays. There are many causes of hepatitis, including hepatitis B virus (HBV), hepatitis C virus (HCV) and hepatitis delta virus (HDV). Similarly, GB virus C (GBV-C) is a relevant agent in co-infection with HIV. In this study, several regions of South America were studied. In Colombia, the states of Amazonas and Magdalena were identified as highly endemic areas for HBV. Genotype F3 (75%) was the most prevalent. It was determined that subgenotype F3 is the oldest among all F subgenotypes. In the state of Chocó, subgenotype A1 (52.1%) was the most prevalent. Surprisingly, nine indigenous cases of infection by genotype E (39.1%) were found in this state. For HCV, in Bogotá, subtype 1b (82.8%) was the most frequent. Likewise, it was estimated that this subtype was introduced around 1950 and spread exponentially from 1970 to 1990. HDV has been identified in cases of fulminant hepatitis in the state of Amazonas, all of them classified as genotype 3. It was determined that the HDV/3 spread exponentially from 1950 to 1970 in South America and after this time, this infection stopped to increase, probably due to introduction of vaccination against HBV. GBV-C was sought in Colombian blood donors infected with HCV and/or HBV in Bogotá and indigenous peoples with HBV infection in the Amazon. The phylogenetic analysis revealed the presence of genotype 3 as the most prevalent among blood donors and in three studied indigenous people. The presence of genotype 3 in the indigenous population has been previously reported in the region of Santa Marta, Colombia, and in the indigenous peoples of Venezuela and Bolivia. In Chile, a study was carried out with 21 patients chronically infected with HBV without any prior antiviral treatment. All sequences obtained belonged to subgenotype F1b and clustered into four different groups, suggesting that different strains that are circulating in Chile. In Brazil, the state of Rondônia, we found HCV subtype 1b (50.0%) as the most frequent. This was the first report on HCV genotypes in this state. For HBV, subgenotype A1 (37.0%) was the most frequent. The results of the state of Rondônia are consistent with other studies carried out in Brazil, showing the presence of several HBV genotypes, reflecting the mixed origin of the Brazilian population. Studying the state of Maranhão, we evaluated the frequency of HBV infection and its genotypes and we found 4 genotype A1 sequences that grouped with other sequences reported in Brazil. In another study, we characterized HBV subgenotypes in 68 patients with chronic hepatitis B in Pernambuco and we found subgenotype A1 in 78.7% cases. Finally, in a study of samples from São Paulo, we found a case of HBV genotype C in a native Brazilian patient and this is the first complete genome sequence of HBV/C2 reported in Brazil

APA, Harvard, Vancouver, ISO, and other styles

41

Santos, Márcio Bezerra. "Prevalência de marcadores sorológicos dos vírus das Hepatites B (VHB) e C (VHC) em indivíduos infectados por Schistosoma mansoni no bairro Santa Maria, Aracaju/SE." Universidade Federal de Sergipe, 2012. https://ri.ufs.br/handle/riufs/3246.

Full text

Abstract:

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior
The Schistosomiasis is a parasitic disease, severe, chronic waterborne and development, whose etiologic agent is Schistosoma mansoni. It occurs in 74 countries with 207 million people infected and 700 million in risky areas. In Brazil, data indicate a prevalence of eight million. The Schistosomiasis can be exacerbated when patients are carriers of the Hepatitis B Virus (HBV) and C (HCV), resulting in simultaneous evolution of both pathologies. In Brazil, the prevalence of co-infection with HBV/HCV and S. mansoni found in studies ranged from 13.6% to 40% for HBV and 0.5% to 19.66% for the HCV. On this basis, this research aimed to identify the prevalence of serological markers of HBV and HCV and risky factors in individuals carrying the S. mansoni in the Santa Maria neighborhood, Aracaju, state of Sergipe. We conducted a cross-sectional epidemiological study. Data were collected for each patient by means of a questionnaire investigation. This questionnaire included variables identifying the subject of the research participants and variables that included the epidemiological risky factors for infection with HBV or HCV. We collected serum samples of research participants and forwarded to the laboratory testing to identify serological markers of hepatitis B and C: Total Anti-HBc IgG, Anti-HBs, HBsAg and Anti-HCV. All procedures performed using the technique of chemiluminescence immunoassay using the ARCHITECT assay for each serological marker following the protocols established by the laboratory equipment manufacturer SYSTEM ARCHITECT. In addition, we carried out the analysis of spatial distribution of co-infection in the district through the program using the TerraView Kernel intensity estimation. It was found that 16 individuals had contact with HBV (9.41%), one of these was positive for HBsAg. Only Thirty-two samples (18.82%) were positive for the marker Anti-HBs. Three samples were positive for anti-HCV (1.76%), and also a positive for Anti-HBc. The main risks of HBV and HCV infection were related to parenteral interventions of health services, as well as sexual activity without condom use in the case of HBV. Spatial analysis of cases of co-infection (Schistosomiasis and Hepatitis) allowed the visualization of areas of higher concentration of these infections, as well as those that are exposed to different degrees of risk of transmission. The survey results allow to offer, the municipal health services, a tool to facilitate the understanding of the spatial distribution of schistosomiasis and hepatitis (B and C) in Santa Maria neighborhood. Although our values are above the estimated prevalence for the Brazilian population and the Northeast, we can t infer that the individuals with Schistosomiasis are more susceptible to infection with HBV or HCV, since the risky factors were the means of risky transmission of causative agents of hepatitis and not infected with S. mansoni.
A Esquistossomose Mansônica é uma doença parasitária grave, de veiculação hídrica e evolução crônica, cujo agente etiológico é o Schistosoma mansoni. Ocorre em 74 países, com 207 milhões de pessoas infectadas e 700 milhões em áreas de risco. No Brasil, dados indicam uma prevalência de oito milhões. A Esquistossomose pode ser agravada quando os pacientes são portadores dos Vírus das Hepatites B (VHB) e C (VHC), resultando na evolução simultânea de ambas as patologias. No Brasil, As prevalências da co-infecção VHB/VHC e S. mansoni encontradas nos estudos realizados variaram de 13,6% a 40% para o HBV e de 0,5% a 19,66% para o HCV. Com base nisso, esta pesquisa objetivou identificar a prevalência de marcadores sorológicos do VHB e VHC e os fatores de risco em indivíduos portadores do S. mansoni no Bairro Santa Maria, Aracaju/SE. Foi realizado um estudo epidemiológico do tipo transversal. Coletaram-se dados de cada paciente por meio de um questionário investigativo. Este questionário contemplou variáveis de identificação do sujeito participante da pesquisa e variáveis epidemiológicas que incluíram os fatores de risco para infecção pelo HBV ou HCV. Foram coletadas alíquotas de soro dos participantes da pesquisa e encaminhadas para a realização das análises laboratoriais para identificação de marcadores sorológicos dos Vírus das Hepatites B e C: Anti-HBc Total IgG, Anti-HBs, HBsAg e Anti-HCV. Todos os procedimentos realizados utilizaram a técnica de Imunoensaio Quimioluminescente através do Ensaio ARCHITECT para cada marcador sorológico seguindo os protocolos de análises laboratoriais estabelecidos pelo fabricante do equipamento ARCHITECT SYSTEM. Além disso, realizou-se a análise espacial da distribuição da co-infecção no bairro através do programa TerraView utilizando o estimador de intensidade Kernel. Constatou-se que 16 indivíduos tiveram contato com o HBV (9,41%), desses um foi positivo para HBsAg. Apenas Trinta e duas amostras (18,82%) foram positivas para o marcador Anti-HBs. Três amostras foram positivas para Anti-HCV (1,76%), sendo uma também positiva para Anti-HBc. Os principais riscos de infecção pelo HBV e HCV foram relacionados às intervenções parenterais dos serviços de saúde, assim como à atividade sexual sem uso de preservativo, no caso do HBV. A análise espacial dos casos de co-infecção (Esquistossomose e Hepatite) permitiu a visualização de áreas de maior concentração dessas infecções, assim como as que são expostas a diferentes graus de risco de transmissão. Os resultados da pesquisa possibilitam oferecer, aos serviços municipais de saúde, um instrumento que facilite a compreensão da distribuição espacial da Esquistossomose e Hepatites (B e C) no bairro Santa Maria. Embora nossos valores sejam acima da prevalência estimada para a população brasileira e da região nordeste, não podemos inferir que os indivíduos portadores da Esquistossomose são mais susceptíveis à infecção pelo HBV ou HCV, uma vez que, os fatores de risco foram as vias de risco de transmissão de agentes causadores de hepatite e não a infecção pelo S. mansoni.

