Outbreak of hepatitis C virus infection during sclerotherapy of varicose veins: long-term follow-up of 196 patients (4535 patient-years).
OBJECTIVE
The aim of this study was to describe the natural history of a HCV infection outbreak in 196 patients who had sclerotherapy by a same physician and to confirm patient-to-patient transmission using phylogenetic analysis in a large series of patients.


METHODS
Demographic information included clinical and biological parameters. Fibrosis evaluation was performed using liver biopsy or transient elastography. Follow-up was maintained until death, or the end of the observation period. In order to determine if the virus had been transmitted between the HCV genotype 2 patients, sequence analysis was undertaken of a part of the NS5b region of the genomes in samples of patients.


RESULTS
The mean duration of follow-up was 23.1+/-6.7 years (4535 patient-years). In patients with fibrosis evaluation, 55.7% had no or mild fibrosis and 44.3% had significant fibrosis. No patient died from HCV-related disease. Nucleotide sequence analysis of a part of the NS5b region revealed that patients were all infected with the same HCV subtype (genotype 2d). The most evident feature of the tree is the clustering of all patients involved in the outbreak without any unrelated isolates.


CONCLUSIONS
This study emphasizes the risk for nosocomial spread of HCV during intravenous therapy.
de Lédinghen
Victor
V
Service d'Hépato-Gastroentérologie, Hôpital Haut-Lévêque, Pessac, France. victor.deledinghen@chu-bordeaux.fr
Trimoulet
Pascale
P
Mannant
Paul-Régis
PR
Dumas
Francis
F
Champbenoît
Patrick
P
Baldit
Christian
C
Foucher
Juliette
J
Faure
Muriel
M
Vergniol
Julien
J
Castéra
Laurent
L
Bertet
Julien
J
Fleury
Hervé
H
Couzigou
Patrice
P
Bernard
Pierre-Henri
PH
D000328:Adult; D003428:Cross Infection / Q000453:epidemiology* / Q000635:transmission* / Q000821:virology; D004196:Disease Outbreaks; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D005838:Genotype; D016174:Hepacivirus / Q000145:classification / Q000235:genetics / Q000302:isolation & purification; D006526:Hepatitis C / Q000453:epidemiology* / Q000635:transmission* / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010802:Phylogeny; D015911:Sclerotherapy / Q000009:adverse effects*; D013997:Time Factors; D014648:Varicose Veins / Q000628:therapy*; D017361:Viral Nonstructural Proteins / Q000235:genetics; D012324:RNA-Dependent RNA Polymerase
D017361:Viral Nonstructural Proteins; C087036:NS-5 protein, hepatitis C virus; D012324:RNA-Dependent RNA Polymerase