BACKGROUND: Adverse transfusion reactions (ATRs) are clinically relevant to patients with significant morbidity and mortality. This study aimed to review the cases of ATR reported in the recipient-triggered trace back system for a recent nine-year period in Korea. METHODS: Nine-year data obtained from 2006 to 2014 by the trace back system at the Division of Human Blood Safety Surveillance of the Korean Centers for Disease Control (KCDC) were reviewed. The suspected cases were assessed according to six categories: (i) related to, (ii) probably related to, (iii) probably not related to, (iv) not related to transfusion, (v) unable to investigate, and (vi) under investigation. RESULTS: Since 2006, 199 suspected serious ATRs were reported in hospitals and medical institutions in Korea, and these ATRs were reassessed by the division of Human Blood Safety Surveillance of the KCDC. Among the reported 193 cases as transfusion related infections, hepatitis C virus (HCV) infection (135, 67.8%) was reported most frequently, followed by hepatitis B virus (HBV) infection (27, 13.6%), HIV infection (13, 6.5%), syphilis (9, 4.5%), malarial infection (4, 2.0%), other bacterial infections (3, 1.5%), HTLV infection (1, 0.5%), and scrub typhus infection (1, 0.5%), respectively. Of the 199 cases, 13 (6.5%) cases were confirmed as transfusion-related (3 HCV infections, 3 malarial infections, 1 HBV infection, 2 Staphylococcus aureus sepsis, 3 transfusion-related acute lung injuries, and 1 hemolytic transfusion reaction). CONCLUSIONS: This is the first nationwide data regarding serious ATRs in Korea and could contribute to the implementation of an effective hemovigilance system.
Acute Lung Injury/epidemiology/etiology ; Blood Transfusion/*adverse effects ; HIV Infections/epidemiology/etiology ; Hepatitis C/epidemiology/etiology ; Humans ; Malaria/epidemiology/etiology ; Republic of Korea ; Retrospective Studies ; Transfusion Reaction/*etiology

BACKGROUNDThe prevalence of thrombocytopenia among Chinese antiretroviral therapy (ART)-naïve HIV-infected adults has not been well-described. The aim of this study was to investigate the prevalence and associated risk factors of thrombocytopenia among Chinese ART-naïve HIV-infected adults.

METHODSWe performed a cross-sectional study of Chinese adult ART-naïve HIV-infected patients from September 2005 through August 2014. Socio-demographic variables and laboratory results including platelets, CD4+ cell count, and viral load were obtained from medical records. Factors and outcomes associated with thrombocytopenia were assessed using logistic regression.

RESULTSA total of 1730 adult ART-naïve HIV-infected patients was included. The mean age was 38 years. The prevalence of thrombocytopenia was 4.5%. There were significant differences in the prevalence of thrombocytopenia between patients <30 years of age (2.8%) and 30-39 years (4.0%) compared with patients greater than 50 years (7.0%) (P = 0.006 and P = 0.044, respectively). The prevalence of thrombocytopenia was also significantly different between patients with CD4+ counts of 200-349 cells/mm 3 (3.3%) and >350 cells/mm 3 (2.8%) compared with patients with CD4+ counts of 50-199 cells/mm 3 (7.1%) (P = 0.002 and P = 0.005, respectively). The prevalence of thrombocytopenia was significantly different by hepatitis C virus antibody (HCV-Ab) seropositivity (10.2% for HCV-Ab positive vs. 3.9% for HCV-Ab negative, P = 0.001). We observed differences in prevalence of thrombocytopenia by mode of transmission of HIV infection: Blood transmission (10.7%) versus men who have sex with men (3.9%) (P = 0.002) and versus heterosexual transmission (3.9%) (P = 0.001). In binary logistic regression analyses, age ≥ 50 years, HCV-Ab positivity and having a CD4+ cell count of 50-199 cells/mm 3 were significantly associated with thrombocytopenia with adjusted odds ratio of 2.482 (95% confidence interval [CI]: 1.167, 5.281, P = 0.018), 2.091 (95% CI: 1.078, 4.055, P = 0.029) and 2.259 (95% CI: 1.028, 4.962, P = 0.042), respectively.

CONCLUSIONSThrombocytopenia is not common among adult ART-naïve HIV-infected patients in China. Older age (age over 50 years), HCV-Ab positivity and lower CD4+ cell count are associated with an increased risk of thrombocytopenia. Therefore, early diagnosis and treatment of thrombocytopenia in these patients are necessary.

