51
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Valerio H, Alavi M, Law M, Tillakeratne S, Amin J, Janjua NZ, Krajden M, George J, Matthews GV, Hajarizadeh B, Degenhardt L, Grebely J, Dore GJ. High hepatitis C treatment uptake among people with recent drug dependence in New South Wales, Australia. J Hepatol 2021; 74:293-302. [PMID: 32931879 DOI: 10.1016/j.jhep.2020.08.038] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/11/2020] [Accepted: 08/31/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS High HCV treatment uptake among people at most risk of transmission is essential to achieve elimination. We aimed to characterise subpopulations of people with HCV based on drug dependence, to estimate direct-acting antiviral (DAA) uptake in an unrestricted treatment era, and to evaluate factors associated with treatment uptake among people with recent drug dependence. METHODS HCV notifications in New South Wales, Australia (1995-2017) were linked to opioid agonist therapy (OAT), hospitalisations, incarcerations, HIV notifications, deaths, and prescription databases. Drug dependence was defined as hospitalisation due to injectable drugs or receipt of OAT, with indicators in 2016-2018 considered recent. Records were weighted to account for spontaneous clearance. Logistic regression was used to analyse factors associated with treatment uptake among those with recent drug dependence. RESULTS 57,467 people were estimated to have chronic HCV throughout the DAA era. Treatment uptake was highest among those with recent (47%), compared to those with distant (38%), and no (33%) drug dependence. Among those with recent drug dependence, treatment was more likely among those with HIV (adjusted odds ratio [aOR] 1.71; 95% CI 1.24-2.36), recent incarceration (aOR 1.10; 95% CI 1.01-1.19), and history of alcohol use disorder (aOR 1.22; 95% CI 1.13-1.31). Treatment was less likely among women (aOR 0.78; 95% CI 0.72-0.84), patients of Indigenous ethnicity (aOR 0.75; 95% CI 0.69-0.81), foreign-born individuals (aOR 0.86; 95% CI 0.78-0.96), those with outer-metropolitan notifications (aOR 0.90; 95% CI 0.82-0.98), HBV coinfection (aOR 0.69; 95% CI 0.59-0.80), and >1 recent hospitalisation (aOR: 0.91; 95% CI 0.84-0.98). CONCLUSIONS These data provide evidence of high DAA uptake among people with recent drug dependence, including those who are incarcerated. Enhancing this encouraging initial uptake among high-risk populations will be essential to achieve HCV elimination. LAY SUMMARY To facilitate HCV elimination, those at highest risk of infection and transmission are a treatment priority. This study shows the successes of Australia's universal provision of DAA therapy in reducing the barriers to treatment which have historically persisted among people who inject drugs. Despite higher DAA therapy uptake among those with recent drug dependence, gaps remain. Strategies which aim to reduce marginalisation and increase treatment uptake to ensure equitable HCV elimination must be advanced.
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Affiliation(s)
| | - Maryam Alavi
- The Kirby Institute, UNSW Sydney, Sydney, Australia
| | - Matthew Law
- The Kirby Institute, UNSW Sydney, Sydney, Australia
| | | | - Janaki Amin
- The Kirby Institute, UNSW Sydney, Sydney, Australia; Department of Health Systems and Populations, Maquarie University, Sydney, Australia
| | - Naveed Z Janjua
- British Columbia Centre for Disease Control, Vancouver, Canada; School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Mel Krajden
- British Columbia Centre for Disease Control, Vancouver, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - Jacob George
- Storr Liver Centre, Westmead Millennium Institute, University of Sydney and Westmead Hospital, Westmead, Australia
| | | | | | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
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Bartlett SR, Buxton J, Palayew A, Picchio CA, Janjua NZ, Kronfli N. Hepatitis C Virus Prevalence, Screening, and Treatment Among People Who Are Incarcerated in Canada: Leaving No One Behind in the Direct-Acting Antiviral Era. Clin Liver Dis (Hoboken) 2021; 17:75-80. [PMID: 33680440 PMCID: PMC7916434 DOI: 10.1002/cld.1023] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/21/2020] [Accepted: 08/02/2020] [Indexed: 02/04/2023] Open
Affiliation(s)
- Sofia R. Bartlett
- Department of Pathology and Laboratory MedicineFaculty of MedicineUniversity of British ColumbiaVancouverBCCanada
- The Kirby InstituteUniversity of New South WalesSydneyAustralia
- British Columbia Centre for Disease ControlProvincial Health Services AuthorityVancouverBCCanada
| | - Jane Buxton
- British Columbia Centre for Disease ControlProvincial Health Services AuthorityVancouverBCCanada
- School of Population and Public HealthFaculty of MedicineUniversity of British ColumbiaVancouverBCCanada
| | - Adam Palayew
- Department of Epidemiology, Biostatistics, and Occupational HealthMcGill UniversityMontrealQCCanada
| | - Camila A. Picchio
- Barcelona Institute for Global Health (ISGlobal)Hospital ClínicUniversity of BarcelonaBarcelonaSpain
| | - Naveed Z. Janjua
- British Columbia Centre for Disease ControlProvincial Health Services AuthorityVancouverBCCanada
- School of Population and Public HealthFaculty of MedicineUniversity of British ColumbiaVancouverBCCanada
| | - Nadine Kronfli
- Department of MedicineDivision of Infectious Diseases and Chronic Viral Illness ServiceMcGill UniversityMontrealQCCanada
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53
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Pearce ME, Yu A, Alvarez M, Bartlett SR, Binka M, Jeong D, Clementi E, Adu P, Wilton J, Yoshida EM, Pick N, Buxton JA, Wong J, Jassem A, Krajden M, Janjua NZ. Prenatal hepatitis C screening, diagnoses, and follow-up testing in British Columbia, 2008-2019. PLoS One 2020; 15:e0244575. [PMID: 33382774 PMCID: PMC7775094 DOI: 10.1371/journal.pone.0244575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 12/11/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Current guidelines in British Columbia recommend prenatal screening for hepatitis C antibodies (anti-HCV) if risk factors are present. We aimed to estimate frequency of prenatal anti-HCV testing, new diagnoses, repeated and follow-up testing among BC women. METHODS BC Centre for Disease Control Public Health Laboratory data estimated the number of BC women (assigned female at birth or unknown sex) aged 13-49 who received routine prenatal serological screening (HIV, hepatitis B, syphilis and rubella) from 2008-2019. Anti-HCV tests ordered the same day as routine prenatal screens were considered prenatal anti-HCV tests. Assessment of follow-up was based on HCV RNA and/or genotype testing within one year of new prenatal anti-HCV diagnoses. RESULTS In 2019, 55,202 routine prenatal screens were carried out for 50,392 BC women. Prenatal anti-HCV tests increased significantly, from 19.6% (9,704/49,515) in 2008 to 54.6% (27,516/50,392) in 2019 (p<0.001). New prenatal anti-HCV diagnoses (HCV positive diagnoses at first test or seroconversions) declined from 14.3% in 2008 to 10.1% in 2019. The proportion of women with new prenatal anti-HCV diagnoses that were a result of a first HCV test declined from 0.3% (29/9,701) in 2008 to 0.03% (8/27,500) in 2019. For women known to be anti-HCV positive at the time of prenatal screening, the proportion who had a prenatal anti-HCV test increased from 35.6% in 2008 to 50.8% in 2019. CONCLUSION Prenatal anti-HCV testing increased substantially over the study period. However, new HCV diagnoses remained relatively stable, suggesting that a considerable proportion of BC women with low or no risk are being screened as part of prenatal care. The vast majority of women with new HCV diagnoses receive appropriate follow-up HCV RNA and genotype testing, which may indicate interest in HCV treatment. These findings contribute to the discussion around potential for prenatal anti-HCV screening in an effort to eliminate HCV.
