What is the current point prevalence of vitiligo among adults in the US?

This cross-sectional, population-based online survey study of more than 40 000 adults in the US was conducted between December 2019 and March 2020. Participant self-report, and adjudication of vitiligo by 3 dermatologists through participant submission of photographs of their skin lesions, resulted in an estimated point prevalence for diagnosed and undiagnosed vitiligo combined of 1.38% (self-reported) and 0.76% (clinician adjudicated).

This study provides current US population-based point prevalence estimates of all vitiligo, beyond just the diagnosed population, including estimates for undiagnosed, segmental, and nonsegmental vitiligo.

Vitiligo can have profound effects on patients and is often associated with other autoimmune comorbid conditions. It is important to understand the current prevalence of vitiligo, including diagnosed, undiagnosed, and subtypes (nonsegmental and segmental).

To estimate the point prevalence of vitiligo in the US.

For this population-based study of adults in the US, a cross-sectional online survey was administered between December 2019 and March 2020 to obtain participant self-reported vitiligo status. A representative sample of the US adult general population, aged 18 to 85 years, was recruited using a stratified proportional, sampling design from general population research panels. Additionally, 3 expert dermatologists adjudicated participants’ self-reported vitiligo diagnosis by reviewing photographs uploaded by the participants using a teledermatology app designed and tested specifically for this study.

The main outcomes were the point prevalence estimates of overall vitiligo, as well as diagnosed, undiagnosed, nonsegmental, and segmental vitiligo.

Among the 40 888 eligible adult participants, the mean (SD) age was 44.9 (17.4) years, 23 170 (56.7%) were female, 30 428 (74.4%) were White, and 4225 (10.3%) were of Hispanic, Latino, or Spanish origin. Self-reported vitiligo prevalence was 1.38% (95% CI, 1.26%-1.49%), with 0.77% (95% CI, 0.68%-0.85%) for diagnosed and 0.61% (95% CI, 0.54%-0.69%) for undiagnosed. Based on expert dermatologist review of 113 photographs of participants with self-reported vitiligo, clinician-adjudicated vitiligo prevalence (sensitivity bounds) was 0.76% (0.76%-1.11%), with 0.46% (0.46%-0.61%) for diagnosed and 0.29% (0.29%-0.50%) for undiagnosed. Self-reported nonsegmental vitiligo prevalence was 0.77% (95% CI, 0.68%-0.85%), with 0.48% (95% CI, 0.41%-0.55%) for diagnosed and 0.29% (95% CI, 0.23%-0.34%) for undiagnosed. Clinician-adjudicated nonsegmental vitiligo prevalence (sensitivity bounds) was 0.58% (0.57%-0.84%), with 0.37% (0.37%-0.49%) for diagnosed and 0.21% (0.20%-0.36%) for undiagnosed. Self-reported segmental vitiligo prevalence was 0.61% (95% CI, 0.53%-0.69%), with 0.28% (95% CI, 0.23%-0.33%) for diagnosed and 0.33% (95% CI, 0.27%-0.38%) for undiagnosed. Clinician-adjudicated segmental vitiligo prevalence (sensitivity bounds) was 0.18% (0.18%-0.27%), with 0.09% (0.09%-0.12%) for diagnosed and 0.08% (0.08%-0.15%) for undiagnosed.

Results of this survey study demonstrated that the current US population-based prevalence estimate of overall (diagnosed and undiagnosed combined) vitiligo in adults is between 0.76% (1.9 million cases in 2020) and 1.11% (2.8 million cases in 2020). Additionally, this study suggests that approximately 40% of adult vitiligo in the US may be undiagnosed. Future studies should be performed to confirm these findings.

Vitiligo is an acquired, idiopathic, and common depigmentation disorder. The values of various epidemiologic parameters are often doubtful due to the methodological weaknesses of the studies.

To elicit the magnitude of various epidemiological parameters and important correlates of vitiligo.