Adult ; CD4 Lymphocyte Count ; Cross-Sectional Studies ; Female ; HIV Infections ; blood ; epidemiology ; immunology ; Hepatitis C Antibodies ; blood ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Thrombocytopenia ; blood ; epidemiology ; etiology

BACKGROUND/AIMS: We compared the accuracy and usefulness of clinical diagnostic criteria for hepatocellular carcinoma in a hepatitis B virus (HBV)-endemic area. METHODS: We reviewed the medical records of 355 patients who had undergone liver resection or biopsy at our institution between January 2008 and December 2009. These patients were reevaluated using four noninvasive diagnostic criteria for hepatocellular carcinoma proposed by the European Association for the Study of the Liver (EASL), the American Association for the Study of Liver Diseases (AASLD), the Korean Liver Cancer Study Group and the National Cancer Center (KLCSG/NCC), and National Comprehensive Cancer Network (NCCN) guidelines. RESULTS: The overall sensitivity was highest using the KLCSG/NCC criteria (79.8%), followed by the AASLD (51.5%), EASL (38.4%), and NCCN (10.1%; P<0.001) criteria, whereas the specificity (84.5-98.3%) and positive predictive value (96.2-98.3%) were similar for all of the criteria. The KLCSG/NCC criteria had an acceptable false-positive rate and the highest sensitivity among all of the patients, including those positive for HBsAg, those without liver cancer, and those with a tumor of at least 2 cm. CONCLUSIONS: The KLCSG/NCC and AASLD criteria exhibited the highest sensitivity, and all four guidelines had a high specificity among all of the patients. Based on the sensitivity and false-positive rate, the KLCSG/NCC criteria was the most useful in the majority of patients. Inclusion of HBV infection in the clinical diagnostic criteria for hepatocellular carcinoma would be reasonable and may lead to an improvement in the sensitivity, with acceptable false-positive rates, in HBV-endemic areas.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Carcinoma, Hepatocellular/*diagnosis/etiology/pathology ; Female ; Hepatitis B/complications/*diagnosis/epidemiology ; Hepatitis B Surface Antigens/blood ; Hepatitis C/diagnosis/epidemiology ; Humans ; Liver/pathology ; Liver Neoplasms/*diagnosis/etiology/pathology ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Practice Guidelines as Topic ; Predictive Value of Tests ; Retrospective Studies ; Risk Factors ; Tomography, X-Ray Computed ; Young Adult ; alpha-Fetoproteins/analysis

BACKGROUNDUnhygienic blood collection in the early 1990s led to blood-borne infections in Central China. This study aimed to estimate human immunodeficiency virus (HIV) co-infection with hepatitis C and B viruses (HCV and HBV) and their risk factors in a rural area of Shanxi Province with a history of commercial blood donation.

METHODSA cross-sectional study was conducted in 2004. All adult residents in the target area were invited to participate in the study. Face-to-face interviews were completed and blood specimens were tested for HIV, HCV, and HBV surface antigen (HBsAg).

RESULTSPrevalence rates of HIV, HCV, and HBsAg were 1.3% (40/3 062), 12.7% (389/3 062), and 3.5% (103/2982), respectively. Of the 40 HIV-positive specimens, 85% were HCV positive and 2.5% were HBsAg positive. The history of commercial blood donation was positively associated with HIV, HCV, and HIV/HCV co-infections, but was negatively associated with HBsAg seropositivity. Migration for employment in the last 5 years was positively related to HIV, HBsAg, and HIV/HCV co-infections. Univariate logistic analysis showed that illegal drug use, number of sex partners, extramarital sex behavior, commercial sex behavior, and condom use rate were not related to anti-HIV, anti-HCV, HBsAg seropositivity or their co-infections.

CONCLUSIONThe history of commercial blood donation was the main risk factor for HIV, HCV, and HIV/HCV co-infections in this former commercial blood donation area. HIV and HCV prevention and treatment interventions are important in this area.