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Affiliation(s)
- Margo E. Pearce
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- * E-mail:
| | - Amanda Yu
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Maria Alvarez
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Sofia R. Bartlett
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mawuena Binka
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Dahn Jeong
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Emilia Clementi
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Prince Adu
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - James Wilton
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Eric M. Yoshida
- Department of Medicine, Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada
- Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Neora Pick
- Department of Medicine, Division of Infectious Diseases, University of British Columbia Vancouver, British Columbia, Canada
- British Columbia Women’s Hospital, Vancouver, British Columbia, Canada
| | - Jane A. Buxton
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jason Wong
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Agatha Jassem
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mel Krajden
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Naveed Z. Janjua
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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54
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Anderson SC, Edwards AM, Yerlanov M, Mulberry N, Stockdale JE, Iyaniwura SA, Falcao RC, Otterstatter MC, Irvine MA, Janjua NZ, Coombs D, Colijn C. Quantifying the impact of COVID-19 control measures using a Bayesian model of physical distancing. PLoS Comput Biol 2020; 16:e1008274. [PMID: 33270633 PMCID: PMC7738161 DOI: 10.1371/journal.pcbi.1008274] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 12/15/2020] [Accepted: 08/19/2020] [Indexed: 12/22/2022] Open
Abstract
Extensive non-pharmaceutical and physical distancing measures are currently the primary interventions against coronavirus disease 2019 (COVID-19) worldwide. It is therefore urgent to estimate the impact such measures are having. We introduce a Bayesian epidemiological model in which a proportion of individuals are willing and able to participate in distancing, with the timing of distancing measures informed by survey data on attitudes to distancing and COVID-19. We fit our model to reported COVID-19 cases in British Columbia (BC), Canada, and five other jurisdictions, using an observation model that accounts for both underestimation and the delay between symptom onset and reporting. We estimated the impact that physical distancing (social distancing) has had on the contact rate and examined the projected impact of relaxing distancing measures. We found that, as of April 11 2020, distancing had a strong impact in BC, consistent with declines in reported cases and in hospitalization and intensive care unit numbers; individuals practising physical distancing experienced approximately 0.22 (0.11-0.34 90% CI [credible interval]) of their normal contact rate. The threshold above which prevalence was expected to grow was 0.55. We define the "contact ratio" to be the ratio of the estimated contact rate to the threshold rate at which cases are expected to grow; we estimated this contact ratio to be 0.40 (0.19-0.60) in BC. We developed an R package 'covidseir' to make our model available, and used it to quantify the impact of distancing in five additional jurisdictions. As of May 7, 2020, we estimated that New Zealand was well below its threshold value (contact ratio of 0.22 [0.11-0.34]), New York (0.60 [0.43-0.74]), Washington (0.84 [0.79-0.90]) and Florida (0.86 [0.76-0.96]) were progressively closer to theirs yet still below, but California (1.15 [1.07-1.23]) was above its threshold overall, with cases still rising. Accordingly, we found that BC, New Zealand, and New York may have had more room to relax distancing measures than the other jurisdictions, though this would need to be done cautiously and with total case volumes in mind. Our projections indicate that intermittent distancing measures-if sufficiently strong and robustly followed-could control COVID-19 transmission. This approach provides a useful tool for jurisdictions to monitor and assess current levels of distancing relative to their threshold, which will continue to be essential through subsequent waves of this pandemic.
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Affiliation(s)
- Sean C. Anderson
- Pacific Biological Station, Fisheries and Oceans Canada, Nanaimo, Canada
| | - Andrew M. Edwards
- Pacific Biological Station, Fisheries and Oceans Canada, Nanaimo, Canada
- Department of Biology, University of Victoria, Victoria, Canada
| | - Madi Yerlanov
- Department of Mathematics, Simon Fraser University, Burnaby, Canada
| | - Nicola Mulberry
- Department of Mathematics, Simon Fraser University, Burnaby, Canada
| | | | - Sarafa A. Iyaniwura
- Department of Mathematics and Institute of Applied Mathematics, University of British Columbia, Vancouver, Canada
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Rebeca C. Falcao
- Department of Mathematics and Institute of Applied Mathematics, University of British Columbia, Vancouver, Canada
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Michael C. Otterstatter
- British Columbia Centre for Disease Control, Vancouver, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Michael A. Irvine
- British Columbia Children’s Hospital Research Institute, Vancouver, Canada
| | - Naveed Z. Janjua
- British Columbia Centre for Disease Control, Vancouver, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Daniel Coombs
- Department of Mathematics and Institute of Applied Mathematics, University of British Columbia, Vancouver, Canada
| | - Caroline Colijn
- Department of Mathematics, Simon Fraser University, Burnaby, Canada
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55
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Hamadeh A, Haines A, Feng Z, Thein HH, Janjua NZ, Krahn M, Wong WWL. Estimating chronic hepatitis C prevalence in British Columbia and Ontario, Canada, using population-based cohort studies. J Viral Hepat 2020; 27:1419-1429. [PMID: 32810886 DOI: 10.1111/jvh.13373] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 03/23/2020] [Accepted: 07/30/2020] [Indexed: 12/19/2022]
Abstract
Patients identified as having chronic hepatitis C (CHC) infection can be effectively and rapidly treated using direct-acting antiviral agents. However, there remains a substantial burden of subclinical undetected infection. This study estimates the prevalence and undiagnosed proportion of CHC in British Columbia (BC) and Ontario, Canada, using a model-based approach, informed by provincial population-level health administrative data. A two-step approach was used: Step 1) Two population-based retrospective analyses of administrative health data for a cohort of British Columbians and a cohort of Ontarians with CHC were conducted to generate population-level statistics of CHC-related health events; Step 2) using a validated natural history model of hepatitis C virus (HCV) infection, the historical prevalence of CHC was back-calculated from the data collected in Step 1. Our retrospective study found that, in BC and Ontario, the number of newly diagnosed CHC cases is declining yearly while the complications of the disease are increasing yearly. BC had a 2014 CHC prevalence of 1.04% (95% CI: 0.84%-1.44%), with 33.3% (95% CI: 25.5%-42.0%) of CHC cases undiagnosed. Ontario had a 2014 CHC prevalence of 0.91% (95% CI: 0.83%-1.02%) with 36.0% (95% CI: 31.2%-38.9%) of CHC cases undiagnosed. Our study offers robust estimates based on the integration of a validated natural history model with population-level health administrative data on HCV-related events, which can provide vital evidence for policymakers to develop appropriate policies to achieve elimination targets. Our approach can also be applied to produce robust region-specific estimates in other countries.
