• Bacterial infections
• Cytomegalovirus
• Hepatitis
• Neonatal transfusion

• Antigen assay
• biomarkers
• hepatitis B
• hepatitis C
• hepatocellular carcinoma
• molecular diagnostics
• viral hepatitis

Hepatitis C virus (HCV) is a major public health concern and data on its molecular epidemiology in Sweden is scarce. We carried out an 8-year population-based study of newly diagnosed HCV cases in one of Sweden's centrally situated counties, Södermanland (D-county). The aim was to characterize the HCV strains circulating, analyze their genetic relatedness to detect networks, and in combination with demographic data learn more about transmission.

Molecular analyses of serum samples from 91% (N=557) of all newly notified cases in D-county, 2002–2009, were performed. Phylogenetic analysis (NS5B gene, 300 bp) was linked to demographic data from the national surveillance database, SmiNet, to characterize D-county transmission clusters. The linear-by-linear association test (LBL) was used to analyze trends over time.

The most prevalent subtypes were 1a (38%) and 3a (34%). Subtype 1a was most prevalent among cases transmitted via sexual contact, via contaminated blood, or blood products, while subtype 3a was most prevalent among people who inject drugs (PWIDs). Phylogenetic analysis revealed that the subtype 3a sequences formed more and larger transmission clusters (50% of the sequences clustered), while the 1a sequences formed smaller clusters (19% of the sequences clustered), possibly suggesting different epidemics.

We found different transmission patterns in D-county which may, from a public health perspective, have implications for how to control virus infections by targeted interventions.

• clusters
• genotype
• hepatitis C virus
• networks
• subtype
• transmission

More than twenty years of study has provided a better understanding of hepatitis C virus (HCV) life cycle, including the general properties of viral RNA and proteins. This effort facilitates the development of sensitive diagnostic tools and effective antiviral treatments. At present, serologic screening test is recommended to perform on individuals in the high risk groups and nucleic acid tests are recommended to confirm the active HCV infections. Quantization and genotyping of HCV RNAs are important to determine the optimal duration of anti-viral therapy and predict the likelihood of response. In the early 2000s, pegylated interferon plus ribavirin became the standard anti-HCV treatment. However, this therapy is not ideal. To 2014, boceprevir, telaprevir, simeprevir, sofosbuvir and Harvoni are approved by Food and Drug Administration for the treat of HCV infections. It is likely that the new all-oral, interferon-free, pan-genotyping anti-HCV therapy will be available within the next few years. Majority of HCV infections will be cured by these anti-viral treatments. However, not all patients are expected to be cured due to viral resistance and the high cost of antiviral treatments. Thus, an efficient prophylactic vaccine will be the next challenge in the fight against HCV infection.

• Hepatitis C virus
• Diagnosis
• Treatment
• Hepatocellular carcinoma
• Nucleic acid test
• Enzyme immunoassay
• Interferon
• Direct acting antivirals
• Host-targeted agents
• Sofosbuvir

• CLIA
• Serological screening
• blood donors
• concordance

While hepatitis B virus (HBV) screening relies on hepatitis B surface antigen to confirm HBV infection since the early days of hepatitis B disease management, hepatitis C virus (HCV) infection screening is based on anti-HCV testing which does not discriminate active from past infection. Thus to confirm infection HCV RNA testing has been required; recently a HCV core antigen assay became widely commercially available which could serve to confirm infection. That assay is less sensitive than current HCV RNA assays, but as more than 50% of anti-HCV positive persons will be HCV core antigen positive, HCV core antigen testing can be a cost effective and reflex test to confirm HCV infection in anti-HCV positive individuals and will be easier as it can be applied on the same platform. For treatment monitoring, more data need to be generated, but the early data available at present suggest that HCV core antigen may be an alternative to HCV RNA monitoring. With direct antivirals, HCV core antigen could even be superior to HCV RNA testing, as direct antivirals might already prevent virus formation when HCV core antigen is still produced and thereby correlates better with eventual viral clearance.

• Hepatitis C virus
• Hepatitis C
• Diagnostic assay
• Diagnostic accuracy
• Hepatitis C virus core antigen
• Treatment monitoring

• Antiviral Agents/therapeutic use
• Biomarkers/blood
• Drug Monitoring/methods
• Hepacivirus/drug effects
• Hepacivirus/genetics
• Hepacivirus/immunology
• Hepatitis C/blood
• Hepatitis C/diagnosis
• Hepatitis C/drug therapy
• Hepatitis C Antibodies/blood
• Hepatitis C Antigens/blood
• Humans
• Predictive Value of Tests
• RNA, Viral/blood
• Treatment Outcome
• Viral Core Proteins/blood