Health Service Executive -Health Protection Surveillance Centre, Dublin, Ireland; European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control, Stockholm, Sweden. Electronic address: email@example.com.
Health Service Executive -Health Protection Surveillance Centre, Dublin, Ireland.
St Luke's Hospital, Kilkenny, Ireland.
Cork University Hospital, Cork, Ireland.
Mater Misericordiae University Hospital, Dublin, Ireland.
St Vincent's University Hospital, Dublin, Ireland.
University College Hospital, Galway, Ireland.
Beaumont Hospital, Dublin, Ireland.
Trinity College Dublin, Dublin, Ireland.
Health Service Executive, Dr. Steevens Hospital, Dublin, Ireland.
St James's Hospital, Dublin, Ireland.
In the mid 1990s, a group of Rh negative women was diagnosed with hepatitis C virus (HCV) genotype 1b infection following administration of contaminated anti-D immunoglobulin in 1977-79. We describe their disease history and estimate the effect of selected host and treatment factors on disease progression.
We conducted a cohort study on the women infected with HCV. Information was collected from records at seven HCV treatment centres on demographics, treatment and health outcomes up to 31st December 2013. We calculated cumulative incidence, case fatality, and sub hazard ratios (SHR) for disease progression using competing risks regression.
682 participants were included in the study. Among chronically infected participants (n=374), 35% completed interferon-based antiviral treatment; 42% of whom had a sustained virological response. At the end of 2013, 19%, 1.9%, and 4.9% of chronically infected participants had developed cirrhosis, hepatocellular carcinoma, and liver-related death, respectively, compared with 10%, 0.8%, and 2.4% at the end of 2008. At the end of 2013, 321 (86%) of chronically infected participants remained alive, 247 (77%) of whom were still chronically infected. Factors associated with increased cirrhosis rates included high alcohol intake (aSHR=4.9 (2.5-9.5)) and diabetes mellitus (aSHR=5.0 (2.9-8.8)).
Development of liver-related outcomes accelerated with time, with the risk of cirrhosis, hepatocellular carcinoma, and liver-related death doubling in the latest five years of follow-up, particularly in women with high alcohol consumption and diabetes mellitus. We recommend that patients with chronic HCV infection be advised of the additive harmful effect of alcohol, and that data be collected on this cohort after a further five years to capture the effect of subsequent antiviral treatment during this rapidly evolving period in HCV treatment history.
In the mid 1990s, a group of women were diagnosed with chronic hepatitis C virus (HCV) infection following receipt of contaminated anti-D immunoglobulin between 1977 and 1979 in Ireland. Seventy-two (19%) developed cirrhosis and 18 had died from liver-related causes (5%) after 36 years of infection. Disease progression accelerated in the latest five years of follow-up, particularly in women with diabetes mellitus and high alcohol consumption. We recommend that patients with chronic HCV infection be advised of the additive harmful effect of high alcohol consumption.