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Affiliation(s)
- Abdullah Hamadeh
- School of Pharmacy, University of Waterloo, Kitchener, ON, Canada
| | - Alex Haines
- Toronto Health Economics and Technology Assessment Collaborative (THETA), University Health Network, Toronto, ON, Canada
| | - Zeny Feng
- Department of Mathematics and Statistics, University of Guelph, Guelph, ON, Canada
| | - Hla-Hla Thein
- Toronto Health Economics and Technology Assessment Collaborative (THETA), University Health Network, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,ICES, Toronto, ON, Canada
| | - Naveed Z Janjua
- BC Centre for Disuse Control, University of British Columbia, Vancouver, BC, Canada
| | - Murray Krahn
- Toronto Health Economics and Technology Assessment Collaborative (THETA), University Health Network, Toronto, ON, Canada.,ICES, Toronto, ON, Canada
| | - William W L Wong
- School of Pharmacy, University of Waterloo, Kitchener, ON, Canada.,Toronto Health Economics and Technology Assessment Collaborative (THETA), University Health Network, Toronto, ON, Canada.,ICES, Toronto, ON, Canada
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56
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Anderson SC, Edwards AM, Yerlanov M, Mulberry N, Stockdale JE, Iyaniwura SA, Falcao RC, Otterstatter MC, Irvine MA, Janjua NZ, Coombs D, Colijn C. Quantifying the impact of COVID-19 control measures using a Bayesian model of physical distancing. PLoS Comput Biol 2020; 16:e1008274. [PMID: 33270633 DOI: 10.1101/2020.04.17.20070086] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 12/15/2020] [Accepted: 08/19/2020] [Indexed: 05/23/2023] Open
Abstract
Extensive non-pharmaceutical and physical distancing measures are currently the primary interventions against coronavirus disease 2019 (COVID-19) worldwide. It is therefore urgent to estimate the impact such measures are having. We introduce a Bayesian epidemiological model in which a proportion of individuals are willing and able to participate in distancing, with the timing of distancing measures informed by survey data on attitudes to distancing and COVID-19. We fit our model to reported COVID-19 cases in British Columbia (BC), Canada, and five other jurisdictions, using an observation model that accounts for both underestimation and the delay between symptom onset and reporting. We estimated the impact that physical distancing (social distancing) has had on the contact rate and examined the projected impact of relaxing distancing measures. We found that, as of April 11 2020, distancing had a strong impact in BC, consistent with declines in reported cases and in hospitalization and intensive care unit numbers; individuals practising physical distancing experienced approximately 0.22 (0.11-0.34 90% CI [credible interval]) of their normal contact rate. The threshold above which prevalence was expected to grow was 0.55. We define the "contact ratio" to be the ratio of the estimated contact rate to the threshold rate at which cases are expected to grow; we estimated this contact ratio to be 0.40 (0.19-0.60) in BC. We developed an R package 'covidseir' to make our model available, and used it to quantify the impact of distancing in five additional jurisdictions. As of May 7, 2020, we estimated that New Zealand was well below its threshold value (contact ratio of 0.22 [0.11-0.34]), New York (0.60 [0.43-0.74]), Washington (0.84 [0.79-0.90]) and Florida (0.86 [0.76-0.96]) were progressively closer to theirs yet still below, but California (1.15 [1.07-1.23]) was above its threshold overall, with cases still rising. Accordingly, we found that BC, New Zealand, and New York may have had more room to relax distancing measures than the other jurisdictions, though this would need to be done cautiously and with total case volumes in mind. Our projections indicate that intermittent distancing measures-if sufficiently strong and robustly followed-could control COVID-19 transmission. This approach provides a useful tool for jurisdictions to monitor and assess current levels of distancing relative to their threshold, which will continue to be essential through subsequent waves of this pandemic.
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Affiliation(s)
- Sean C Anderson
- Pacific Biological Station, Fisheries and Oceans Canada, Nanaimo, Canada
| | - Andrew M Edwards
- Pacific Biological Station, Fisheries and Oceans Canada, Nanaimo, Canada
- Department of Biology, University of Victoria, Victoria, Canada
| | - Madi Yerlanov
- Department of Mathematics, Simon Fraser University, Burnaby, Canada
| | - Nicola Mulberry
- Department of Mathematics, Simon Fraser University, Burnaby, Canada
| | | | - Sarafa A Iyaniwura
- Department of Mathematics and Institute of Applied Mathematics, University of British Columbia, Vancouver, Canada
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Rebeca C Falcao
- Department of Mathematics and Institute of Applied Mathematics, University of British Columbia, Vancouver, Canada
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Michael C Otterstatter
- British Columbia Centre for Disease Control, Vancouver, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Michael A Irvine
- British Columbia Children's Hospital Research Institute, Vancouver, Canada
| | - Naveed Z Janjua
- British Columbia Centre for Disease Control, Vancouver, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Daniel Coombs
- Department of Mathematics and Institute of Applied Mathematics, University of British Columbia, Vancouver, Canada
| | - Caroline Colijn
- Department of Mathematics, Simon Fraser University, Burnaby, Canada
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57
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Samji H, Yu A, Wong S, Wilton J, Binka M, Alvarez M, Bartlett S, Pearce M, Adu P, Jeong D, Clementi E, Butt Z, Buxton J, Gilbert M, Krajden M, Janjua NZ. Drug-related deaths in a population-level cohort of people living with and without hepatitis C virus in British Columbia, Canada. Int J Drug Policy 2020; 86:102989. [PMID: 33091735 PMCID: PMC7569420 DOI: 10.1016/j.drugpo.2020.102989] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 09/30/2020] [Accepted: 10/08/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND The majority of new HCV infections in Canada occur in people who inject drugs. Thus, while curative direct antiviral agents (DAAs) herald a promising new era in hepatitis C virus (HCV) treatment, improving the lives and wellbeing of people living with HCV (PLHCV) must be considered in the context of reducing overdose-related harms and with a syndemic lens. We measure drug-related deaths (DRDs) among HCV-negative people and PLHCV in British Columbia (BC), Canada, and the impact of potent contaminants like fentanyl on deaths. METHODS We identified DRDs among PLHCV and HCV-negative individuals from 2010 to 2018 in the BC Hepatitis Testers Cohort, a population-based dataset of ~1.7 million British Columbians comprising comprehensive administrative and clinical data. We estimated annual standardized liver- and drug-related mortality rates per 100,000 person-years (PY) and described the contribution of specific drugs, including fentanyl and its analogues, implicated in DRDs over time. RESULTS DRDs constituted 20.1% of deaths among PLHCV and 4.7% of deaths among HCV-negative individuals; a 4.3-fold (95% confidence interval: 4.0-4.5) difference. Drug-related mortality overtook liver-related mortality for PLHCV in 2015 and HCV-negative individuals in 2016 and rose from 241.7 to 436.5 per 100,000 PY from 2010 to 2018 amongPLHCV and from 20.0 to 57.1 per 100,000 PY for HCV-negative individuals over the same period. The proportion of deaths attributable to drugs among PLHCV and HCV-negative individuals increased from 15.1% to 26.1% and 3.1% to 8.0%, in 2010 and 2018, respectively. The proportion of DRDs attributed solely to synthetic opioids such as fentanyl averaged across both groups increased from 2.1% in 2010 to 69.6% in 2017. CONCLUSION Steep drug-related mortality increases among PLHCV and HCV-negative individuals over the last decade highlight the urgent need to address overdose-related drivers and harms in these populations using an integrated care approach.