Adolescent ; Adult ; Blood Donors ; China ; epidemiology ; Cross-Sectional Studies ; Female ; HIV Infections ; epidemiology ; etiology ; Hepatitis B ; epidemiology ; etiology ; Hepatitis C ; epidemiology ; etiology ; Humans ; Male ; Middle Aged ; Transfusion Reaction ; Young Adult

INTRODUCTIONThyroid dysfunction (TD) is a well-established adverse effect in chronic hepatitis C virus (HCV)-infected patients, treated with interferon-alpha (IFN-α), with or without ribavirin. However, the long-term outcome is not well-studied. The purpose of this study was to estimate the prevalence and long-term outcome of TD after HCV-therapy.

MATERIALS AND METHODSRetrospective analysis of 109 HCV-treated patients (for 6 to 12 months, according to HCV genotype), for the period 1996 to 2008. Thyroid function tests were performed every 3 months during therapy and after discontinuation (3 months to 12 years). Routine laboratory tests and virological assessment were performed according to generally accepted practice.

RESULTSTD was observed in 26 patients (23.85%). The positive and negative predictive value for thyroid autoantibodies (ATA) was 80% and 72.7%, respectively. Relative risk for those with positive ATA was 2.9 (95% CI: 1.6 to 5.3, P = 0.014). The median duration of TD was 12.0 months (min: 3; max: 132). The median follow-up period for the patients with TD was 25.5 months (min: 12; max: 144). Finally, 15 patients developed permanent TD (57.69%), compared to 11 with temporary TD (42.31%). Sex is a risk factor for TD, as there were more females than males affected (P = 0.011). Genotype, viral load, time of HCV-exposure prior to therapy, and virological response did not differ between patients with and without TD.

CONCLUSIONTD among HCV-treated patients was more frequent than usually reported, with >50% developing permanent TD. ATA status may play a role in estimating the risk of subsequent TD. Women appear to be more vulnerable to TD than men.

Adult ; Aged ; Antiviral Agents ; administration & dosage ; adverse effects ; therapeutic use ; Case-Control Studies ; Female ; Hepatitis C ; complications ; drug therapy ; Humans ; Interferon-alpha ; administration & dosage ; adverse effects ; therapeutic use ; Male ; Middle Aged ; Prevalence ; Ribavirin ; administration & dosage ; therapeutic use ; Sex Factors ; Thyroid Diseases ; chemically induced ; epidemiology ; etiology ; Thyroid Function Tests ; Time Factors ; Young Adult

BACKGROUNDThe prevalence of hepatitis C virus (HCV) infection among maintenance hemodialysis (MHD) patients varies among countries and among dialysis units within a single country. The present study aimed to investigate the prevalence and characteristics of HCV infection in MHD patients in a Chinese hemodialysis unit.

METHODSOne hundred and ninety-two patients on MHD for an average of (86.1 ± 30.0) months (range 6 - 181 months) were enrolled in this cross-sectional study. HCV antibody and HCV-RNA were measured in these MHD patients before hemodialysis by enzyme-linked immunosorbent assay (ELISA) and polymerase chain reaction (PCR) methods. According to the result, all the patients were then divided into two groups: Group I was positive for HCV antibody and/or HCV-RNA (n = 32), and Group II was negative for HCV antibody and HCV-RNA (n = 160). The following information was obtained for all the patients: socio-demographic data, history of blood transfusions and kidney transplantation, and some laboratory values. The MHD patients who were positive for HCV antibody and/or HCV-RNA were followed for more than three years. The disease activities were graded into "asymptomatic" if alanine aminotransferase (ALT) was less than 40 U/L, "low activities" if ALT was 40 - 79 U/L, and "high activities" if ALT was equal to or above 80 U/L.

RESULTSThe prevalence of HCV infection in MHD patients in our dialysis unit in May 2009 was 16.7%, which was significantly higher than in general population (3.2%). Among the 32 MHD patients with HCV positive, 20 patients were positive for HCV antibody but negative for HCV-RNA, eight patients were positive both for HCV antibody and HCV-RNA, four patients were negative for HCV antibody but positive for HCV-RNA. Eleven patients had a history of kidney transplantation and 12 had a history of blood transfusion, which were significantly more than among the MHD patients without HCV. Thirty of the 32 MHD patients were asymptomatic. There were no significant differences in age, aspartate aminotransferase (AST), ALT, or between HCV-RNA positive group and HCV-RNA negative group. But the dialysis duration in the HCV-RNA positive group was significantly longer than that in the HCV-RNA negative group. All the 20 HCV-RNA negative patients were asymptomatic. Two of the 12 HCV-RNA positive patients had low activity. None of the 32 cases with HCV positive markers had cirrhosis.