Every vitiligo patient attending the outpatient department of medical colleges spread over most of the Indian states were examined over a period of 1 year. Various epidemiological and clinical variables were examined and compared with age and sex-matched controls (registered in the Clinical Trial Registry of India CTRI/2017/06/008854).

A total of 4,43,275 patients were assessed in 30 medical colleges from 21 Indian states. Institutional prevalence of vitiligo was 0.89% (0.86% in males and 0.93% in females, P < 0.001). The mean age at presentation and mean age at onset were 30.12 ± 17.97 years and 25.14 ± 7.48 years, respectively. Head–neck was the most common primary site (n = 1648, 41.6%) and most commonly affected site (n = 2186, 55.17%). Most cases had nonsegmental vitiligo (n = 2690, 67.89%). The disease started before 20 years of age in more than 46% of cases. About 77% of all cases had signs of instability during the last 1 year. The family history, consanguinity, hypothyroid disorders, and depressed mood were significantly (P < 0.001) higher among the cases. First, second, and third-degree family members were affected in 269 (60.04%), 111 (24.78%), and 68 (15.18%) cases, respectively. Work-related exposure to chemicals was significantly higher among cases (P < 0.008). Obesity was less common among vitiligo cases [P < 0.001, odds ratio (OR) 0.78, 95% confidence interval (CI): 0.71–0.86].

This is one of the largest studies done on vitiligo in India. The prevalence of vitiligo was found to be 0.89% among hospital attendees. Prevalence of vitiligo was higher among females than in males and prevalence of family history, consanguinity, hypothyroid disorders were higher in vitiligo than among controls.

• Epidemiology
• India
• family history
• multicentric study
• prevalence
• psychosocial
• vitiligo

• dentist
• hepatitis B virus
• hepatitis C virus
• hepatocellular carcinoma
• lichen planus

• autoimmunity
• chemokines
• infection
• rig-i-like receptors

• Case-Control Studies
• Chemokines/metabolism
• Humans
• Interferon-Induced Helicase, IFIH1/genetics
• Keratinocytes/metabolism
• Melanocytes/metabolism
• Neoplasm Invasiveness
• Signal Transduction
• Transfection
• Vitiligo/genetics

• National Natural Science Foundation of China (National Science Foundation of China)

• hepatitis c
• acute kidney injury
• chronic kidney disease

• Adult
• Antiviral Agents/pharmacology
• Arthritis, Rheumatoid/drug therapy
• Arthritis, Rheumatoid/etiology
• Autoimmune Diseases/drug therapy
• Cohort Studies
• Drug Therapy, Combination/methods
• Female
• Hepatitis C/complications
• Hepatitis C/drug therapy
• Hepatitis C, Chronic/complications
• Hepatitis C, Chronic/drug therapy
• Humans
• Incidence
• Interferon-alpha/pharmacology
• Lupus Erythematosus, Systemic/drug therapy
• Lupus Erythematosus, Systemic/etiology
• Male
• Middle Aged
• Polyethylene Glycols/pharmacology
• Proportional Hazards Models
• Ribavirin/pharmacology
• Sustained Virologic Response
• Taiwan/epidemiology
• Viral Load/drug effects

• China Medical University Hospital (CMUH)
• Kaohsiung Medical University (KMU)
• Ministry of Health and Welfare (Ministry of Health and Welfare, Taiwan)