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Affiliation(s)
- Hasina Samji
- Faculty of Health Sciences, Simon Fraser University, 8888 University Dr, Burnaby, British Columbia, Canada, V5A 1S6; British Columbia Centre for Disease Control, 655 West 12(th) Avenue, Vancouver, British Columbia, Canada, V5Z 4R4.
| | - Amanda Yu
- British Columbia Centre for Disease Control, 655 West 12(th) Avenue, Vancouver, British Columbia, Canada, V5Z 4R4
| | - Stanley Wong
- British Columbia Centre for Disease Control, 655 West 12(th) Avenue, Vancouver, British Columbia, Canada, V5Z 4R4
| | - James Wilton
- British Columbia Centre for Disease Control, 655 West 12(th) Avenue, Vancouver, British Columbia, Canada, V5Z 4R4
| | - Mawuena Binka
- British Columbia Centre for Disease Control, 655 West 12(th) Avenue, Vancouver, British Columbia, Canada, V5Z 4R4
| | - Maria Alvarez
- British Columbia Centre for Disease Control, 655 West 12(th) Avenue, Vancouver, British Columbia, Canada, V5Z 4R4
| | - Sofia Bartlett
- British Columbia Centre for Disease Control, 655 West 12(th) Avenue, Vancouver, British Columbia, Canada, V5Z 4R4; Department of Pathology and Laboratory Medicine, University of British Columbia, 2211 Wesbrook Mall, Vancouver, British Columbia, Canada, BC V6T 2B5
| | - Margo Pearce
- British Columbia Centre for Disease Control, 655 West 12(th) Avenue, Vancouver, British Columbia, Canada, V5Z 4R4; School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, British Columbia, Canada, V6T 1Z3
| | - Prince Adu
- British Columbia Centre for Disease Control, 655 West 12(th) Avenue, Vancouver, British Columbia, Canada, V5Z 4R4; School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, British Columbia, Canada, V6T 1Z3
| | - Dahn Jeong
- British Columbia Centre for Disease Control, 655 West 12(th) Avenue, Vancouver, British Columbia, Canada, V5Z 4R4; School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, British Columbia, Canada, V6T 1Z3
| | - Emilia Clementi
- British Columbia Centre for Disease Control, 655 West 12(th) Avenue, Vancouver, British Columbia, Canada, V5Z 4R4; School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, British Columbia, Canada, V6T 1Z3
| | - Zahid Butt
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, Canada, N2L 3G1
| | - Jane Buxton
- British Columbia Centre for Disease Control, 655 West 12(th) Avenue, Vancouver, British Columbia, Canada, V5Z 4R4; School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, British Columbia, Canada, V6T 1Z3
| | - Mark Gilbert
- British Columbia Centre for Disease Control, 655 West 12(th) Avenue, Vancouver, British Columbia, Canada, V5Z 4R4; School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, British Columbia, Canada, V6T 1Z3
| | - Mel Krajden
- British Columbia Centre for Disease Control, 655 West 12(th) Avenue, Vancouver, British Columbia, Canada, V5Z 4R4; Department of Pathology and Laboratory Medicine, University of British Columbia, 2211 Wesbrook Mall, Vancouver, British Columbia, Canada, BC V6T 2B5
| | - Naveed Z Janjua
- British Columbia Centre for Disease Control, 655 West 12(th) Avenue, Vancouver, British Columbia, Canada, V5Z 4R4; School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, British Columbia, Canada, V6T 1Z3
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58
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Min JE, Pearce LA, Janjua NZ, Ti L, Nosyk B. The Causal Effect of Opioid Agonist Treatment on Adherence to Direct-Acting Antiviral Treatment for Hepatitis C Virus. Open Forum Infect Dis 2020. [DOI: 10.1093/ofid/ofaa418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Opioid agonist treatment (OAT) supports adherence in medication regimens for other concurrent conditions. However, sparse evidence is available on its effect on promoting retention to direct-acting antivirals (DAAs) for people with opioid use disorder (PWOUD) with concurrent hepatitis C virus (HCV). Our objective was to determine the causal impact of OAT exposure on DAA adherence among HCV-positive PWOUD.
Methods
We executed a retrospective study using linked population-level data for British Columbia, Canada (January 1996–September 2018). We estimated the effect of OAT on DAA adherence using generalized estimating equations (GEEs) and marginal structural modeling (MSM) for time-varying confounding. The primary outcome was 85% DAA adherence (minimum 6 of 7 days).
Results
We included 2820 HCV-positive PWOUD who initiated a DAA regimen (32.6% female, 83.9% previously accessing OAT), with 2410 (95% among uncensored episodes) completing the regimen. The GEE-adjusted odds ratio of DAA adherence after OAT exposure was 1.05 (0.89–1.23), whereas the MSM-adjusted odds ratio was 0.97 (0.78–1.22).
Conclusions
In a setting with universal healthcare and widespread access to OAT and DAA treatment, DAA regimen completion rates were high regardless of OAT, and engagement in OAT did not increase DAA adherence. Nonengagement in OAT should not preclude DAA treatment for PWOUD.
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Affiliation(s)
- Jeong E Min
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Lindsay A Pearce
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- University of Melbourne, School of Population and Global Health, Victoria, Melbourne, Australia
| | - Naveed Z Janjua
- British Columbia Centre for Disease Control, Vancouver, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Lianping Ti
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - Bohdan Nosyk
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
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59
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Khinda J, Janjua NZ, Cheng S, van den Heuvel ER, Bhatti P, Darvishian M. Association between markers of immune response at hospital admission and COVID-19 disease severity and mortality: A meta-analysis and meta-regression. J Med Virol 2020; 93:1078-1098. [PMID: 32776551 PMCID: PMC7436507 DOI: 10.1002/jmv.26411] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/23/2020] [Accepted: 08/01/2020] [Indexed: 01/08/2023]
Abstract
Background To determine the utility of admission laboratory markers in the assessment and prognostication of coronavirus disease‐2019 (COVID‐19), a systematic review and meta‐analysis were conducted on the association between admission laboratory values in hospitalized COVID‐19 patients and subsequent disease severity and mortality. Material and Methods Searches were conducted in MEDLINE, Pubmed, Embase, and the WHO Global Research Database from December 1,2019 to May 1, 2020 for relevant articles. A random effects meta‐analysis was used to calculate the weighted mean difference (WMD) and 95% confidence interval (95% CI) for each of 27 laboratory markers. The impact of age and sex on WMDs was estimated using meta‐regression techniques for 11 markers. Results In total, 64 studies met the inclusion criteria. The most marked WMDs were for neutrophils (ANC) at 3.82 × 109/L (2.76, 4.87), lymphocytes (ALC) at −0.34 × 109/L (−0.45, −0.23), interleukin‐6 (IL‐6) at 32.59 pg/mL (23.99, 41.19), ferritin at 814.14 ng/mL (551.48, 1076.81), C‐reactive protein (CRP) at 66.11 mg/L (52.16, 80.06), D‐dimer at 5.74 mg/L (3.91, 7.58), LDH at 232.41 U/L (178.31, 286.52), and high sensitivity troponin I at 90.47 pg/mL (47.79, 133.14) when comparing fatal to nonfatal cases. Similar trends were observed comparing severe to non‐severe groups. There were no statistically significant associations between age or sex and WMD for any of the markers included in the meta‐regression. Conclusion The results highlight that hyper inflammation, blunted adaptive immune response, and intravascular coagulation play key roles in the pathogenesis of COVID‐19. Markers of these processes are good candidates to identify patients for early intervention and, importantly, are likely reliable regardless of age or sex in adult patients.
