Hepatitis C virus kinetics during the acute phase of infection after occupational exposure in healthcare workers
Abstract number: 1733_1191
Pape M., Mandraveli K., Politou A., Isticoglou I., Alexiou-Daniel S.
Objective: The aim of our study was to estimate the host immune response in the initial phase of infection after occupational exposure in healthcare workers (HCWs) and to evaluate HCV-RNA, anti-HCV and ALT levels as markers of acute infection and reliable predictors of infectivity.
Methods: Over a 4-year period (19982002), 134 occupational exposures of HCWs to possible infectious for HCV material, were reported in AHEPA University Hospital. Blood specimens from HCWs and source patients were drawn for the identification of their immune status to HBV, HCV and HIV. The HCWs were also followed up at 3, 6, 9, 16 weeks with repeated tests for anti-HCV, HCV-RNA and ALT. Anti-HCV immunoreactivity was confirmed by a line immunoassay. HCV-RNA was detected by using the Cobas Amplicor HCV v2.0 assay. HCV genotyping was performed in all HCV-RNA positive HCWs.
Results: Fourty-six source patients were found to be anti-HCV positive. None of these were positive for HIV or HbsAg. In the remaining 88 of the injuries the source of the contact was not known. Among the 46 anti-HCV(+) patients, twelve (26%) had detectable HCV-RNA levels, with 1b genotype being the predominant one. One HCW demonstrated elevated ALT on 6th, 9th and 16th, two on 6th and one on 9th week, respectively. ALT levels were normalised during the remaining follow-up period. One HCW seroconverted for anti-HCV antibodies on 16th week and 6 months after exposure. Anti-HCV antibodies were also detected in two others HCWs on 6th and 9th and on 9th week, respectively.
Two HCWs had detectable HCV-RNA on 6th, 9th, 16th and on 6th and 9th week, respectively. HCV RNA was detected in four HCWs only on the 6th week after exposure. All HCWs 6 and 12 months after exposure were HCV-RNA negative. Three HCWs were assigned to genotypes 1b, 2 and 3 respectively. Genotype could not be determined in the remaining HCWs. One HCW with detectable HCV-RNA received antiviral therapy (combination of ribavirin and interferon) and sustained virological response was defined by a negative HCV-RNA measurement until the end of the follow up.
Conclusion: The risk of acquiring HCV through occupational exposure is very low. It is difficult to establishe diagnosis of acute HCV infection with both serological and virological tests. HCV RNA is temporarily detectable during the follow up examination. Treatment decisions cannot be based only on HCV RNA measurements since a self-limiting infection is a possible outcome.
|Session name:||European Society of Clinical Microbiology and Infectious Diseases|
|Location:||ICC, Munich, Germany|
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