• Hypothyroidism
• Interferon
• Ribavirin
• Thyroid

Background: Data about the association between hepatitis virus infection and colorectal neoplasia (CRN) are extremely limited. We examined the association between hepatitis B virus (HBV) and hepatitis C virus (HCV) infection with the risk of CRN. Methods: A cross-sectional study was performed on asymptomatic examinees who underwent a colonoscopy and serologic testing for hepatitis B surface antigen (HBsAg) and hepatitis C antibody (HCV Ab) between 2004 and 2015. Results: Of 155,674 participants who underwent serologic testing for HBsAg, 5476 (3.5%) were positive for HBsAg. The mean age of the study participants was 41.1 ± 9.1 years. The prevalence of CRN was higher in the HBsAg (+) than in HBsAg (-) participants (16.9% vs. 15.6%, p = 0.009). Even after adjusting for confounders, HBsAg positivity was correlated with an increased risk of CRN (odds ratio (OR), 1.10; 95% confidence interval (CI), 1.01–1.19; p = 0.025). Of 155,180 participants who underwent serologic testing for HCV Ab, only 240 (0.15%) were positive for HCV Ab. The prevalence of CRN was higher in HCV Ab (+) than in HCV Ab (-) participants (22.9% vs. 15.6%, p = 0.002). However, the association disappeared after adjusting for confounders (OR, 1.04; 95% CI, 0.72–1.50; p = 0.839). Conclusions: HBV infection was independently correlated with an increased risk of CRN. Our results indicate the possibility that HBV infection may contribute to colorectal carcinogenesis. Screening colonoscopy may have to be recommended more thoroughly for HBV-infected patients.

• Colorectal neoplasia
• Hepatitis B
• Hepatitis C

• atrial fibrillation
• chronic hepatitis C
• extrahepatic manifestations
• inflammation
• population‐based cohort study

Hepatitis C virus (HCV) infection greatly increases the risk of nephropathy. In this observational study, we aimed to explore the relationship between viral hepatitis infection and chronic kidney disease (CKD), identify risk factors, and determine the effect of antiviral treatment on CKD in Chinese patients with chronic HCV infection. A total of 2,435 study subjects were enrolled and divided into four groups: the HCV infection, HBV infection, HBV and HCV co-infection, and uninfected control groups. Of these, 207 patients with chronic hepatitis C (CHC) were given standard dual therapy [subcutaneous injection of recombinant interferon (IFN)-α2b and oral ribavirin (RBV)] for 48 weeks. We found that the prevalence of CKD gradually increased with age in all groups and was significantly increased in patients 60 years or older. Multivariate logistic regression analyses showed that persistent HCV infection was significantly associated with CKD [odds ratio (OR), 1.33; 95% confidence interval (CI), 1.06–1.66; P = 0.013], whereas there was no significant link between CKD and spontaneous HCV clearance (OR, 1.23; 95% CI, 0.79–1.90; P = 0.364), HBV infection (OR, 0.73; 95% CI, 0.44–1.19; P = 0.201), or HBV/HCV co-infection (OR, 1.40; 95% CI, 0.81–2.40; P = 0.234). Notably, after anti-HCV therapy, the serum creatinine concentration was significantly decreased (76.0, 75.5–79.4 μmol/L) from the pretreatment level (95.0, 93.0–97.2 μmol/L), both in patients who showed an end of treatment virological response (ETVR) and those who did not (P < 0.001). Also, in both the ETVR and non-ETVR groups, the percentages of patients with an estimated glomerular filtration rate (eGFR) ≥90 ml/min/1.73 m² increased significantly (P < 0.001), whereas the percentages of those with an eGFR <60 ml/min/1.73 m² significantly decreased (P < 0.001). In conclusion, persistent HCV infection was independently associated with CKD, and antiviral treatment with IFN plus RBV can improve renal function and reverse CKD in HCV-infected patients.

• Disease Progression
• ESRD
• Epidemiology and outcomes
• Hepatitis C
• Kidney Failure, Chronic
• Proportional Hazards Models
• Renal Insufficiency, Chronic
• Retrospective Studies
• chronic kidney disease
• clinical epidemiology
• end-stage renal disease
• glomerular filtration rate
• hepatitis

• Aged
• Cohort Studies
• Disease Progression
• Female
• Glomerular Filtration Rate
• Hepatitis C, Chronic/complications
• Humans
• Male
• Renal Insufficiency, Chronic/complications
• Renal Insufficiency, Chronic/physiopathology
• Retrospective Studies

• chronic hepatitis C virus infection
• direct-acting antiviral agents
• extrahepatic manifestations

• Direct-acting agents
• Kidney transplantation
• Renal insufficiency, chronic
• Hepatitis C virus