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Affiliation(s)
| | - Naveed Z. Janjua
- University of British ColumbiaVancouverCanada
- BC Centre for Disease ControlVancouverCanada
- Centre for Health Evaluation and Outcome Sciences (CHÉOS)VancouverCanada
| | | | - Edwin R. van den Heuvel
- Department of Mathematics and Computer ScienceEindhoven University of TechnologyEindhovenNetherlands
- Department of Preventive Medicine and Epidemiology, School of MedicineBoston UniversityBostonMassachusetts
| | - Parveen Bhatti
- Cancer Control ResearchBC Cancer Research CentreVancouverCanada
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60
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Clementi E, Bartlett S, Otterstatter M, Buxton JA, Wong S, Yu A, Butt ZA, Wilton J, Pearce M, Jeong D, Binka M, Adu P, Alvarez M, Samji H, Abdia Y, Wong J, Krajden M, Janjua NZ. Syndemic profiles of people living with hepatitis C virus using population-level latent class analysis to optimize health services. Int J Infect Dis 2020; 100:27-33. [PMID: 32810594 DOI: 10.1016/j.ijid.2020.08.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/09/2020] [Accepted: 08/11/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Hepatitis C (HCV) affects diverse populations such as people who inject drugs (PWID), 'baby boomers,' gay/bisexual men who have sex with men (gbMSM), and people from HCV endemic regions. Assessing HCV syndemics (i.e.relationships with mental health/chronic diseases) among subpopulations using Latent Class Analysis (LCA) may facilitate targeted program planning. METHODS The BC Hepatitis Testers Cohort(BC-HTC) includes all HCV cases identified in BC between 1990 and 2015, integrated with medical administrative data. LCA grouped all BC-HTC HCV diagnosed people(n = 73,665) by socio-demographic/clinical indicators previously determined to be relevant for HCV outcomes. The final model was chosen based on fit statistics, epidemiological meaningfulness, and posterior probability. Classes were named by most defining characteristics. RESULTS The six-class model was the best fit and had the following names and characteristics: 'Younger PWID'(n =11,563): recent IDU (67%), people born >1974 (48%), mental illness (62%), material deprivation (59%). 'Older PWID'(n =15,266): past IDU (78%), HIV (17%), HBV (17%) coinfections, alcohol misuse(68%). 'Other Middle-Aged People'(n = 9019): gbMSM (26%), material privilege (31%), people born between 1965-1974 (47%). 'People of Asian backgrounds' (n = 4718): East/South Asians (92%), no alcohol misuse (97%) or mental illness (93%), people born <1945 (26%), social privilege (66%). 'Rural baby boomers' (n = 20,401): rural dwellers (32%), baby boomers (79%), heterosexuals (99%), no HIV (100%). 'Urban socially deprived baby boomers' (n = 12,698): urban dwellers (99%), no IDU (100%), liver disease (22%), social deprivation (94%). CONCLUSIONS Differences between classes suggest variability in patients' service needs. Further analysis of health service utilization patterns may inform optimal service layout.
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Affiliation(s)
- Emilia Clementi
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; BC Centre for Disease Control, Vancouver, BC, Canada
| | - Sofia Bartlett
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; BC Centre for Disease Control, Vancouver, BC, Canada; University of New South Wales, Sydney, New South Wales, Australia
| | - Michael Otterstatter
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; BC Centre for Disease Control, Vancouver, BC, Canada
| | - Jane A Buxton
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; BC Centre for Disease Control, Vancouver, BC, Canada
| | - Stanley Wong
- BC Centre for Disease Control, Vancouver, BC, Canada
| | - Amanda Yu
- BC Centre for Disease Control, Vancouver, BC, Canada
| | - Zahid A Butt
- BC Centre for Disease Control, Vancouver, BC, Canada; University of Waterloo Faculty of Applied Health Sciences, Waterloo, ON, Canada
| | - James Wilton
- BC Centre for Disease Control, Vancouver, BC, Canada
| | - Margo Pearce
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; BC Centre for Disease Control, Vancouver, BC, Canada
| | - Dahn Jeong
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; BC Centre for Disease Control, Vancouver, BC, Canada
| | - Mawuena Binka
- BC Centre for Disease Control, Vancouver, BC, Canada
| | - Prince Adu
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; BC Centre for Disease Control, Vancouver, BC, Canada
| | - Maria Alvarez
- BC Centre for Disease Control, Vancouver, BC, Canada
| | - Hasina Samji
- BC Centre for Disease Control, Vancouver, BC, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Younathan Abdia
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; BC Centre for Disease Control, Vancouver, BC, Canada
| | - Jason Wong
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; BC Centre for Disease Control, Vancouver, BC, Canada
| | - Mel Krajden
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Naveed Z Janjua
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; BC Centre for Disease Control, Vancouver, BC, Canada; Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada.
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61
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Butt ZA, Wong S, Rossi C, Binka M, Wong J, Yu A, Darvishian M, Alvarez M, Chapinal N, Mckee G, Gilbert M, Tyndall MW, Krajden M, Janjua NZ. Concurrent Hepatitis C and B Virus and Human Immunodeficiency Virus Infections Are Associated With Higher Mortality Risk Illustrating the Impact of Syndemics on Health Outcomes. Open Forum Infect Dis 2020; 7:ofaa347. [PMID: 32964065 PMCID: PMC7489531 DOI: 10.1093/ofid/ofaa347] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 08/10/2020] [Indexed: 02/06/2023] Open
Abstract
Background Hepatitis C virus (HCV), hepatitis B virus (HBV), and human immunodeficiency virus (HIV) infections are associated with significant mortality globally and in North America. However, data on impact of concurrent multiple infections on mortality risk are limited. We evaluated the effect of HCV, HBV, and HIV infections and coinfections and associated factors on all-cause mortality in British Columbia (BC), Canada. Methods The BC Hepatitis Testers Cohort includes ~1.7 million individuals tested for HCV or HIV, or reported as a case of HCV, HIV, or HBV from 1990 to 2015, linked to administrative databases. We followed people with HCV, HBV, or HIV monoinfection, coinfections, and triple infections from their negative status to date of death or December 31, 2016. Extended Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for factors associated with all-cause mortality. Results Of 658 704 individuals tested for HCV, HBV, and HIV, there were 33 804 (5.13%) deaths. In multivariable Cox regression analysis, individuals with HCV/HBV/HIV (HR, 8.9; 95% CI, 8.2–9.7) infections had the highest risk of mortality followed by HCV/HIV (HR, 4.8; 95% CI, 4.4–5.1), HBV/HIV (HR, 4.1; 95% CI, 3.5–4.8), HCV/HBV (HR, 3.9; 95% CI, 3.7–4.2), HCV (HR, 2.6; 95% CI, 2.6–2.7), HBV (HR, 2.2; 95% CI, 2.0–2.3), and HIV (HR, 1.6; 95% CI, 1.5–1.7). Additional factors associated with mortality included injection drug use, problematic alcohol use, material deprivation, diabetes, chronic kidney disease, heart failure, and hypertension. Conclusions Concurrent multiple infections are associated with high mortality risk. Substance use, comorbidities, and material disadvantage were significantly associated with mortality independent of coinfection. Preventive interventions, including harm reduction combined with coinfection treatments, can significantly reduce mortality.
