Hospital related morbidity from chronic hepatitis C virus (HCV) infection in Australia and mortality from HCV infection in a population cohort in Denmark: Two complementary studies relevant to counseling patients It is already well established that chronic HCV infection is associated with an increased risk for death and higher incidence of hepatocellular carcinoma (HCC). However, less is known about the burden of hospitalization in population cohorts of infected patients as well as the impact

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... resolved viremia on over-all mortality. In this issue of the Journal of Hepatology, Gidding and coworkers report hospital admission patterns expressed as standardized hospitalization ratios, in 82,601 mono-infected HCV patients from New South Wales, Australia (after exclusion of individuals with HBV and HIV co-infection as well as patients with missing demographic information). Between 2000-2006, hospitalization rates across all age groups were 42% higher than expected over-all as compared to the general population and especially in 15-64 year old HCV patients. The greatest excess was noted for 15-19 year old females. Lifestyle factors such as illicit drug abuse, alcohol intake, and alcoholic liver disease were among the major risk factors for hospitalization. As expected, non-alcoholic liver disease and HCC were associated with a 14to 16-fold excess rate of hospital admissions. Finally, hospitalization rates were also increased in HCV patients with renal failure and diabetes mellitus. In a second paper in this issue, Omland and co-workers conducted a population based survey (from 1996 to 2005), comparing mortality rates between patients who cleared HCV infection to HCV patients with viremia (after exclusion of patients with HIV). Out of 13,005 patients with chronic HCV infection, 6292 patients met the study criteria and were included in the analysis. Clearance of HCV infection was established in 2323 patients (37%), while 3969 were viremic (63%). Five year survival was higher, while over-all mortality and liver related as well as HCC-associated mortality were significantly lower in HCV patients who cleared viremia as compared to viremic patients. The two studies have a number of common features. Both were population surveys conducted in highly industrialized countries with a well recorded patient population registry system and excellent data bases using similar International Classification of Diseases ICD-8 and ICD-10 versions. Furthermore, the study populations in both reports from Australia and Denmark were of similar size, ranging from 7 million to 5.4 million, respectively. The statements that only 1.4% of infected HCV patients in Australia and 2% in Denmark had been treated for HCV should be of concern to health policy makers. As stated in both reports, certain risk-taking behavior, i.e., illicit drug abuse and alcohol intake, contribute to the increased morbidity and mortality of patients with chronic HCV infection. Many of the results obtained in both studies confirm previous observations regarding the natural history of HCV infection and the impact of anti-viral treatment on survival. However, the two surveys are population based studies which provide important information devoid of the selection bias which is common for patient cohorts selected for clinical trials. Despite a number of limitations including among others, the lack of information on duration of HCV infection, viral load, and genotype, the fact that these studies were conducted in countries with a relatively high income per capita, and without going into more details, both studies contain important demographic and epidemiologic information which will be useful for future counseling of patients as well as for strategic planning for health authorities. New insight into the mechanism of hepatic involvement in brucellosis Brucellosis, historically called undulant, Mediterranean, or Malta fever, is a zoonotic infection which has rarely attracted the attention of hepatologists in the last two decades. Infection may present with fever of unknown origin, night sweats, malaise, anorexia, arthralgias, fatigue, weight loss, and depression, and is curable when properly treated and does not lead to cirrhosis. It is caused in humans by one of four species: Brucella melitensis, Brucella abortus, Brucella suis, and Brucella canis. Although relatively rare in industrialized countries, these species are still frequently found in various geographic regions worldwide, mainly in domesticated animals as well as in humans who consume unpasteurized dairy products or are occupationally exposed. Having a predilection for the reticuloendothelial system (RES) including bone marrow and lymphnodes, these organisms commonly affect the liver, being the largest RES organ [1, 2] . Hepatic involvement in Brucellosis comprises a clinical-pathological spectrum, ranging from mild elevation of liver function tests, hepatitis, granulomatous hepatitis, and liver abscess. The characteristics of hepatic involvement were previously reported through liver biopsies in a series of 40 Spanish patients with clinical or biochemical evidence of liver disease in whom 65% had