• Antiviral Agents/therapeutic use
• Drug Therapy, Combination
• Hepacivirus/drug effects
• Hepatitis C
• Hepatitis C, Chronic/complications
• Hepatitis C, Chronic/therapy
• Hepatitis C, Chronic/virology
• Humans
• Renal Insufficiency, Chronic/complications
• Renal Insufficiency, Chronic/therapy
• Ribavirin

• Chronic kidney disease
• Direct-acting antivirals
• End stage renal disease
• Hepatitis C
• Sustained virological response

• I01 RX000194 RRD VA
• P30 DK041301 NIDDK NIH HHS
• T32 DK007180 NIDDK NIH HHS

• Epidemiology
• Surveillance
• and End Results (SEER)-Medicare
• cancers
• cholangiocarcinoma
• elderly
• hepatitis C virus
• hepatocellular carcinoma
• lymphoma

• Clinical/economic burden
• Extrahepatic manifestations
• Hepatitis C virus
• Liver mortality/morbidity
• Sustained virologic response

• AbbVie

To conduct a meta-analysis assessing the prevalence of vitiligo.

Literatures that reported prevalence rates of vitiligo were identified using EMBASE, PubMed, the Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang database and Weipu database for the period from inception to May 2016. We performed stratified analyses on possible sources of bias, including areas difference, years of publication, gender and age. Publication bias was assessed with Egger’s test method.

A total of 103 studies were eligible for inclusion. The pooled prevalence of vitiligo from 82 population- or community-based studies was 0.2% (95%CI: 0.1%–0.2%) and from 22 hospital-based studies was 1.8% (95%CI: 1.4%–2.1%). A relatively high prevalence of vitiligo was found in Africa area and in female patients. For population- or community-based studies, the prevalence has maintained at a low level in recent 20 years and it has increased with age gradually. For hospital-based studies, the prevalence has showed a decreased trend from 60s till now or from young to old. No significant publication bias existed in hospital-based studies (t = 0.47, P = 0.643), while a significant publication bias existed in population- or community-based studies (t = 2.31, P = 0.026).

A relatively high prevalence of vitiligo was found in Africa area and in female patients. The prevalence has maintained at a low level in recent years. It showed an inverse trend with age increment in population- or community-based studies and hospital-based studies.

• Vitiligo Research Foundation

• HIV
• co-infection
• colonoscopy
• colorectal cancer (CRC)
• hepatitis C
• screening colonoscopy

Hepatitis C virus (HCV) infected patients are known to be exposed to major liver complications i.e. cirrhosis and hepatocellular carcinoma. In addition, many extrahepatic manifestations including rheumatologic disorders have been reported in up to two-third of HCV infected patients. These manifestations include frank auto-immune and rheumatic diseases (such as arthralgia, myalgia, arthritis, sicca syndrome and vasculitis) which may dominate the course of infection. Until recently, the standard of care of HCV has been the use of interferon-alpha based regimens, which not only had limited effectiveness in HCV cure but were poorly tolerated. In patients with rheumatic diseases interferon-based regimens may be problematic given their association with a wide variety of autoimmune toxicities. Recent therapeutic advances with new direct anti-HCV therapies (interferon-free) which are more effective and better tolerated, make screening for this comorbidity in patients with rheumatic disorders more important than ever. This review aimed to outline main HCV extrahepatic with a special focus on rheumatologic manifestations.

• Arthritis
• Cryoglobulinemia
• HCV
• Lymphoma
• Treatment
• Vasculitis

• Chronic kidney disease
• Cryoglobulinemia
• Dialysis
• Direct acting antiviral agents
• Hepatitis C
• Membranoproliferative glomerulonephritis
• Sustained virological response
• Transplantation

The incidence of post-infectious glomerulonephritis (PIGN) in developed countries has decreased over the last 50 years. Here we identified the trends of the incidence of PIGN in Japan during the past four decades.

We explored the frequency, clinicopathological findings, and prognosis of PIGN based on 6,369 cases from the Renal Biopsy Database of our institute in the Kanto region of Japan, diagnosed histologically from 1976 to 2009.