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Affiliation(s)
- Zahid A Butt
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada.,British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stanley Wong
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Carmine Rossi
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Mawuena Binka
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Jason Wong
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Amanda Yu
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | | | - Maria Alvarez
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | | | - Geoff Mckee
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Mark Gilbert
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mark W Tyndall
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mel Krajden
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.,BCCDC Public Health Laboratory, Vancouver, British Columbia, Canada
| | - Naveed Z Janjua
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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62
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Janjua NZ, Wong S, Darvishian M, Butt ZA, Yu A, Binka M, Alvarez M, Woods R, Yoshida EM, Ramji A, Feld J, Krajden M. The impact of SVR from direct-acting antiviral- and interferon-based treatments for HCV on hepatocellular carcinoma risk. J Viral Hepat 2020; 27:781-793. [PMID: 32187430 DOI: 10.1111/jvh.13295] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 02/02/2020] [Accepted: 02/17/2020] [Indexed: 12/12/2022]
Abstract
We evaluated the effect of sustained virologic response (SVR) from direct-acting antiviral (DAA)- and interferon-based treatments on hepatocellular carcinoma (HCC) risk in a large population-based cohort in Canada. We used data from the BC Hepatitis Testers Cohort, which includes ~1.3 million individuals tested for HCV since 1990, linked with healthcare administrative and registry datasets. Patients were followed from the end of HCV treatment to HCC, death or 31 December 2016. We assessed HCC risk among those who did and did not achieve SVR by treatment type using proportional hazard models. Of 12 776 eligible individuals, 3905 received DAAs while 8871 received interferon-based treatments, followed for a median of 1.0 [range: 0.6-2.7] and 7.9 [range: 4.4-17.1] years, respectively. A total of 3613 and 6575 achieved SVR with DAAs- and interferon-based treatments, respectively. Among DAAs-treated patients, HCC incidence rate was 6.9 (95%CI: 4.7-10.1)/1000 person yr (PY) in SVR group (HCC cases: 26) and 38.2 (95%CI: 20.6-71.0) in the no-SVR group (HCC cases: 10, P < .001). Among interferon-treated individuals, HCC incidence rate was 1.8 (95%CI: 1.5-2.2) in the SVR (HCC cases: 99) and 13.9 (95%CI: 12.3-15.8) in the no-SVR group (HCC cases: 239, P < .001). Compared with no-SVR from interferon, SVR from DAA- and interferon-based treatments resulted in significant reduction in HCC risk (adjusted subdistribution hazard ratio (adjSHR) DAA = 0.30, 95%CI: 0.19-0.48 and adjSHR interferon = 0.2, 95%CI: 0.16-0.26). Among those with SVR, treatment with DAAs compared to interferon was not associated with HCC risk (adjSHR = 0.93, 95%CI: 0.51-1.71). In conclusion, similar to interferon era, DAA-related SVR is associated with 70% reduction in HCC risk.
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Affiliation(s)
- Naveed Z Janjua
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Stanley Wong
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Maryam Darvishian
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.,BC Cancer, Vancouver, BC, Canada
| | - Zahid A Butt
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Amanda Yu
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Mawuena Binka
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Maria Alvarez
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | | | - Eric M Yoshida
- Division of Gastroenterology, University of British Columbia, Vancouver, BC, Canada
| | - Alnoor Ramji
- Division of Gastroenterology, University of British Columbia, Vancouver, BC, Canada
| | - Jordan Feld
- Toronto Centre for Liver Disease, Sandra Rotman Centre for Global Health, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - Mel Krajden
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
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63
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Binka M, Janjua NZ, Grebely J, Estes C, Schanzer D, Kwon JA, Shoukry NH, Kwong JC, Razavi H, Feld JJ, Krajden M. Assessment of Treatment Strategies to Achieve Hepatitis C Elimination in Canada Using a Validated Model. JAMA Netw Open 2020; 3:e204192. [PMID: 32374397 PMCID: PMC7203608 DOI: 10.1001/jamanetworkopen.2020.4192] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 03/04/2020] [Indexed: 12/19/2022] Open
Abstract
Importance Achievement of the World Health Organization (WHO) target of eliminating hepatitis C virus (HCV) by 2030 will require an increase in key services, including harm reduction, HCV screening, and HCV treatment initiatives in member countries. These data are not available for Canada but are important for informing a national HCV elimination strategy. Objective To use a decision analytical model to explore the association of different treatment strategies with HCV epidemiology and HCV-associated mortality in Canada and to assess the levels of service increase needed to meet the WHO elimination targets by 2030. Design, Setting, and Participants Study participants in this decision analytical model included individuals with hepatitis C virus infection in Canada. Five HCV treatment scenarios (optimistic, very aggressive, aggressive, gradual decrease, and rapid decrease) were applied using a previously validated Markov-type mathematical model. The optimistic and very aggressive treatment scenarios modeled a sustained annual treatment of 10 200 persons and 14 000 persons, respectively, from 2018 to 2030. The aggressive, gradual decrease, and rapid decrease scenarios assessed decreases in treatment uptake from 14 000 persons to 10 000 persons per year, 12 000 persons to 8500 persons per year, and 12 000 persons to 4500 persons per year, respectively, between 2018 and 2030. Main Outcomes and Measures Hepatitis C virus prevalence and HCV-associated health outcomes were assessed for each of the 5 treatment scenarios with the goal of identifying strategies to achieve HCV elimination by 2030. Results An estimated mean 180 142 persons (95% CI, 122 786-196 862 persons) in Canada had chronic HCV infection at the end of 2017. The optimistic and gradual decrease scenarios estimated a decrease in HCV prevalence from 180 142 persons to 37 246 persons and 37 721 persons, respectively, by 2030. Relative to 2015, this decrease in HCV prevalence was associated with 74%, 69%, and 69% reductions in the prevalence of decompensated cirrhosis, hepatocellular carcinoma, and liver-associated mortality, respectively, leading to HCV elimination by 2030. More aggressive treatment uptake (very aggressive scenario) could result in goal achievement up to 3 years earlier than 2030, although a rapid decrease in the initiation of treatment (rapid decrease scenario) would preclude Canada from reaching the HCV elimination goal by 2030. Conclusions and Relevance The study findings suggest that Canada could meet the WHO goals for HCV elimination by 2030 by sustaining the current national HCV treatment rate during the next decade. This target will not be achieved if treatment uptake is allowed to decrease rapidly.