APA, Harvard, Vancouver, ISO, and other styles

42

Funk, Anna. "Reconciling the first epidemiological findings following emerging disease events : examples from Zika and Hepatitis C." Thesis, Sorbonne université, 2018. http://www.theses.fr/2018SORUS150.

Full text

Abstract:

Les enquêtes épidémiologiques initiales effectuées à la suite d'événements épidémiques émergents révèlent parfois des associations fallacieuses et conduisent à des interprétations erronées de la gravité éventuelle de la maladie. Dans les Districts Français d’Amérique, nous avons estimé le risque d'anomalies congénitales liées au virus Zika à 7% (IC 95%: 5,0-9,5%) grâce au suivi d'une cohorte prospective de 546 femmes enceintes infectées. Après comparaison avec un groupe témoin, notre estimation du risque a diminué à 1,6% (IC 95%: 0,4-4,1%). En outre, une étude de surveillance menée dans quatre villes d’Afrique subsaharienne et d’Asie et basée sur une définition standardisée de la microcéphalie, a révélé des proportions très variables (3% à 35%). En Égypte, des antiviraux à action directe très efficaces contre le virus de l'hépatite C ont été introduits à grande échelle en 2014. Nos recherches, menées dans le cadre d'études de cohortes «en vie réelle», ont mis en évidence un lien étroit entre la récurrence du cancer du foie et le traitement par ces nouvelles thérapies, ainsi qu'un risque non négligeable de réactivation de l'hépatite B pour les personnes co-infectées par les deux virus. Nos difficultés pour réconcilier ces résultats avec d'autres estimations contemporaines est probablement due aux différences entre les schémas d'étude utilisés, à l’absence de groupes contrôles appropriés, et à l'utilisation de définitions de cas discutables pour des affections clés. Après une maladie émergente, les priorités et hypothèses de recherche peuvent être ciblées à l'aide de techniques telles que la collecte d'opinions d'experts et la collaboration via divers réseaux de recherche
Initial epidemiological investigations following emerging disease events may uncover spurious associations and lead to misinterpretations of disease severity. In the French Territories of the Americas, we estimated the risk of Zika-related birth defects to be 7% (95%CI: 5.0%-9.5%) through a prospective cohort of 546 infected pregnant women. When compared to a control group, this estimate decreased to 1.6% (95%CI: 0.4-4.1%). In a surveillance study in four cities in sub-Saharan Africa and Asia, we found highly varied (from 3-35%) proportions of microcephaly when using a standardised definition. Difficulties in reconciling our findings with others comes from a variation in study procedures, a lack of appropriate control groups, and use of problematic definitions for key conditions, such as microcephaly. In Egypt, highly effective direct acting antivirals for hepatitis C virus were introduced in 2014. Through ‘real-life’ cohort studies, found a strong association between liver cancer recurrence and treatment with these new regimens, as well as a non-negligible risk of hepatitis B reactivation following therapy for persons co-infected. We encountered difficulties in drawing conclusions from these finding when compared with others due to variability in research methods as well as in the definitions used for the adverse events. Following an emerging disease event, research priorities and hypotheses can be focused using techniques such as expert opinion elicitation, as well as collaboration through diverse research networks. Transparency as well as use of standardised protocols and case definitions will ameliorate delays in drawing a consensus

APA, Harvard, Vancouver, ISO, and other styles

43

Andrade, Andreia Alves de. "Prevalência da infecção pelo vírus da hepatite C e práticas de risco em homens que fazem sexo com homens em Goiânia-Goiás, empregando o método respondent-driven sampling (RDS)." Universidade Federal de Goiás, 2016. http://repositorio.bc.ufg.br/tede/handle/tede/5782.