The numbers of PIGN cases were 131 (2.1%) in total, and 2.4%, 1.1%, 2.6% and 2.1% identified in the 1970s, 1980s, 1990s, and 2000s, respectively. Acute glomerulonephritis (AGN), including post-streptococcal glomerulonephritis (PSGN), accounted for almost all of the PIGN cases in the 1970s, but decreased to approx. 40%–50% since the 1990s. In the 1990s, Staphylococcus aureus infection-related nephritis (SARN) showed a rapid increase in rate, reaching 30%. The incidence of hepatitis C virus infection-associated GN (HCVGN) has increased since the 1990s. The average age at onset rose from 33 to 51 years over the study period. These transitions can be summarized as increases in SARN and HCVGN and decreases in PSGN and other types of AGN, since SARN and HCVGN have older onsets compared to PSGN and other AGN types. The clinicopathological features were marked for each PIGN. Regarding the prognosis, the renal death rates of both the SARN and HCVGN groups were significantly higher than those of other PIGN.

Based on our analysis of the Renal Biopsy Database, the incidence of PIGN in Japan reached its peak in the 1990s. The temporal changes in the incidence of PIGN reflected the trends in infectious diseases of each decade and the continual aging of the population, with a related higher susceptibility to infections.

• extrahepatic manifestations
• hepatitis C virus
• treatment

• Cancer
• Cholangiocarcinoma
• Extra-hepatic malignancies
• Hepatitis C virus
• Hepatocellular carcinoma
• Neoplasm
• Pancreatic cancer
• Risk factors

• Carcinoma, Hepatocellular/virology
• Hepacivirus/pathogenicity
• Hepatitis C/diagnosis
• Hepatitis C/epidemiology
• Hepatitis C/virology
• Humans
• Liver Neoplasms/virology
• Neoplasms/diagnosis
• Neoplasms/epidemiology
• Neoplasms/virology
• Risk Assessment
• Risk Factors

• CHC
• alisporivir
• risk factor
• type 2 diabetes

• Sjögren syndrome
• hepatitis C
• meta-analysis
• sicca syndrome

• HCV infection
• cryoglobulinaemia
• immunoglobulin variable gene
• lymphoproliferation
• somatic hypermutation

• Chronic kidney disease
• Cryoglobulinemia
• Dialysis
• Direct acting antivirals
• Hepatitis C
• Interferon
• Renal disease

Hepatitis C infection and chronic kidney disease are major health burden worldwide. Hepatitis C infection is associated with a wide range of extra-hepatic manifestations in various organs including the kidneys. A strong association between hepatitis C and chronic kidney disease has come to light. Hemodialysis in supporting the end stage renal disease patients unfortunately carries a risk for hepatitis C infection. Despite much improvement in the care of this group of patients, the prevalence of hepatitis C infection in hemodialysis patients is still higher than the general population. Hepatitis C infection has a negative effect on the survival of hemodialysis and renal transplant patients. Treatment of hepatitis C in end stage renal disease patients using conventional or pegylated interferon with or without ribavirin remains a clinical challenge with low response rate, high dropout rate due to poor tolerability and many unmet needs. The approval of new direct acting antiviral agents for hepatitis C may dramatically change the treatment approach in hepatitis C infected patients with mild to moderate renal impairment. However it remains to be confirmed if the newer Hepatitis C therapies are safe in individuals with severe renal impairment. This review article discusses the relationship between hepatitis C and chronic kidney disease, describe the various types of renal diseases associated with hepatitis C and the newer as well as the existing treatments for hepatitis C in the context of this subpopulation of hepatitis C patients.