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Affiliation(s)
- Mawuena Binka
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Naveed Z. Janjua
- British Columbia Centre for Disease Control, Vancouver, Canada
- Canadian Network on Hepatitis C, Montreal, Quebec, Canada
- University of British Columbia, Vancouver, Canada
| | - Jason Grebely
- Canadian Network on Hepatitis C, Montreal, Quebec, Canada
- Kirby Institute, University of New South Wales Sydney, Sydney, Australia
| | - Chris Estes
- Center for Disease Analysis, Lafayette, Colorado
| | - Dena Schanzer
- Canadian Network on Hepatitis C, Montreal, Quebec, Canada
| | - Jisoo A. Kwon
- Kirby Institute, University of New South Wales Sydney, Sydney, Australia
| | - Naglaa H. Shoukry
- Canadian Network on Hepatitis C, Montreal, Quebec, Canada
- Centre de Recherche du Centre Hospitalier de l’Universite de Montreal, Montreal, Quebec, Canada
| | - Jeffrey C. Kwong
- Canadian Network on Hepatitis C, Montreal, Quebec, Canada
- ICES, Toronto, Ontario, Canada
| | - Homie Razavi
- Center for Disease Analysis, Lafayette, Colorado
| | - Jordan J. Feld
- Canadian Network on Hepatitis C, Montreal, Quebec, Canada
- Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada
| | - Mel Krajden
- British Columbia Centre for Disease Control, Vancouver, Canada
- Canadian Network on Hepatitis C, Montreal, Quebec, Canada
- University of British Columbia, Vancouver, Canada
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64
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Hajarizadeh B, Cunningham EB, Valerio H, Martinello M, Law M, Janjua NZ, Midgard H, Dalgard O, Dillon J, Hickman M, Bruneau J, Dore GJ, Grebely J. Hepatitis C reinfection after successful antiviral treatment among people who inject drugs: A meta-analysis. J Hepatol 2020; 72:643-657. [PMID: 31785345 DOI: 10.1016/j.jhep.2019.11.012] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 10/30/2019] [Accepted: 11/05/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS HCV reinfection following successful treatment can compromise treatment outcomes. This systematic review assessed the rate of HCV reinfection following treatment among people with recent drug use and those receiving opioid agonist therapy (OAT). METHODS We searched bibliographic databases and conference abstracts for studies assessing post-treatment HCV reinfection rates among people with recent drug use (injecting or non-injecting) or those receiving OAT. Meta-analysis was used to cumulate reinfection rates and meta-regression was used to explore heterogeneity across studies. RESULTS Thirty-six studies were included (6,311 person-years of follow-up). The overall rate of HCV reinfection was 5.9/100 person-years (95% CI 4.1-8.5) among people with recent drug use (injecting or non-injecting), 6.2/100 person-years (95% CI 4.3-9.0) among people recently injecting drugs, and 3.8/100 person-years (95% CI 2.5-5.8) among those receiving OAT. Reinfection rates were comparable following interferon-based (5.4/100 person-years; 95% CI 3.1-9.5) and direct-acting antiviral (3.9/100 person-years; 95% CI 2.5-5.9) therapy. In stratified analysis, reinfection rates were 1.4/100 person-years (95% CI 0.8-2.6) among people receiving OAT with no recent drug use, 5.9/100 person-years (95% CI 4.0-8.6) among people receiving OAT with recent drug use, and 6.6/100 person-years (95% CI 3.4-12.7) among people with recent drug use not receiving OAT. In meta-regression analysis, longer follow-up was associated with lower reinfection rate (adjusted rate ratio [aRR] per year increase in mean/median follow-up 0.77; 95% CI 0.69-0.86). Compared with people receiving OAT with no recent drug use, those with recent drug use receiving OAT (aRR 3.50; 95% CI 1.62-7.53), and those with recent drug use not receiving OAT (aRR 3.96; 95% CI 1.82-8.59) had higher reinfection rates. CONCLUSION HCV reinfection risk following treatment was higher among people with recent drug use and lower among those receiving OAT. The lower rates of reinfection observed in studies with longer follow-up suggested higher reinfection risk early post-treatment. LAY SUMMARY Our findings demonstrate that although reinfection by hepatitis C virus occurs following successful treatment in people with recent drug use, the rate of hepatitis C reinfection is lower than the rates of primary infection reported in the literature for this population - reinfection should not be used as a reason to withhold therapy from people with ongoing injecting drug use. The rate of hepatitis C reinfection was lowest among people receiving opioid agonist therapy with no recent drug use. These data illustrate that harm reduction services are required to reduce the reinfection risk, while regular post-treatment hepatitis C assessment is required for early detection and retreatment.
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Affiliation(s)
| | | | | | | | - Matthew Law
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Naveed Z Janjua
- British Columbia Centre for Disease Control, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Håvard Midgard
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
| | | | - John Dillon
- Ninewells Hospital and Medical School, University of Dundee, Dundee, The United Kingdom
| | - Matthew Hickman
- Population Health Sciences, University of Bristol, Bristol, The United Kingdom
| | - Julie Bruneau
- Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Gregory J Dore
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Jason Grebely
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
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Darvishian M, Wong S, Binka M, Yu A, Ramji A, Yoshida EM, Wong J, Rossi C, Butt ZA, Bartlett S, Pearce ME, Samji H, Cook D, Alvarez M, Chong M, Tyndall M, Krajden M, Janjua NZ. Loss to follow-up: A significant barrier in the treatment cascade with direct-acting therapies. J Viral Hepat 2020; 27:243-260. [PMID: 31664755 DOI: 10.1111/jvh.13228] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 09/19/2019] [Accepted: 10/22/2019] [Indexed: 12/15/2022]
Abstract
Effectiveness of direct-acting antiviral (DAA) therapies could be influenced by patient characteristics such as comorbid conditions, which could lead to premature treatment discontinuation and/or irregular medical follow-ups. Here, we evaluate loss to follow-up and treatment effectiveness of sofosbuvir/ledipasvir ± ribavirin (SOF/LDV ± RBV), ombitasvir/paritaprevir/ritonavir + dasabuvir ± ribavirin (OBV/PTV/r + DSV ± RBV) for hepatitis C virus (HCV) genotype 1 (GT1) and sofosbuvir + ribavirin (SOF + RBV) for genotype 3 (GT3) in British Columbia Canada: The British Columbia Hepatitis Testers Cohort includes data on individuals tested for HCV since 1992, integrated with medical visit, hospitalization and prescription drug data. HCV-positive individuals who initiated DAA regimens, irrespective of treatment completion, for GT1 and GT3 until 31 December, 2017 were included. Factors associated with sustained virological response (SVR) and loss to follow-up were assessed by using multivariable logistic regression models. In total 4477 individuals initiated DAAs. The most common prescribed DAA was SOF/LDV ± RBV with SVR of 95%. The highest SVR of 99.5% was observed among OBV/PTV/r + DSV-treated patients. Overall, 453 (10.1%) individuals were lost to follow-up. Higher loss to follow-up was observed among GT1 patients treated with OBV (17.8%) and GT3 patients (15.7%). The loss to follow-up rate was significantly higher among individuals aged <60 years, those with a history of injection drug use (IDU), on opioid substitution therapy and with cirrhosis. Our findings indicate that loss to follow-up exceeds viral failure in HCV DAA therapy and its rate varies significantly by genotype and treatment regimen. Depending on the aetiology of lost to follow-up, personalized case management for those with medical complications and supporting services among IDU are needed to achieve the full benefits of effective treatments.