Full text

Abstract:

Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2016-08-02T11:33:16Z No. of bitstreams: 2 Dissertação - Andreia Alves de Andrade - 2016.pdf: 1386895 bytes, checksum: 6f80be3c2d79383a9a1b2a10381fbac7 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5)
Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2016-08-02T11:36:03Z (GMT) No. of bitstreams: 2 Dissertação - Andreia Alves de Andrade - 2016.pdf: 1386895 bytes, checksum: 6f80be3c2d79383a9a1b2a10381fbac7 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5)
Made available in DSpace on 2016-08-02T11:36:03Z (GMT). No. of bitstreams: 2 Dissertação - Andreia Alves de Andrade - 2016.pdf: 1386895 bytes, checksum: 6f80be3c2d79383a9a1b2a10381fbac7 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2016-02-29
Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq
Hepatitis C is the most common cause of chronic liver disease. Men who have sex with men (MSM) may be at increased risk of acquiring infections transmitted by parenteral and sexual routes, such as hepatitis C. Despite the relevance of this subject, only one investigation regarding hepatitis C virus (HCV) infection in MSM was conducted in Brazil. Therefore, this study aimed to investigate the prevalence of HCV infection and risk practices among men who have sex with men in the City of Goiânia, Goiás. Cross-sectional study conducted in 522 MSM in Goiania, recruited by respondent-method driven sampling (RDS), from March to November 2014. After signing the informed consent, participants were interviewed about sociodemographic and risk behaviors/practices for HCV infection and then blood samples collected. All samples were subjected to determine the levels of alanine aminotransferase and aspartate aminotransferase (ALT and AST) and anti-HCV marker detection. Samples that had high levels of ALT/AST and/or were anti-HCV positive were tested for HCV RNA by reverse transcription-polymerase chain reaction (RT-PCR), and the positive samples were genotyped by a line probe assay (LiPA). Of 522 samples, four were anti-HCV positive and 14 had high levels of ALT/AST. Of these, only two (Y-421/anti-HCV positive and Y-180/anti-HCV negative/elevated ALT and AST) were HCV RNA positive, and then were genotyped by LiPA as genotype 1, subtypes 1a and 1b. Thus, five samples were anti-HCV and/or HCV RNA positive, resulting in an adjusted prevalence of 1.71% (95% CI: 0.32-8.55) for HCV infection among MSM in Goiânia-GO. Despite it is a low prevalence, many risk behaviors/practices were reported by the studied individuals (tattoo/piercing, sharing of personal hygiene tools, illicit drug use, multiple sexual partners in lifetime, sex with more than one partner in the same relationship, sex with a drug user partner, non-use or occasional condom use during anal sex, alcohol/drug use during sex, among others), which may characterize the target population as potentially vulnerable to infectious diseases transmitted by parenteral and sexual routes.
A hepatite C é a causa mais frequente de doença hepática crônica. Homens que fazem sexo com homens (HSH) podem apresentar risco aumentado em adquirir infecções transmitidas pelas vias parenteral e sexual, como a hepatite C. Apesar da relevância desse tema, apenas uma investigação sobre a infecção pelo vírus da hepatite C (HCV) foi conduzida no Brasil em HSH. Assim, o presente estudo teve como objetivo investigar a prevalência da infecção pelo HCV e práticas de risco em homens que fazem sexo com homens na cidade de Goiânia, Goiás. Estudo de corte transversal conduzido em 522 HSH em Goiânia, recrutados pelo método respondent-driven sampling (RDS), de março a novembro de 2014. Após assinatura do termo de consentimento livre e esclarecido, os participantes foram entrevistados sobre dados sociodemográficos e comportamentos/práticas de risco para infecção pelo HCV e, em seguida, amostras sanguíneas coletadas. Todas as amostras foram submetidas à dosagem dos níveis de alanina aminotransferase e aspartato aminotransferase (ALT e AST) e à detecção do marcador anti-HCV. As amostras que apresentaram níveis de ALT/AST elevados e/ou anti-HCV positivas foram testadas para detecção do RNA viral pela reação em cadeia pela polimerase pós-transcrição reversa (RT-PCR), sendo as positivas genotipadas pelo line probe assay (LiPA). Das 522 amostras, quatro foram anti-HCV positivas e 14 apresentaram níveis elevados de ALT/AST. Destas, apenas duas (Y-421/anti-HCV positiva e Y-180/anti-HCV negativa/ALT e AST elevadas) foram RNA HCV positivas, sendo genotipadas pelo LiPA como do genótipo 1, subtipos 1a e 1b. Portanto, cinco amostras foram anti-HCV e/ou RNA HCV positivas, resultando em uma prevalência ajustada de 1,71% (IC 95%: 0,32-8,55) para infecção pelo HCV em HSH em Goiânia-GO. Apesar desta prevalência ser baixa, vários comportamentos/práticas de riscos foram relatados pelos individuos estudados (tatuagem/piercing, compartilhamento de objetos cortantes de higiene pessoal, uso de drogas ilícitas, múltiplos parceiros sexuais ao longo da vida, sexo com mais de um parceiro na mesma relação, sexo com parceiro usuário de drogas, não uso/uso ocasional de preservativo no sexo anal, relação sexual sob efeito de álcool/drogas, dentre outros), caracterizando a população-alvo como potencialmente vulnerável às doenças infecciosas transmitidas pelas vias parenteral e/ou sexual.

APA, Harvard, Vancouver, ISO, and other styles

44

Del-Rios, Nativa Helena Alves. "Estudo epidemiológico e molecular da infecção pelo vírus da Hepatite C em indivíduos infectados pelo vírus da Imunodeficiência Humana em Goiânia-Goiás." Universidade Federal de Goiás, 2011. http://repositorio.bc.ufg.br/tede/handle/tede/7241.

Full text

Abstract:

Submitted by Erika Demachki (erikademachki@gmail.com) on 2017-04-27T18:05:38Z No. of bitstreams: 2 Dissertação - Nativa Helena Alves Del-Rios - 2011.pdf: 2685862 bytes, checksum: a88d60dfeef4b6b920f7a23cc00881a3 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5)
Rejected by Erika Demachki (erikademachki@gmail.com), reason: on 2017-04-27T18:05:52Z (GMT)
Submitted by Erika Demachki (erikademachki@gmail.com) on 2017-04-27T18:06:12Z No. of bitstreams: 2 Dissertação - Nativa Helena Alves Del-Rios - 2011.pdf: 2685862 bytes, checksum: a88d60dfeef4b6b920f7a23cc00881a3 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5)
Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2017-05-03T11:47:33Z (GMT) No. of bitstreams: 2 Dissertação - Nativa Helena Alves Del-Rios - 2011.pdf: 2685862 bytes, checksum: a88d60dfeef4b6b920f7a23cc00881a3 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5)
Made available in DSpace on 2017-05-03T11:47:33Z (GMT). No. of bitstreams: 2 Dissertação - Nativa Helena Alves Del-Rios - 2011.pdf: 2685862 bytes, checksum: a88d60dfeef4b6b920f7a23cc00881a3 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2011-03-30
Fundação de Amparo à Pesquisa do Estado de Goiás - FAPEG
The hepatitis C virus (HCV) and human immunodeficiency virus (HIV) are characterized by causing chronic infections in the host. The advent of potent antiretroviral therapy has resulted in a significant reduction in the incidence of opportunist infections, and thus greater life expectancy for HIV positive patients. However, the liver disease appears as a major cause of morbidity and mortality among these patients, especially those related to hepatitis C virus. Co-infection with HCV/HIV induces a worse prognosis for both infections, which may lead to the development of AIDS, a faster rapid evolution to chronic active hepatitis and / or liver cirrhosis and death. This study aimed to investigate the epidemiology and molecular profile HCV infection in HIV-infected individuals with no prior antiretroviral therapy, seen in the referral hospital for the treatment of infectious diseases (Hospital for Tropical Diseases - Anuar Auad / HDT) in Goiania, Goiás. A total of 505 treatment naïve individuals and were referred to the HDT, from April 2009 to April 2010 were interviewed and underwent blood collection. All sera were tested for antibodies to HCV (anti-HCV) and for HCV RNA by polymerase chain reaction (PCR). Genotyping was performed by reverse hybridization by the Line Probe Assay (LiPA) method. The prevalence of anti-HCV was 4.6% (95% CI: 3.0 to 6.8). The viral RNA was detected in 65.2% (15/23) of anti-HCV positive samples. The genotypes identified were 1 (subtypes 1a and 1b) and 3 (subtype 3a). The age > 40 years, living in other states or Goiania city, surgery, injecting and non-injecting drug and anti-HBc positive (antibody to core antigen of hepatitis B virus) were associated with HCV infection after logistic regression. The data presented shows the vulnerability of the HIV sropositive population to acquisition of infectious diseases such as HCV infection. Thus, the information obtained will be essential for planning public health interventions, preventing and control of hepatitis C in this population.
Os vírus da hepatite C (HCV) e da imunodeficiência humana (HIV) causam infecções crônicas no hospedeiro. O advento da terapia antiretroviral potente trouxe uma redução da incidência de infecções oportunistas, e consequentemente, uma maior expectativa de vida aos pacientes HIV soropositivos. No entanto, as hepatopatias surgem como uma das principais causas de morbimortalidade entre esses pacientes, principalmente aquelas relacionadas ao vírus C. A coinfecção HCV/HIV induz a um pior prognóstico de ambas as infecções, podendo levar ao desenvolvimento da Aids, evolução mais rápida para hepatite crônica ativa e/ou cirrose hepática e morte. Este estudo teve como objetivo investigar o perfil epidemiológico e molecular da infecção pelo HCV em indivíduos infectados pelo HIV, sem tratamento antiretroviral prévio, atendidos no Hospital de referência para o tratamento de doenças infecciosas (Hospital de Doenças Tropicais - Anuar Auad / HDT) em Goiânia, Goiás. Um total de 505 indivíduos, virgens de tratamento, encaminhados ao HDT, no período de abril/2009 a abril/2010, foram entrevistados e submetidos à coleta de sangue. As amostras (soros) foram testadas para a detecção de anticorpos para o HCV (ELISA/LIA) e submetidas à identificação do RNA-HCV pela reação em cadeia da polimerase (PCR). A genotipagem foi realizada por hibridização reversa, pelo método Line Probe Assay (LiPA). A prevalência para anti-HCV foi de 4,6% (IC 95%: 3,0-6,8). O RNA viral foi detectado em 15 amostras, sendo todas elas anti-HCV positivas. Foram identificados os genótipos 1 e 3, com predomínio do subtipo 1a, seguido dos subtipos 1b e 3a. As variáveis idade superior a 40 anos, ser procedente de Goiânia ou outros estados, cirurgia, uso de drogas injetáveis e não-injetáveis, história de prisão e positividade ao anti-HBc foram associados à infecção pelo vírus da hepatite C, após regressão logística. Os dados apresentados revelam a vulnerabilidade da população HIV soropositiva à aquisição de doenças infecciosas como a infecção pelo HCV. Assim, as informações obtidas serão essenciais para o planejamento de ações de saúde pública para a prevenção e controle da hepatite C nessa população.

APA, Harvard, Vancouver, ISO, and other styles

45

Vogler, Ingridt Hildegard. "Infecção pelo vírus da hepatite C na população de Londrina e região norte do Paraná: aspectos soroepidemiológicos e moleculares." Universidade de São Paulo, 2003. http://www.teses.usp.br/teses/disponiveis/9/9136/tde-30092006-183635/.

Full text

Abstract:

O objetivo deste trabalho foi avaliar a infecção pelo vírus da hepatite C (HCV) em indivíduos de Londrina e regiões circunvizinhas. Amostras de doadores de sangue e de indivíduos infectados pelo vírus da imunodeficiência humana (HIV) foram analisadas pela metodologia de enzimaimunoensaio de micropartículas (MEIA), obtendo-se a freqüência de positividade para anticorpos anti-HCV de 0,8% e de 20,2%, respectivamente. Um conjunto de 185 amostras soropositivas para anti-HCV pelo MEIA foi submetido a outros testes laboratoriais, para avaliação da correlação entre os diferentes métodos empregados. Apenas 79% destas amostras apresentaram resultado reagente em um segundo teste imunoenzimático (ELISA) empregado, sendo que a maior proporção de resultados discordantes ocorreu entre doadores de sangue. O mesmo ocorreu na pesquisa do RNA viral, onde 111 (67%) das 166 amostras analisadas apresentaram resultado positivo, sendo que a positividade foi maior entre indivíduos HIV soropositivos e pacientes com hepatite crônica do que entre os doadores de sangue. Quinze amostras foram submetidas ao immunoblot (IB), tendo-se obtido resultados positivos neste teste apenas nas amostras reagentes nos dois métodos imunoenzimáticos utilizados. Também pudemos verificar um grande número de amostras com resultado indeterminado no IB, inclusive entre amostras que eram negativas no segundo teste sorológico. Embora a amostragem fosse pequena, com apenas 61 amostras analisadas, a genotipagem do HCV revelou que os genótipos circulantes em nossa região são o tipo 1 (77,1%), seguido do tipo 3 (21,3%) e o tipo 2 (1,6%). Finalmente, avaliamos alguns fatores de risco associados à infecção pelo HCV, sendo que o principal fator de risco encontrado em indivíduos co-infectados pelo HIV/HCV foi o uso de drogas injetáveis, e em indivíduos sem infecção pelo HIV foi a transfusão sangüínea. O presente estudo contribuiu para a avaliação do perfil da infecção pelo HCV em indivíduos da nossa população, permitindo inclusive verificar a distribuição dos genótipos do HCV nesta região.
The objective of this work was to evaluate hepatitis C virus (HCV) infection in individuals of Londrina, Paraná State, Brazil, and adjacent areas. Samples of blood donors and individuals infected with Human Immunodeficiency virus (HIV) were analyzed by microparticle enzyme immunoassay (MEIA). Anti-HCV antibody frequency was 0.8% in blood donors, and 20.2% in HIV patients. A group of 185 anti-HCV positive samples by MEIA was submitted to other laboratorial tests, in order to access the correlation among different methods used. Only 79% of samples were reactive by a second antibody-screening test (enzime-linked immunosorbent assay - ELISA), and a great proportion of discordant results was verified among blood donors. The same happened at HCV-RNA detection by polymerase chain reaction (PCR), where 111/166 (67%) of samples showed positive results, which was greater among HIV positive individuals and patients with chronic hepatitis than among blood donors. Only 15 samples were submitted to immunoblot (IB): positive results were obtained only at samples which were also reactive by the two antibody-screening tests used. We could also verify a great number of anti-HCV indeterminate results by IB, which also happened among samples tested negative by the second serologic assay. Although the small number of samples used in genotype determination of HCV, only 61, our data revealed that the circulating genotypes in our region are type 1 (77.1%), followed by type 3 (21.3%) and type 2 (1.6%). Finally, we evaluated some risk factors associated to HCV infection, and we found that intravenous drug use was the most common risk factor among patients HIV/HCV co-infected, while blood transfusion was the most important risk factor in the group without HIV infection. The present study contributed to the evaluation of HCV infection in our population, so that the distribution of HCV genotypes in the region could be accessed.

