Santantonio T, Medda E, Ferrari C, Fabris P, Cariti G, Massari M, Babudieri S, Toti M, Francavilla R, Ancarani F, Antonucci G, Scotto G, Di Marco V, Pastore G, Stroffolini T
Clinic of Infectious Diseases, University of Bari, Bari, Italy.
Clin Infect Dis. 2006 Nov 1;43(9):1154-9. doi: 10.1086/507640. Epub 2006 Sep 27.
The epidemiology of acute hepatitis C has changed during the past decade in Western countries. Acute HCV infection has a high rate of chronicity, but it is unclear when patients with acute infection should be treated.
To evaluate current sources of hepatitis C virus (HCV) transmission in Italy and to assess the rate of and factors associated with chronic infection, we enrolled 214 consecutive patients with newly acquired hepatitis C during 1999-2004. The patients were from 12 health care centers throughout the country, and they were followed up for a mean (+/- SD) period of 14+/-15.8 months. Biochemical liver tests were performed, and HCV RNA levels were monitored.
A total of 146 patients (68%) had symptomatic disease. The most common risk factors for acquiring hepatitis C that were reported were intravenous drug use and medical procedures. The proportion of subjects with spontaneous resolution of infection was 36%. The average timespan from disease onset to HCV RNA clearance was 71 days (range, 27-173 days). In fact, 58 (80%) of 73 patients with self-limiting hepatitis experienced HCV RNA clearance within 3 months of disease onset. Multiple logistic regression analyses showed that none of the variables considered (including asymptomatic disease) were associated with increased risk of developing chronic hepatitis C.
These findings underscore the importance of medical procedures as risk factors in the current spread of HCV infection in Italy. Because nearly all patients with acute, self-limiting hepatitis C--both symptomatic and asymptomatic--have spontaneous viral clearance within 3 months of disease onset, it seems reasonable to start treatment after this time period ends to avoid costly and useless treatment.
在过去十年中，西方国家急性丙型肝炎的流行病学发生了变化。急性丙型肝炎病毒（HCV）感染的慢性化率很高，但急性感染患者何时应接受治疗尚不清楚。
为了评估意大利当前丙型肝炎病毒（HCV）的传播来源，并评估慢性感染的发生率及相关因素，我们纳入了1999年至2004年期间连续收治的214例新感染丙型肝炎的患者。这些患者来自全国12个医疗中心，平均随访时间为（±标准差）14±15.8个月。进行了肝脏生化检查，并监测了HCV RNA水平。
共有146例患者（68%）出现症状性疾病。报告的感染丙型肝炎最常见的危险因素是静脉注射吸毒和医疗操作。感染自发清除的受试者比例为36%。从疾病发作到HCV RNA清除的平均时间为71天（范围为27 - 173天）。实际上，73例自限性肝炎患者中有58例（80%）在疾病发作后3个月内实现了HCV RNA清除。多因素logistic回归分析表明，所考虑的变量（包括无症状疾病）均与慢性丙型肝炎发生风险增加无关。
这些发现强调了医疗操作作为意大利当前HCV感染传播危险因素的重要性。由于几乎所有急性自限性丙型肝炎患者——无论有无症状——在疾病发作后3个月内都能实现病毒自发清除，因此在这个时间段结束后开始治疗似乎是合理的，以避免昂贵且无用的治疗。
