title: Outcome of a hepatitis C outbreak among patients in a pain management clinic.
abstract: OBJECTIVE
  The aims of this study are to evaluate the natural history and response to therapy of patients following a hepatitis C outbreak in a pain management clinic.
  
  
  METHODS
  A retrospective cohort study was conducted on patients who acquired hepatitis C virus (HCV) at a pain management clinic. Medical records were retrospectively reviewed for 77% of patients with hepatitis C included in the outbreak to obtain data regarding laboratory results, treatment, and outcomes. Chi-square, Fisher's exact, and Student's t-test were used to determine variables that were significantly associated with spontaneous clearance or sustained virologic response to therapy.
  
  
  RESULTS
  Fifty Caucasian patients (31 women, 19 men; mean age 52 years) were included. Eleven of 50 (22%) patients cleared HCV spontaneously (clearers). The mean age of clearers was 47 years as compared with 57 years for nonclearers (P = 0.04). Liver biopsies were obtained by treating gastroenterologists in 31 patients with mean grade and stage of 2.1 and 1.7, respectively. Gastroenterologists treated 31 of 39 patients with pegylated interferon and ribavirin after a median of 354 (range 140-1,099) days post exposure. Sustained viral response (SVR) was observed in 65% (20/31) on an intention-to-treat basis. In patients who completed therapy, 91% (20/22) achieved SVR. Age, sex, weight, pretreatment alanine aminotransferase (ALT), and histologic parameters were not associated with SVR.
  
  
  CONCLUSIONS
  In this large cohort of US immunocompetent patients with recent HCV infection, 22% resolved spontaneously. Younger age was the only predictor of spontaneous clearance. In patients with early chronic HCV, 65% achieved SVR.
authors.affiliation: Digestive Diseases, Internal Medicine, University of Oklahoma Health Sciences Center, Williams Pavilion 1360, Oklahoma City, OK 73104, USA. javid-fazili@ouhsc.edu
authors.forename: Javid
authors.initials: J
authors.lastname: Fazili
authors.forename: Sue
authors.initials: S
authors.lastname: Mallonee
authors.forename: William M
authors.initials: WM
authors.lastname: Tierney
authors.forename: Teddy F
authors.initials: TF
authors.lastname: Bader
authors.forename: Arun K
authors.initials: AK
authors.lastname: Sachdev
authors.forename: Philip C
authors.initials: PC
authors.lastname: Bird
authors.forename: Robert D
authors.initials: RD
authors.lastname: Schmidt
authors.forename: Sikander A
authors.initials: SA
authors.lastname: Mesiya
authors.forename: Charles L
authors.initials: CL
authors.lastname: Lackey
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000998:Antiviral Agents / Q000627:therapeutic use; D001706:Biopsy; D016009:Chi-Square Distribution; D003428:Cross Infection / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology; D004196:Disease Outbreaks; D005260:Female; D016174:Hepacivirus / Q000235:genetics / Q000276:immunology; D018937:Hepatitis C Antibodies / Q000097:blood; D019698:Hepatitis C, Chronic / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D007372:Interferons / Q000627:therapeutic use; D008099:Liver / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009825:Oklahoma / Q000453:epidemiology; D018710:Pain Clinics; D012367:RNA, Viral / Q000097:blood; D012189:Retrospective Studies; D012254:Ribavirin / Q000627:therapeutic use; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D019562:Viral Load; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D018937:Hepatitis C Antibodies; D012367:RNA, Viral; D012254:Ribavirin; D007372:Interferons
references.citation: Gut. 2001 Jul;49 Suppl 1:I1-21
references.pmid: 11413125
references.citation: N Engl J Med. 2000 Dec 7;343(23):1666-72
references.pmid: 11106715
references.citation: Gastroenterology. 2003 Jul;125(1):80-8
references.pmid: 12851873
references.citation: N Engl J Med. 2001 Nov 15;345(20):1452-7
references.pmid: 11794193
references.citation: Hepatology. 2008 Jan;47(1):321-31
references.pmid: 18161707
references.citation: Hepatology. 2004 May;39(5):1213-9
references.pmid: 15122749
references.citation: Dig Liver Dis. 2003 Feb;35(2):104-13
references.pmid: 12747629
references.citation: Ann Intern Med. 2005 Jun 7;142(11):898-902
references.pmid: 15941696
references.citation: Hepatology. 2002 Nov;36(5 Suppl 1):S35-46
references.pmid: 12407575
references.citation: J Hepatol. 1999;31 Suppl 1:9-16
references.pmid: 10622554
references.citation: Hepatogastroenterology. 2003 Jul-Aug;50(52):1057-9
references.pmid: 12845981
references.citation: Hepatology. 2002 Oct;36(4 Pt 1):993-1000
references.pmid: 12297849
references.citation: Hepatology. 1999 Mar;29(3):908-14
references.pmid: 10051497
references.citation: Infect Control Hosp Epidemiol. 2004 Jul;25(7):576-83
references.pmid: 15301030
references.citation: Gastroenterology. 2006 Mar;130(3):632-8
references.pmid: 16530503
references.citation: CMAJ. 2001 Oct 2;165(7):889-95
references.pmid: 11599327
references.citation: Wkly Epidemiol Rec. 1999 Dec 10;74(49):425-7
references.pmid: 10645164
references.citation: Hepatology. 2002 Nov;36(5 Suppl 1):S195-200
references.pmid: 12407594
references.citation: Hepatology. 2002 Nov;36(5 Suppl 1):S21-9
references.pmid: 12407573
references.citation: Hepatology. 2001 Aug;34(2):395-403
references.pmid: 11481625
references.citation: MMWR Morb Mortal Wkly Rep. 2008 May 16;57(19):513-7
references.pmid: 18480743
references.citation: Hepatology. 2000 Jul;32(1):91-6
references.pmid: 10869294
references.citation: Lancet. 2001 Sep 22;358(9286):958-65
references.pmid: 11583749
references.citation: Tissue Antigens. 2000 Aug;56(2):154-8
references.pmid: 11019916
references.citation: MMWR Morb Mortal Wkly Rep. 2003 Sep 26;52(38):901-6
references.pmid: 14508437
references.citation: Infect Control Hosp Epidemiol. 2004 Jul;25(7):584-90
references.pmid: 15301031
references.citation: N Engl J Med. 2002 Sep 26;347(13):975-82
references.pmid: 12324553
references.citation: Semin Liver Dis. 2000;20(1):17-35
references.pmid: 10895429