• Chronic hepatitis C
• Kidney disease
• Management

The present study investigated the association of thyroid dysfunction (TD) with the distribution of chronic hepatitis C virus (HCV) infection in untreated patients. A total of 1,012 cases of HCV-infected patients were collected from different regions, of which 209 patients demonstrated a type of TD (chronic thyroiditis complicated with hyperthyroidism, chronic thyroiditis complicated with hypothyroidism, subclinical hyperthyroidism, subclinical hypothyroidism, hyperthyroidism, hypothyroidism or chronic thyroiditis). The results showed the existence of geographical differences in the types of TD present with HCV infection. The female patients had a higher incidence of autoimmune-related TD than the male patients. High levels of HCV RNA expression were most common in all HCV-infected patients, regardless of the presence of TD. High and medium expression levels of HCV RNA were more prevalent in the patients with autoimmune-related TD. Relative analysis of the HCV RNA levels showed that the pathogenesis of TD was not correlated with the HCV RNA expression levels; however, it may have been associated with autoimmunity. The HCV-infected patients with TD were most commonly middle-aged, whereas young adults were the largest group of patients with HCV and normal thyroid function. Among all HCV genotypes, type 1b was the most common HCV genotype and type 2 was the second most common. Types 3 and 6 were scarce in this study population. No associations were identified between HCV genotypes and thyroid disease. The data of liver function showed that HCV-infected patients with TD had a higher liver dysfunction rate compared with that of the patients with normal thyroid function. Therefore, liver dysfunction may be associated with thyroid disease. This study supports the potential of individualized treatment for HCV-infected patients.

• Chinese population
• hepatitis type C
• liver dysfunction
• thyroid dysfunction

The incidence of hepatocellular carcinoma (HCC) continues to increase in Japan, but the clinical characteristics of Japanese patients with HCC have not been well described. The aim of this study was to determine the frequencies and utilities of elevated α-fetoprotein (AFP) and des-gamma-carboxy prothrombin (DCP) levels as biomarkers in cryptogenic HCC.

A total of 2638 patients with HCC diagnosed between 1999 and 2010 in the Nagasaki Association Study of Liver (NASLD) were recruited for this study. The cause of HCC was categorized into 4 groups; HCC-B, HCC-C, HCC-BC, and HCC-nonBC. The significance of factors was examined for HCC-nonBC using logistic regression analysis in all patients.

Multivariate analysis identified age, sex, BMI, alcohol consumption, platelet count, AST, ALT, AFP, DCP, and TNM stage as independent and significant risk factors for HCC-nonBC. According to TNM stage, the median AFP levels in HCC-nonBC with TNM stages I, II, and III were significantly lower than in either HCC-B or HCC-C. In TNM stage IV, the median AFP level in HCC-nonBC was significantly lower than in either HCC-B or HCC-BC. The median DCP levels in HCC-nonBC with TNM stages I and II were significantly higher than those in either HCC-B or HCC-C. In TNM stage III, the median DCP level in HCC-nonBC was significantly higher than that in HCC-C.

DCP was more sensitive than AFP for the diagnosis of early stage cryptogenic HCC. DCP should be used as the main serum test for cryptogenic HCC detection.

• Aged
• Biomarkers/blood
• Biopsy
• Cross-Sectional Studies
• Female
• Heart Ventricles/microbiology
• Heart Ventricles/physiopathology
• Hepacivirus/classification
• Hepacivirus/genetics
• Hepacivirus/isolation & purification
• Hepacivirus/metabolism
• Hepatitis C Antibodies/analysis
• Hepatitis C, Chronic/blood
• Hepatitis C, Chronic/microbiology
• Hepatitis C, Chronic/pathology
• Hepatitis C, Chronic/physiopathology
• Humans
• Japan
• Liver/microbiology
• Liver/pathology
• Male
• Middle Aged
• Molecular Typing
• Myocarditis/etiology
• Natriuretic Peptide, Brain/blood
• Peptide Fragments/blood
• RNA, Viral/blood
• Up-Regulation
• Ventricular Dysfunction/etiology

Oral lichen planus (OLP) is seen frequently in patients with hepatitis C virus (HCV) infection. The aim of this study was to evaluate the occurrence of oral candidiasis, other mucosal lesions, and xerostomia during interferon (IFN) therapy for HCV infection.