APA, Harvard, Vancouver, ISO, and other styles

46

Farías, Adrián Alejandro. "Hepatitis C en Córdoba: Implicancias de la coinfección HIV/HCV y cambios locales en el perfil epidemiológico molecular." Doctoral thesis, Farías AA. Hepatitis C en Córdoba: Implicancias de la coinfección HIV/HCV y cambios locales en el perfil epidemiológico molecular [Internet]. Universidad Nacional de Córdoba, 2013 [citado el 13 de febrero de 2020]. Disponible en: https://rdu.unc.edu.ar/handle/11086/6732, 2013. http://hdl.handle.net/11086/6732.

Full text

Abstract:

Tesis - Doctor en Ciencias de la Salud - Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. Secretaría de Graduados en Ciencias de la Salud, 2013
139 h. : il., 29 cm.
The hepatitis C virus (HCV) is considered one of the major causes of chronic hepatitis, cirrhosis and liver cancer. Co-infection with HIV accelerates the progression of liver disease, increases the efficiency of transmission of HCV by non-parental routes and has been associated with the decrease in the effectiveness of HAART. Worldwide, HCV distribution and its molecular pattern are markedly heterogeneous and are continuously changing, due to cultural changes, associated to new risk behaviors, as well as population movements. The aim of this work was to study the prevalence and genetic diversity of HCV infection in HIV co-infected individuals of Córdoba, evaluate its influence on antiretroviral therapy (HAART) and in HCV transmission, and identify possible changes in HCV genotype distribution pattern of Córdoba in the last 10 years. This study included the following samples obtained from patients of Córdoba: a) 349 serum samples from chronically infected individuals collected between 1999-2009; b) 86 serum samples from HCV/HIV co-infected patients obtained from a total of 558 HIV+ patients, collected in 2 periods between 2003-2007; and c) 37 biological fluid samples of HCV moninfected (n=21) and HCV/HIV co-infected individuals (n=16) [cervical swab (n=16), saliva (n=37), seminal plasma (n=21) and peripheral blood mononuclear cells (n=37)]. RT-nested PCR of the 5’ non-coding region (5’ NC) was used for HCV molecular detection. For genomic characterization and subsequent phylogenetic and viral evolution analysis, non-structural 5B and E1/E2 genomic regions were amplified and sequenced.
El virus de la Hepatitis C es considerado una de las principales causas de hepatitis crónica, cirrosis hepática y cáncer hepático. La coinfección con HIV acelera la progresión de la enfermedad hepática, aumenta la efectividad de la transmisión de HCV por vías no parenterales y ha sido asociada a la disminución de la efectividad de la terapia HAART. A nivel mundial, la distribución y el patrón molecular de HCV son marcadamente heterogéneos y se modifican continuamente debido tanto a cambios culturales, asociados a nuevas conductas de riesgo, como a movimientos poblacionales. El objetivo del presente trabajo fue estudiar la prevalencia y la diversidad genética de la infección por HCV en individuos coinfectados con HIV de Córdoba, evaluar su influencia en la terapia antiretroviral (HAART) y en la transmisión de HCV, y detectar posibles cambios en el patrón regional de distribución de genotipos en los últimos 10 años. En este estudio se incluyeron las siguientes muestras obtenidas de pacientes de Córdoba: a) 349 muestras de suero obtenidas de individuos crónicamente infectados por HCV colectados entre 1999-2009; b) 86 sueros de pacientes coinfectados HCV/HIV obtenidos de un total de 558 pacientes HIV+, colectados en dos periodos entre 2003-2007; y c) 37 muestras de fluidos biológicos de pacientes monoinfectados (n=21) y coinfectados HCV/HIV (n=16) [hisopado cervical (n=16), saliva (n=37), plasma seminal (n=21) y células mononucleares de sangre periférica (n=37)]. Para la detección molecular de HCV se utilizó RT-nested PCR de la región 5’ no codificante (5’ NC), y para la caracterización genómica y posterior análisis filogenético y evolución viral, se amplificaron y secuenciaron las regiones no estructural 5B y E1/E2.
Fil: Farías, Adrián Alejandro. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas Instituto de Virología Dr. José María Vanella; Argentina.

APA, Harvard, Vancouver, ISO, and other styles

47

Bezerra, Cristianne Sousa. "Estudo molecular do vÃrus da hepatite C isolado de pacientes atendidos em hospital de referÃncia em Fortaleza, CearÃ." Universidade Federal do CearÃ, 2006. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=127.