CONCLUSIONSA high prevalence of HCV infection in MHD patients is related to blood transfusion and kidney transplantation. Occult HCV infection is present in MHD patients. Chronic hepatitis C among MHD patients is mild in disease activity, and is not progressive, perhaps due to immunological abnormalities in these patients.

Adult ; Aged ; Aged, 80 and over ; Alanine Transaminase ; blood ; China ; epidemiology ; Cross-Sectional Studies ; Female ; Hepatitis C ; epidemiology ; etiology ; Hepatitis C Antibodies ; blood ; Humans ; Male ; Middle Aged ; Prevalence ; RNA, Viral ; blood ; Renal Dialysis ; adverse effects ; Time Factors

BACKGROUND/AIMS: An association between past history of hepatitis B virus (HBV) infection and pancreatic cancer (PC) has recently been reported. We investigated whether HBV and hepatitis C virus (HCV) infections are associated with the development of PC in Korea. METHODS: We retrospectively recruited patients with PC and sex- and, age-matched control patients with stomach cancer (SC) during the previous 5 years. Serum HBsAg and anti-HCV were examined, and data on smoking, alcohol intake, diabetes, and the history of chronic pancreatitis (CP) were collected. RESULTS: A total of 506 PC and 1008 SC were enrolled, with respectively 58.1% and 97.3% of these cases being confirmed histologically. The mean age and sex ratio (male:female) were 63.5 years and 1.5:1 in the PC patients and 63.9 years and 1.5:1 in the SC patients respectively (P>0.05). The odds ratios (95% confidence interval, 95% CI) in univariate analysis were 0.90 (0.52-1.56; P=0.70) for HBsAg, 1.87 (0.87-4.01; P=0.11) for anti-HCV, 2.66 (2.04-3.48; P<0.001) for the presence of diabetes, 2.30 (1.83-2.90; P<0.001) for smoking, 1.14 (0.89-1.46; P=0.31) for alcohol intake, and 4.40 (1.66-11.66; P=0.003) for the history of CP. Independent risk factors for PC were presence of diabetes (OR, 2.67; 95% CI, 2.00-3.56; P<0.001), smoking (OR, 2.49; 95% CI, 1.93-3.21; P<0.001) and history of CP (OR, 4.60; 95% CI, 1.56-13.53; P=0.006). CONCLUSIONS: There was no significant association between seropositivity for HBsAg or anti-HCV and PC. Further studies are warranted to clarify the association between HBV infection and PC in regions where HBV is endemic.
Aged ; Case-Control Studies ; Data Interpretation, Statistical ; Female ; Hepatitis B/*complications/diagnosis ; Hepatitis C/complications/diagnosis ; Humans ; Incidence ; Male ; Middle Aged ; Odds Ratio ; Pancreatic Neoplasms/diagnosis/*epidemiology/etiology ; Retrospective Studies ; Risk Factors

Adult ; Aged ; Aged, 80 and over ; China ; epidemiology ; Diabetes Mellitus ; epidemiology ; etiology ; Fatty Liver ; complications ; Female ; Glucose Metabolism Disorders ; epidemiology ; etiology ; Hepatitis B, Chronic ; complications ; virology ; Hepatitis C ; complications ; virology ; Humans ; Liver ; metabolism ; pathology ; Liver Cirrhosis ; epidemiology ; etiology ; Liver Cirrhosis, Alcoholic ; epidemiology ; etiology ; Male ; Middle Aged ; Odds Ratio ; Retrospective Studies

Biopsy ; China ; epidemiology ; Fatty Liver ; complications ; Hepatitis C, Chronic ; complications ; virology ; Humans ; Insulin Resistance ; Liver Cirrhosis ; complications ; diagnosis ; epidemiology ; Metabolic Syndrome ; epidemiology ; etiology ; RNA, Viral ; blood ; Risk Factors

Animals ; Cholesterol ; blood ; Fatty Liver ; epidemiology ; etiology ; virology ; Genotype ; Hepacivirus ; genetics ; Hepatitis B ; blood ; complications ; virology ; Hepatitis C ; blood ; complications ; virology ; Humans ; Insulin Resistance ; Metabolic Syndrome ; etiology ; Mice ; Risk Factors ; Triglycerides ; blood