Of 124 patients with HCV-infected liver diseases treated with IFN therapy in our hospital, 14 (mean age 56.00 ± 12.94 years) who attended to receive administration of IFN once a week were identified and examined for Candida infection and other oral lesions and for the measurement of salivary flow. Serological assays also were carried out.

Cultures of Candida from the tongue surfaces were positive in 7 (50.0%) of the 14 patients with HCV infection at least once during IFN therapy. C. albicans was the most common species isolated. The incidence of Candida during treatment with IFN did not increase above that before treatment. Additional oral mucosal lesions were observed in 50.0% (7/14) of patients: OLP in three (21.4%), angular cheilitis in three (21.4%) and recurrent aphthous stomatitis in one (7.1%). OLP occurred in one patient before treatment with IFN, in one during treatment and in one at the end of treatment. 85.7% of the oral lesions were treated with topical steroids. We compared the characteristics of the 7 patients in whom Candida was detected at least once during IFN therapy (group 1) and the 7 patients in whom Candida was not detected during IFN therapy (group 2). The prevalence of oral mucosal lesions (P=0.0075) and incidence of external use of steroids (P=0.0308) in group 1 were significantly higher than in group 2. The average body weight of group 1 decreased significantly compared to group 2 (P=0.0088). Salivary flow decreased in all subjects throughout the course of IFN treatment and returned at 6^th months after the end of treatment. In group 1, the level of albumin at the beginning of the 6^th month of IFN administration was lower than in group 2 (P=0.0550). According to multivariate analysis, one factor, the presence of oral mucosal lesions, was associated with the detection of Candida. The adjusted odds ratio for the factor was 36.00 (95% confidence interval 2.68-1485.94).

We should pay more attention to oral candidiasis as well as other oral mucosal lesions, in patients with weight loss during IFN treatment.

• hepatitis c virus
• hcv
• hiv
• fracture
• coinfection

Background. Chronic hepatitis C virus (HCV) has become the global “epidemic” with an estimated 123 million people currently infected worldwide. As the same time diabetes is also rapidly emerging as a global health care problem that threatens to reach pandemic levels by 2030. Objective. To investigate the magnitude of HCV infection in type II diabetes as compared to controls. Methodology. A case control study design was conducted at Jimma University Specialized Hospital from May to June 2010. A total of 604 study subjects were included in this study. Sociodemographic and risk factor data were collected by questionnaire. From serum sample, HCVAb screening was done by rapid antibody screening test. Liver functioning tests and total cholesterol tests were done by Dr. Lange LP 800 spectrophotometer. Results. The prevalence of HCV in type II diabetes and nondiabetic controls was 9.9% and 3.3%, respectively. In multivariate analysis, HCV seropositives have high risk of developing diabetes as compared with seronegatives (AOR = 2.997, 95% CI: (1.08, 8.315)). Conclusion. In this study, we found a positive association between past HCV infection and type II diabetes. As we did not perform HCV RNA test, we could not assess the association with HCV viremia.

α-fetoprotein (AFP) is a tumor marker of hepatocellular carcinoma (HCC) and has also been reported to reflect the effectiveness of long-term low-dose interferon (IFN) therapy in hepatitis C virus (HCV)-infected patients with chronic liver disease. The correlation between AFP levels and the incidence of HCC has been discussed over a long period. We investigated whether high levels of AFP at the time of diagnosis were associated with an increased incidence of HCC in patients with HCV. A total of 107 HCV patients with liver cirrhosis without other risks were evaluated for the predictive value of non-invasive risk factors for HCC, including age, gender, alcohol intake, aspartate and alanine aminotransferase levels, bilirubin, albumin, platelet count and AFP levels at study entry, as well as the IFN therapy received. During the follow-up period, HCC developed in 68 (63.6%) patients. Kaplan-Meier estimates were made to assess the cumulative risk of HCC. The 10-year cumulative incidence rate of HCC was 80%. Cox regression analysis was performed on several variables, including age, gender, alcohol consumption, experience of IFN therapy and biochemical parameters. The following factors were identified as exhibiting an increased risk of HCC by univariate analysis: aspartate transaminase (AST) ≥71 IU/l, alanine transaminase (ALT) ≥60 IU/l, AFP ≥6 ng/ml and IFN therapy. Multivariate analysis identified that the AFP level [6–19 ng/ml: hazard ratio (HR), 2.22; P=0.006 and ≥20 ng/ml: HR, 2.09; P=0.003] was an independent and significant risk factor for the development of HCC. A slightly elevated (6–19 ng/ml) AFP level may be a risk factor for HCC in certain cases. By contrast, AFP levels <6 ng/ml indicate a low risk of HCC development in HCV patients with liver cirrhosis.

