Background. CDC estimated 30,500 new HCV infections in the US in 2014 [or 0.096 per 1,000 person-years (PYs)] and HCV incidence of high-risk groups ranged from 2 to 400 per 1000 PYs. High seroprevalence of HCV antibody, evidence of HCV infection ever, is common among urban emergency department (ED) patients. Little is known regarding incidence of HCV infection in ED patients in recent years. Methods. We conducted a retrospective cohort study to determine HCV incidence among ED adult patients.

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... e study ED rolled out an ED-based HCV screening program since November 2015. A secondary data analysis was performed from a seroprevalence study on all adult patients who visited the study ED during December 10, 2015 and January 21, 2016. Patients who had at least two HCV antibody testings from two separate visits at the study hospital from 2003 to 2016 were included for this secondary data analysis. Patients who had reactive HCV antibody result at the first time point were excluded. Follow-up time (PYs) was calculated for each patient by the interval of between two HCV antibody tests. Time of HCV seroconversion was defined as the midpoint between the negative and positive HCV antibody test. Incidence rate ratio (IRR) and corresponding 95% CI was used to present the relative incidence between groups by mid-p exact test. Results. A total of 302 ED patients were identified. The majority of them were female (60%), African American (79%), aged 35 years and older (60%). Sixty-eight percent of patients were born after 1965 (68%) and 25% born between 1945 and 1965 (birth cohort). Fifty-six percent of patients had commercial insurance payor and 36% had Medicaid or Medicare. Thirty-four (11%) patients had HIV infection and 7 (2%) were injection drug users (IDU). Overall, 6 (2%) had HCV seroconversion during 971.1 PYs, resulting in an HCV incidence of 6.2 per 1,000 PYs (95% CI: 2.5, 12.9 per 1,000 PYs). Background. Chronic hepatitis B (CHB) remains a severe global public health concern. Hepatitis B virus (HBV) can be divided into 8 genotypes with different geographical distribution and virological features. We demonstrated genotypes B and C prevalent in southern and northern China, respectively, had divergent genotype-dependent amino acid polymorphisms and variations in reverse transcriptase (RT) gene, a target of anti-HBV therapy. Recently B/C intergenotypic recombination was reported in RT but its prevalence and clinical implications are elusive. This study aimed to characterize novel intergenotypic recombinants in HBV RT and to dissect their association with HBV-related clinical indexes. Methods. A total of 220 CHB cases were enrolled in China. Sera were tested for ALT, AST, or HBV serologic markers or DNA. HBV RT sequences were amplified, sequenced and genotyped. Recombination analysis was done with Simplot program. Results. 29.1% (64/220) of the cases had genotype B while 70.9% genotype C. Though no intergenotypic recombination was detected for genotype C, 37.5% (24/64) of genotype B HBV had recombination with genotype C at 3′ end of RT. No significant difference was found in ALT or AST, or HBeAg positive rate among the cases with the recombinants, or genotype B or C. Remarkably, HBV DNA of the untreated recombinant cases was significantly higher than that of pure genotype B group, though not significantly different from that of genotype C group. The untreated recombinants also had higher mutation rates at 7 residues throughout RT (rt53, 134, 213, 222, 271, 319 and 340) compared with parental genotypes, among which 3-4 substitutions were co-detected for one recombinant. Moreover, a majority of the recombinant HBV carriers were born on the South/North interface of China. Conclusion. Novel HBV B/C intergenotypic recombination at the 3' end of RT is associated with higher HBV DNA, interlinked RT point mutations and birthplace among Chinese patients. Our findings shed new light on the clinical, virological and epidemiological characteristics of novel intergenotypic recombinants. The emergence of new HBV recombinants may contribute to a dramatically enhanced heterogeneity in disease manifestations, treatment response and prognosis among CHB cases.