Full text

Abstract:

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior
O vÃrus da hepatite C Ã considerado como o principal agente causador de hepatite nÃo-A, nÃo-B e, desde sua descoberta em 1989, tem sido reconhecido como a principal causa de doenÃa crÃnica do fÃgado em todo o mundo. O VHC possui um genoma de RNA de sentido positivo e Ã classificado como um flavivÃrus. O vÃrus apresenta considerÃvel variabilidade em sua seqÃÃncia e as variantes do VHC podem ser divididas em seis genÃtipos principais (numerados de 1 a 6) e diversos subtipos. A distribuiÃÃo dos genÃtipos varia tanto geograficamente, quanto entre os grupos de risco. Este estudo teve como objetivo analisar a distribuiÃÃo dos genÃtipos do VHC entre pacientes atendidos em um hospital de referÃncia em Fortaleza, CearÃ. Cento e vinte pacientes com sorologia positiva para anti-VHC ou histÃria clÃnica sugestiva de infecÃÃo pelo vÃrus foram estudados. O RNA viral foi extraÃdo a partir do soro dos pacientes e a detecÃÃo molecular do vÃrus foi feita por PCR, utilizando iniciadores especÃficos para a regiÃo 5 (linha) nÃo-codificadora do genoma viral. A genotipagem foi baseada em tÃcnica de RFLP utilizando as enzimas de restriÃÃo HaeIII, RsaI, MvaI e HinfI. Noventa e seis pacientes (80%) foram positivos no teste qualitativo para VHC. A mÃdia de idade desses pacientes foi de 44 anos. HistÃria clÃnica de cirurgia foi o fator de risco mais presente, seguido por transfusÃo sangÃÃnea, DST, uso de drogas, tatuagem, diÃlise e exposiÃÃo ocupacional. A relaÃÃo entre o resultado do teste qualitativo e o uso de drogas apresentou significÃncia estatÃstica, com 96% dos usuÃrios de drogas positivos para VHC. NÃo houve diferenÃa significativa no resultado do teste qualitativo quando transfusÃes sangÃÃneas feitas antes ou depois de 1993 foram analisadas. ManifestaÃÃes clÃnicas ou Ãndices de ALT alterados tambÃm nÃo foram preditivos de positividade para VHC. O genÃtipo 1 foi o mais prevalente na populaÃÃo estudada (46,9%), seguido pelos genÃtipos 3 (34,4%) e 2 (8,3%). O genÃtipo 4 viral foi detectado em um paciente. Em nove amostras nÃo foi possÃvel a genotipagem do VHC. Esses casos foram denominados indeterminados. CaracterÃsticas epidemiolÃgicas como idade, sexo, fatores de risco, Ãndices de ALT e manifestaÃÃes clÃnicas foram relacionadas com os diversos genÃtipos virais. A distribuiÃÃo dos genÃtipos virais entre as categorias estudadas ocorreu de forma homogÃnea na maioria dos casos. Foi observada significÃncia estatÃstica apenas na relaÃÃo entre genÃtipo e exposiÃÃo ocupacional ao VHC, com predominÃncia do genÃtipo 1 neste grupo de risco. NÃo foram observadas co-infecÃÃes com mais de um genÃtipo viral.
Hepatitis C virus is considered as the main causative agent of non-A non-B hepatitis and has been recognised as the major cause of chronic liver disease worldwide, since its discovery in 1989. It has a positive-sense RNA and belongs to the flavivirus family. The HCV shows considerable sequence variability and its variants can be divided into six main genotypes (numbered from 1 to 6) and several subtypes. The genotypes distribution varies from the geographic area and among risk groups. This study had the main aim to study HCV genotypes distribution in patients from a reference hospital in Fortaleza, Ceara. It was investigated a hundred and twenty patients with anti-HCV positive or clinical history suggesting virus infection. Viral RNA was extracted from patients serum and the virus molecular detection was made by PCR, using specific primers to the 5â non-coding region of viral genome. Genotyping was based in a RFLP technique, using the restriction enzymes HaeIII, RsaI, MvaI and HinfI. Ninety six patients (80%) were positive in the qualitative test for HCV. The mean age of these patients was 44 years old. Surgery clinical history was the most frequent risk factor, followed by blood transfusion, sexual transmitted disease, drugs use, tattoos, dialysis, and occupacional exposure. The relation between qualitative test result and drug users showed statistical significance, with 96% of drugs users being positive for HCV. There was no significant difference in qualitative test result when we analysed blood transfusions done after or before the year 1993. Clinical symptoms and ALT levels also were not predictive of HCV positive result. Genotype 1 was the most prevalent in the studied population (46,9%), followed by genotype 3 (34,4%) and 2 (8,3%). There was also a molecular characterization of one patient with genotype 4 whereas nine samples were not HCV genotyped and were called as undetermined. The epidemiological characteristics such as age, gender, risk factors, ALT levels and clinical manifestations were related with viral genotypes. The HCV genotypes had a homogeneous distribution, in the majority of cases, among the different categories. A statistical significance was observed only when genotype 1 was related to HCV occupational exposure. Co-infections with more than one viral genotype were not observed.

APA, Harvard, Vancouver, ISO, and other styles

48

Souza, Jéssyca Pereira e. "Investigação da infecção pelo vírus da hepatite C em indivíduos em situação de rua albergados em Goiânia, Goiás: prevalência e fatores associados." Universidade Federal de Goiás, 2017. http://repositorio.bc.ufg.br/tede/handle/tede/7430.

Full text

Abstract:

Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2017-06-08T12:48:10Z No. of bitstreams: 2 Dissertação - Jéssyca Pereira e Souza - 2017.pdf: 2226997 bytes, checksum: 1412453f5d9633f529d6f82693e18ed6 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5)
Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2017-06-08T12:48:33Z (GMT) No. of bitstreams: 2 Dissertação - Jéssyca Pereira e Souza - 2017.pdf: 2226997 bytes, checksum: 1412453f5d9633f529d6f82693e18ed6 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5)
Made available in DSpace on 2017-06-08T12:48:33Z (GMT). No. of bitstreams: 2 Dissertação - Jéssyca Pereira e Souza - 2017.pdf: 2226997 bytes, checksum: 1412453f5d9633f529d6f82693e18ed6 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2017-04-25
Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES
Homeless people are at high risk for parental and sexual infections, such as hepatitis C virus (HCV) infection. This study aimed to investigate the epidemiological profile of the infection caused by the hepatitis C virus in homeless people housed in Goiânia, Goiás. This is an observational, cross-sectional and analytical investigation. Between August 2014 and July 2015, 353 homeless people hosted in the only public institution of the state of Goiás were interviewed about sociodemographic characteristics, knowledge and risk factors for hepatitis C, and subsequently tested for the detection of the marker HCV by immunochromatographic test (rapid test) and ELISA. In addition, monitoring of individuals reagentes for HCV was conducted through the information systems of the Unified Health System. The Poisson regression analysis was used to verify the risk factors associated with exposure to HCV with robust variance for the calculation of prevalence ratio (PR). The investigated were mostly male (81.3%), aged between 18 and 45 years (73.62%), singles (59.8%), with no income (35.7), with 5 to 9 years of study (53.3%) and self-reported brown color (61.1%). The study evidenced a knowledge deficit of the homeless people investigated in relation to the HCV transmission. The rapid test used in this study had a high index of agreement with the ELISA, whose sensitivity and specificity was 91.7% and 99.7%, respectively. The overall prevalence of HCV in the homeless people housed was 3.4% (95% CI: 1.9-5.8). It was noted that age (RP: 1.05, 95% CI: 1.02-1.09), be natural from the Southeast region (RP: 2.27, 95% CI: 1.03-5.02), overnight experience in the street (RP: 2.78, 95% CI: 1.11-6.91) and the use of injectable drugs (UID) (PR: 16.59, 95% CI: 4.23-65.09) were statistically associated with HCV infection. Of the 12 housed positive for HCV, only two sought treatment, but there was no adhesion, and another two others evolved to death as a consequence of hepatic cirrhosis due to hepatitis C. The results of the study ratify the extreme condition of homeless people and the increased risk of acquiring and disseminating the hepatitis C virus. Therefore, to prevent and / or minimize risk behaviors for HCV, it is necessary behavioral and structural interventions with combined strategies, such as health education and counseling, permanent education, provision of rapid testing and barrier methods (condom), multidisciplinary treatment, strengthening the strategy of damage reduction, evaluation of policies for homeless people, solidifying the social care equipment provided to this group, such as shelters and access to the services that comprise the health care network.
Indivíduos em situação de rua apresentam risco elevado para infecções parenterais e sexuais, como a infecção causada pelo vírus da hepatite C (HCV). Este estudo objetivou investigar o perfil epidemiológico da infecção causada pelo vírus da hepatite C em indivíduos em situação de rua albergados em Goiânia, Goiás. Trata-se de uma investigação observacional, de corte transversal e analítico. Entre agosto de 2014 e julho de 2015, 353 indivíduos em situação de rua acolhidos na única instituição pública do Estado de Goiás foram entrevistados sobre características sociodemográficas, conhecimento e fatores de risco para hepatite C, e posteriormente, testados para a detecção do marcador anti-HCV por teste imunocromatográfico (teste rápido) e ELISA. Ainda, o monitoramento dos indivíduos reagentes para anti-HCV foi realizado via sistemas de informação do Sistema Único de Saúde. A análise de regressão de Poisson foi utilizada para verificar os fatores de risco associados à exposição ao HCV com variância robusta para o cálculo de razão de prevalência (RP) ajustada. Os investigados eram majoritariamente do sexo masculino (81,3%), com idade entre 18 e 45 anos (73,62%), solteiros (59,8%), sem renda (35,7), com 5 a 9 anos de estudo (53,3%) e de cor parda autodeclarada (61,1%). O estudo evidenciou um déficit de conhecimento da população em situação de rua (PSR) investigada em relação à transmissão do HCV. O teste rápido utilizado neste estudo teve um elevado índice de concordância com o ELISA, cuja sensibilidade e especificidade foi de 91,7% e 99,7%, respectivamente. A prevalência global de anti-HCV na PSR albergada foi de 3,4% (IC 95%: 1,9–5,8). Observou-se que idade (RP: 1,05; IC 95%: 1,02–1,09), ser natural da região sudeste (RP: 2,27; IC 95%: 1,03–5,02), experiência de pernoite na rua (RP: 2,78; IC 95%: 1,11–6,91) e o uso de drogas injetáveis (UDI) (RP: 16,59; IC 95%: 4,23–65,09) foram fatores estatisticamente associados à infecção pelo HCV. Dos 12 albergados positivos para anti-HCV, somente dois buscaram tratamento, porém não houve adesão, e outros dois evoluíram para óbito em decorrência de cirrose hepática por hepatite C. Os resultados do estudo ratificam a condição de extrema vulneração dos indivíduos em situação de rua e o risco aumentado de aquisição e disseminação do vírus da hepatite C. Portanto, para prevenir e/ou minimizar os comportamentos de risco para o HCV, faz-se necessárias intervenções comportamentais e estruturais com junção de estratégias combinadas, como educação em saúde e aconselhamento, educação permanente, disponibilização de testagem rápida e métodos de barreira (preservativo), tratamento multidisciplinar, fortalecimento da estratégia de redução de danos, avaliação das políticas para a PSR, solidificação dos equipamentos sociais de cuidado disponibilizados a esse grupo, como os albergues e acesso aos serviços que compõem a rede de assistência à saúde.

APA, Harvard, Vancouver, ISO, and other styles

49

Santos, lorena Santana de Mendonça. "Investigação do perfil soroepidemiológico da infecção pelo vírus da hepatite C em pacientes com diabetes mellitus tipo 2 em Goiânia- Goiás." Universidade Federal de Goiás, 2015. http://repositorio.bc.ufg.br/tede/handle/tede/8088.

Full text

Abstract:

Submitted by JÚLIO HEBER SILVA (julioheber@yahoo.com.br) on 2018-01-02T17:35:25Z No. of bitstreams: 2 Dissertação - Lorena Santana de Mendonça Santos - 2015.pdf: 5730879 bytes, checksum: 313fa403c8d6affa2de5bcf3c1484bfe (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5)
Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2018-01-08T10:34:40Z (GMT) No. of bitstreams: 2 Dissertação - Lorena Santana de Mendonça Santos - 2015.pdf: 5730879 bytes, checksum: 313fa403c8d6affa2de5bcf3c1484bfe (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5)
Made available in DSpace on 2018-01-08T10:34:40Z (GMT). No. of bitstreams: 2 Dissertação - Lorena Santana de Mendonça Santos - 2015.pdf: 5730879 bytes, checksum: 313fa403c8d6affa2de5bcf3c1484bfe (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2015-04-10
Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq
Hepatitis C (HCV) virus is one of the major cause of chronic liver disease worldwide and 350,000 to 500,000 deaths occur each year related to the virus. Epidemiological studies suggest that chronic HCV infection may have implications in the genesis of some extra-hepatic diseases, among them diabetes mellitius type 2 (DM2). This study aimed to describe the epidemiological profile of HCV infection in DM 2 patients. All patients with DM2 that were followed up at the Hospital das Clinicas da Universidade Federal de Goias and Unidades de Atenção Básica Saúde da Familia in Goiania-GO were invited to take part in the research. 622 patients with DM 2 were recruited, of whom 17 refused to participate. Therefore, the population was composed of 605 individuals, being the casuistry enough to the design of the study according to the sample calculation. Individuals were interviewed and a blood sample was collected. Sera were tested for the detection of anti - HCV by third-generation enzyme-linked immunosorbent assay. Positive samples for this marker were submitted for detection of viral RNA by Polymerase Chain Reaction post Reverse Transition (RT-PCR) and RNAHCV positive samples were genotyped by Line Probe Essay method (LIPA). The average age of the studied population was 62.1 years (SD = 11.3), female predominance and 78.4% have up to 9 years of study. Nine samples were positive for anti-HCV, resulting in a prevalence of 14.9% (95% CI: 0.73-2,9) for HCV infection in patients with DM2. Viral RNA was detected in four anti-HCV positive specimens and genotypes 1 (2/4) and 3 (2/4) were identified. In the multivariate analysis, blood transfusion before 1994 and the use of illicit drugs were associated with HCV infection. Male remained marginally associated (p = 0.06). Despite the global prevalence for HCV in patients with DM 2 in Goiania-GO have been similar to the one found in the population in general, more studies are needed to clarify the epidemiology of HCV infection in individuals with DM 2 and provide information which can support prevention measures and control of infection in this group of the population.
A infecção pelo vírus da hepatite C (HCV) é uma das principais causas de doença hepática crônica em todo o mundo e 350.000 a 500.000 mortes ocorrem a cada ano relacionadas a essa virose. Estudos epidemiológicos sugerem que ser portador de diabetes mellitus tipo 2 (DM 2) constitui um risco elevado para aquisição da infecção pelo HCV. Este estudo teve como objetivo descrever o perfil epidemiológico da infecção pelo HCV em pacientes portadores de DM 2. Todos os pacientes portadores de DM 2 que faziam acompanhamento no Hospital das Clínicas da Universidade Federal de Goiás e em Unidades de Atenção Básica Saúde da Família na cidade de Goiânia-GO foram convidados a participar do estudo. Foram recrutados 622 pacientes portadores de DM 2, destes 17 recusaram a participar do estudo. Portanto, a população foi constituída por 605 indivíduos, sendo esta casuística suficiente para o desenho do estudo de acordo com cálculo amostral. Os indivíduos foram entrevistados e uma amostra de sangue foi coletada. Os soros foram testados para detecção de anti-HCV por ensaio imunoenzimático de 3ª geração. As amostras positivas para esse marcador foram submetidas à detecção do RNA viral pela Reação em Cadeia pela Polimerase pós Transcrição Reversa (RT-PCR) e as amostras RNA-HCV positivas foram genotipadas pelo método Line Probe Assay (LiPA). A média de idade da população estudada foi 62,1 anos (dp=11,3), predomínio do sexo feminino e 78,4% possuíam até nove anos de estudos. Nove amostras foram positivas para anti-HCV, resultando em uma prevalência de 1,49 % (IC 95%: 0,73-2,90) para a infecção pelo HCV nos portadores de DM 2. O RNA viral foi detectado em quatro amostras anti-HCV positivas e os genótipos 1 (2/4) e 3 (2/4) foram identificados. Na análise multivariada, transfusão de sangue antes de 1994 e uso de drogas ilícitas foram associadas à infecção pelo HCV. Sexo masculino manteve-se marginalmente associada (p=0,06). Apesar da prevalência global para o HCV em portadores de DM 2 em Goiânia-GO ter sido semelhante à encontrada na população em geral, são necessários mais estudos para esclarecer melhor a epidemiologia da infecção pelo HCV em indivíduos portadores de DM 2 e fornecer informações que possam subsidiar medidas de prevenção e controle dessa infecção nesse grupo populacional.

APA, Harvard, Vancouver, ISO, and other styles

50

Nucit, Arnaud. "Développement d'une approche basée sur les modèles dynamiques compartimentaux pour évaluer le bénéfice et l'impact des nouveaux médicaments en population générale : application au cas de l'hépatite C." Thesis, Toulouse 3, 2016. http://www.theses.fr/2016TOU30260/document.

Full text

Abstract:

Ce travail de thèse s'articule autour de trois parties distinctes abordant chacune un thème précis lié à l'épidémiologie. La première partie de ces travaux s'inscrit dans le cadre de la propagation de virus via l'utilisation de modèles épidémiques. Dans cette partie, sont analysées différentes méthodes d'estimations paramétriques et y sont étudiés la qualité de ces estimateurs. Une application à des virus informatiques est proposée. La deuxième partie de cette thèse propose une méthode d'estimation de la prévalence actuelle du virus de l'hépatite C en France par l'intermédiaire d'un modèle de rétro-calcul associé à un modèle de Markov modélisant l'histoire naturelle de la maladie. Cette méthode et les résultats qui en découlent sont comparés avec les résultats obtenus via l'approche de référence en France. Enfin, la dernière partie s'intéresse à l'étude de l'impact des nouvelles thérapeutiques anti-hépatite C susceptible d'éradiquer le virus à moyen terme. En assimilant la population d'intérêt à un groupement de graphes aléatoires, la propagation du virus est modélisée à partir d'un modèle de métapopulation construit sur la base de données migratoires où les dynamiques de chaque sous-population sont régies par un ensemble d'équations différentielles déterministes. Ce travail doctoral a été réalisé dans le cadre d'une convention CIFRE avec les laboratoires Bristol-Myers Squibb
The works undertaken in this doctoral thesis are conducted in three parts, each one dealing with a specific epidemiology-related domain. The first part of this work deals with the propagation of viruses by using well-known epidemic models. It is mainly focused on the analyze of different estimation methods and on their performance. An application on computer virus is proposed. The second part of this thesis gives an estimation method of the hepatitis C virus prevalence in France based on a back-calculation model in association with a Markov model of the disease's natural history. This method and its results are compared with those generated by the reference approach in France. The last part is focused on the study of the recent anti-hepatitis C therapeutics impact on the population since is has been stated that those could eradicate the virus at middle term. In that optic, based on published migration data and assuming that the population of interest is organized into a set of specific contact networks, a metapopulation is computed in which the dynamics of each sub-population is governed by a set of deterministic differential equations. This doctoral research has been conducted through a CIFRE industrial research agreement with the Bristol-Myers Squibb pharmaceutical company

APA, Harvard, Vancouver, ISO, and other styles

Dissertations / Theses on the topic 'Hepatitis C Victoria Epidemiology'

Create a spot-on reference in APA, MLA, Chicago, Harvard, and other styles