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Background and Aims: According to clinical trials, the treatment of patients with chronic hepatitis C (CHC) with second-generation direct acting antiviral agents (DAAs) is highly efficient and well tolerated. The goal of this study was to investigate the effectiveness and safety of various combinations of these drugs during their first 2 years of use in the real-world practice of French general hospitals., Methods: Data from patients treated with all-oral DAAs in 24 French non-academic hospital centers from March 1, 2014 to January 1, 2016, were prospectively recorded. The sustained virological response 12-24 weeks after treatment (SVR 12-24) was estimated and severe adverse events (SAE) were evaluated and their predictive factors were determined using logistic regression., Results: Data from 1123 patients were analyzed. The population was 69% genotype (G) 1, 13% G3, 11.5% G4, 5% G2, 49% with cirrhosis and 55% treatment-experienced. The treatment regimens were sofosbuvir/ledipasvir (38%), sofosbuvir/daclatasvir (32%), sofosbuvir/simeprevir (17%), ombitasvir+paritaprevir+ritonavir (5%) (with dasabuvir 3.5%), and sofosbuvir/ribavirin (8%). Ribavirin was given to 24% of patients. The SVR 12-24 was 91.0% (95% CI: 89.2-92.5%). Sofosbuvir-ribavirin was less effective than other regimens. The independent predictors of SVR 12-24 by logistic regression were body weight, albumin, previous hepatocellular carcinoma and treatment regimen (sofosbuvir/ribavirin vs. others). Sixty-four severe adverse events (SAE) were observed in 59 [5.6%] patients, and were independently predicted by cirrhosis and baseline hemoglobin. Serum creatinine increased during treatment (mean 8.5%, [P<10 -5 ]), satisfying criteria for acute kidney injury in 62 patients (7.3%). Patient-reported overall tolerance was excellent, and patient-reported fatigue decreased during and after treatment., Conclusions: Second generation DAAs combinations are as effective and well tolerated in a « real-world » population as in clinical trials. Further studies are needed on renal tolerance., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Background: Thrombocytopenia occurred in a woman given alpha interferon for chronic hepatitis C without cirrhosis. Both central thrombocytopenia, clearly demonstrated, and peripheral thrombocytopenia, probably of autoimunne origin, were involved., Case Report: A 55-year-old woman with active chronic hepatitis C (Metavir score A2, F2) was given alpha interferon. One month after treatment onset, she developed thrombocytopenia (32 G/L). A second bone marrow aspirate and osteomedullary biopsy evidenced megalokaryocytes and the platelet count responded to polyvalent immunoglobulins. Five months after discontinuing interferon, the platelet count progressively returned to normal., Discussion: Central thrombocytopenia is classically described in patients given interferon and usually appears during the first weeks of treatment. In our case, the central mechanism was clearly demonstrated by the bone marrow aspirate and osteomedullary biopsy findings at a time when the platelet count was 32 G/L. A peripheral immunological participation was more difficult to prove but was strongly suggested by the persistence of thrombocytopenia despite the interruption of the interferon and the efficacy of immunoglobulins.

A case of obstructive intramural hematoma of the esophagus post variceal sclerotherapy is reported in a 44-year-old man who presented retrosternal pain and complete dysphagia. Endoscopy showed a bluish submucosal mass occupying the esophageal lumen. Diagnosis was confirmed by Computed Tomography. A favorable outcome was observed with symptomatic treatment.

The risk of transmitting contagious diseases by accidental needle-stick injury has raised a considerable amount of concern among hospital staff. Before generalized vaccination in the early 80s, there was a high risk of hepatitis B transmission. More recently, the development of reliable techniques of detecting serum markers has made it possible to precisely evaluate the risk for hepatitis C. The risk of contamination by the hepatitis C virus by accidental needle-stick injury can be estimated at 0 to 3%, and can only reach a maximum of 10% when the patient is positive for hepatitis C RNA. The risk is thus less than for hepatitis B virus (7 to 30%). The low rate of transmission probably results from the quantity of viral material in blood and secretions. In populations of health personnel exposed to a risk of septic needle-stick injury, the prevalence of anti-hepatitis C virus antibodies has been observed in several studies at rates between 0 and 2%. This is similar to non-exposed populations and would be an argument suggesting that there is a low risk of hepatitis C virus transmission. Nevertheless, because hospital staff is frequently exposed to blood and because a significant number of patients are positive for anti-hepatitis C virus antibodies, adequate preventive measures must be taken. The Immunization Practice Advisory Committee (USA) recommends injection of polyvalent gammaglobulins when stick injury occurs with a needle used for a hepatitis C virus antibody positive patient, but the effectiveness of this protocol has not been demonstrated. Several preliminary studies suggest that treatment of hepatitis C in the acute phase could significantly reduce the rate of chronicity. When interferon has been authorized for this indication, and if effectiveness is confirmed, treatment might be recommended for health personnel with acute needle-stick transmitted HCV infection. Infected needle-stick victims might be followed by having their transaminases checked 4-12 weeks later. In case of positive results, early interferon therapy might be started.

Health care workers are exposed to the risk of viral hepatitis. There has recently been a shift in epidemiology from hepatitis B to hepatitis A, and these subjects are less and less spontaneously immunized before entering their profession; vaccination, therefore, should benefit them. Concerning hepatitis B, vaccination has made a huge impact and considerably reduced the number of occupational cases. The occupational risk for hepatitis C virus infection seems to be much lower than the risk for hepatitis B.