Chronic hepatitis C (HCV) disease can be complicated with comorbid conditions that may impact treatment eligibility and outcomes. The aim of the study was to systematically review comorbidities and symptoms in an HCV infected population, specifically assessing comorbidities associated with HCV anti-viral treatment and disease, as well as comparing comorbidities between an HCV infected and uninfected control population.

This was a retrospective cohort study within a United States medical claims database among patients with chronic HCV designed to estimate the two-year period prevalence of comorbidities. Patients with two HCV diagnosis codes, 24 months of continuous health insurance coverage, and full medical and pharmacy benefits were included.

Among a chronic HCV cohort of 7411 patients, at least one comorbid condition was seen in almost all patients (> 99%) during the study period. HCV-infected patients reported almost double the number of comorbidities compared to uninfected controls. Of the 25 most common comorbidities, the majority of the comorbidities (n = 22) were known to be associated with either HCV antiviral treatment or disease. The five most frequent comorbidities were liver disease [other] (37.5%), connective tissue disease (37.5%), abdominal pain (36.1%), upper respiratory infections (35.6%), and lower respiratory disease (33.7%). Three notable comorbidities not known to be associated with antiviral treatment or disease were benign neoplasms (24.3%), genitourinary symptoms & ill-defined conditions (14.8%), and viral infections (13.8%).

This US medically insured HCV population is highly comorbid. Effective strategies to manage these comorbidities are necessary to allow wider access to HCV treatment and reduce the future burden of HCV disease and its manifestations.

The aims of this study were to assess the prevalence of hepatitis C virus (HCV) infection in Japanese patients with oral lichen planus and identify the impact of amino acid (aa) substitutions in the HCV core region and IFN-sensitivity-determining region (ISDR) of nonstructural protein 5A (NS5A) associated with lichen planus.

In this retrospective study, 59 patients (group 1-A) with oral lichen planus among 226 consecutive patients who visited our hospital and 85 individuals (group 1-B, controls) with normal oral mucosa were investigated for the presence of liver disease and HCV infection. Risk factors for the presence of oral lichen planus were assessed by logistic regression analysis. We compared aa substitutions in the HCV core region (70 and/or 91) and ISDR of NS5A of 12 patients with oral lichen planus (group 2-A) and 7 patients who did not have oral lichen planus (group 2-B) among patients (high viral loads, genotype 1b) who received interferon (IFN) therapy in group1-A.

The prevalence of anti-HCV and HCV RNA was 67.80% (40/59) and 59.32% (35/59), respectively, in group 1-A and 31.76% (27/85) and 16.47% (14/85), respectively, in group 1-B. The prevalence of anti-HCV (P < 0.0001) and HCV RNA (P < 0.0001) in group 1-A was significantly higher than those in group 1-B. According to multivariate analysis, three factors - positivity for HCV RNA, low albumin level (< 4.0 g/dL), and history of smoking - were associated with the development of oral lichen planus. The adjusted odds ratios for these three factors were 6.58, 3.53 and 2.58, respectively, and each was statistically significant. No significant differences in viral factors, such as aa substitutions in the core region and ISDR of NS5A, were detected between the two groups (groups 2-A and -B).

We observed a high prevalence of HCV infection in patients with oral lichen planus. Longstanding HCV infection, hypoalbuminemia, and smoking were significant risk factors for the presence of oral lichen planus in patients. It is advisable for Japanese patients with lichen planus to be tested for HCV infection during medical examination.