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Affiliation(s)
- Maryam Darvishian
- BC Centre for Disease Control, Vancouver, BC, Canada.,University of British Columbia, Vancouver, BC, Canada.,BC Cancer Research Centre, Vancouver, BC, Canada.,Population Oncology, Vancouver, BC, Canada
| | - Stanley Wong
- BC Centre for Disease Control, Vancouver, BC, Canada
| | - Mawuena Binka
- BC Centre for Disease Control, Vancouver, BC, Canada
| | - Amanda Yu
- BC Centre for Disease Control, Vancouver, BC, Canada
| | - Alnoor Ramji
- University of British Columbia, Vancouver, BC, Canada
| | - Eric M Yoshida
- Division of Gastroenterology of the Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jason Wong
- BC Centre for Disease Control, Vancouver, BC, Canada.,University of British Columbia, Vancouver, BC, Canada
| | - Carmine Rossi
- BC Centre for Disease Control, Vancouver, BC, Canada.,University of British Columbia, Vancouver, BC, Canada
| | - Zahid A Butt
- BC Centre for Disease Control, Vancouver, BC, Canada.,University of British Columbia, Vancouver, BC, Canada
| | - Sofia Bartlett
- BC Centre for Disease Control, Vancouver, BC, Canada.,University of British Columbia, Vancouver, BC, Canada
| | - Margo E Pearce
- BC Centre for Disease Control, Vancouver, BC, Canada.,University of British Columbia, Vancouver, BC, Canada
| | - Hasina Samji
- BC Centre for Disease Control, Vancouver, BC, Canada.,Simon Fraser University, Burnaby, BC, Canada
| | - Darrel Cook
- BC Centre for Disease Control, Vancouver, BC, Canada
| | - Maria Alvarez
- BC Centre for Disease Control, Vancouver, BC, Canada
| | - Mei Chong
- BC Centre for Disease Control, Vancouver, BC, Canada
| | - Mark Tyndall
- BC Centre for Disease Control, Vancouver, BC, Canada.,University of British Columbia, Vancouver, BC, Canada
| | - Mel Krajden
- BC Centre for Disease Control, Vancouver, BC, Canada.,University of British Columbia, Vancouver, BC, Canada
| | - Naveed Z Janjua
- BC Centre for Disease Control, Vancouver, BC, Canada.,University of British Columbia, Vancouver, BC, Canada
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Wilton J, Wong S, Yu A, Ramji A, Cook D, Butt ZA, Alvarez M, Binka M, Darvishian M, Jeong D, Bartlett SR, Pearce ME, Adu PA, Yoshida EM, Krajden M, Janjua NZ. Real-world Effectiveness of Sofosbuvir/Velpatasvir for Treatment of Chronic Hepatitis C in British Columbia, Canada: A Population-Based Cohort Study. Open Forum Infect Dis 2020; 7:ofaa055. [PMID: 32154326 PMCID: PMC7052750 DOI: 10.1093/ofid/ofaa055] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 02/12/2020] [Indexed: 12/12/2022] Open
Abstract
Background Clinical trials show high efficacy of sofosbuvir/velpatasvir (SOF/VEL), but there are limited data from “real-world” settings. We aimed to evaluate SOF/VEL effectiveness for all hepatitis C virus (HCV) genotypes (GTs) in British Columbia (BC), Canada. Methods We used the BC Hepatitis Testers Cohort, which includes all HCV cases in the province (1990–2015) linked to administrative databases, including prescriptions to end of 2018. We measured sustained virologic response (SVR; negative RNA ≥10 weeks after treatment end) and identified characteristics associated with non-SVR. Conservatively, we excluded individuals with no assessment for SVR if their last RNA test after treatment initiation was negative (but included if positive). Results Of 2821 eligible participants, most were infected with GT1 (1076, 38.1%) or GT3 (1072, 38.0%), and a minority (278, 9.9%) were treated with RBV. SVR was 94.6% (2670/2821) overall and 94.5% (1017/1076) for GT1, 96.4% (512/531) for GT2, and 93.7% (1004/1072) for GT3. When disaggregated by GT, treatment regimen, and cirrhosis/treatment experience, SVR was lowest (30/40, 75.0%) among treatment-experienced GT3 individuals treated with RBV. Characteristics associated with non-SVR in multivariable analysis included younger age, RBV addition, and being a person with HIV (PWH) or who injects/injected drugs (PWID). When treatment regimen (±RBV) was removed from multivariable model, treatment experience was associated with non-SVR for GT3. Of 151 non-SVR individuals, 56.3% were nonvirological failures (treatment incomplete/no assessment for SVR) and 43.7% were virological failures (nonresponse/relapse). A disproportionately high percentage of non-SVR among PWID was due to nonvirological failure. Conclusions SOF/VEL was highly effective in this “real-world” population-based cohort. Additional support is required for PWID/PWH to reach SVR.
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Affiliation(s)
- James Wilton
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Stanley Wong
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Amanda Yu
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Alnoor Ramji
- Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Darrel Cook
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Zahid A Butt
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.,School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Maria Alvarez
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Mawuena Binka
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Maryam Darvishian
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.,Cancer Control Research, BC Cancer Research Center, Vancouver, British Columbia, Canada.,Population Oncology, BC Cancer Research Center, Vancouver, British Columbia, Canada
| | - Dahn Jeong
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sofia R Bartlett
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Margo E Pearce
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Prince A Adu
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eric M Yoshida
- Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mel Krajden
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Naveed Z Janjua
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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67
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Bartlett SR, Yu A, Chapinal N, Rossi C, Butt Z, Wong S, Darvishian M, Gilbert M, Wong J, Binka M, Alvarez M, Tyndall M, Krajden M, Janjua NZ. The population level care cascade for hepatitis C in British Columbia, Canada as of 2018: Impact of direct acting antivirals. Liver Int 2019; 39:2261-2272. [PMID: 31444846 DOI: 10.1111/liv.14227] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 08/14/2019] [Accepted: 08/19/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Population-level monitoring of hepatitis C virus (HCV) infected people across cascades of care identifies gaps in access and engagement in care and treatment. We characterized the population-level care cascade for HCV in British Columbia (BC), Canada before and after introduction of Direct Acting Antiviral (DAA) treatment. METHODS BC Hepatitis Testers Cohort (BC-HTC) includes 1.7 million individuals tested for HCV, HIV, reported cases of hepatitis B, and active tuberculosis in BC from 1990 to 2018 linked to medical visits, hospitalizations, cancers, prescription drugs and mortality data. We defined six HCV care cascade stages: (a) antibody diagnosed; (b) RNA tested; (c) RNA positive; (d) genotyped; (e) initiated treatment; and (f) achieved sustained virologic response (SVR). RESULTS We estimated 61 127 people were HCV antibody positive in BC in 2018 (undiagnosed: 7686, 13%; diagnosed: 53 441, 87%). Of those diagnosed, 83% (44 507) had HCV RNA testing, and of those RNA positive, 90% (28 716) were genotyped. Of those genotyped, 61% (17 441) received therapy, with 90% (15 672) reaching SVR. Individuals from older birth cohorts had lower progression to HCV RNA testing. While people who currently inject drugs had the highest proportional progression to RNA testing, this group had the lowest proportional treatment uptake. CONCLUSIONS Although gaps in HCV RNA and genotype testing after antibody diagnosis exist, the largest gap in the care cascade is treatment initiation, despite introduction of DAA treatment and removal of treatment eligibility restrictions. Further interventions are required to ensure testing and treatment is equitably accessible in BC.
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Affiliation(s)
- Sofia R Bartlett
- British Columbia Centre for Disease Control (BCCDC), Vancouver, BC, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada.,Kirby Institute, University of New South Wales Australia, Sydney, NSW, Australia
| | - Amanda Yu
- British Columbia Centre for Disease Control (BCCDC), Vancouver, BC, Canada
| | - Nuria Chapinal
- British Columbia Centre for Disease Control (BCCDC), Vancouver, BC, Canada
| | - Carmine Rossi
- British Columbia Centre for Disease Control (BCCDC), Vancouver, BC, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Zahid Butt
- British Columbia Centre for Disease Control (BCCDC), Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Stanley Wong
- British Columbia Centre for Disease Control (BCCDC), Vancouver, BC, Canada
| | - Maryam Darvishian
- British Columbia Centre for Disease Control (BCCDC), Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Mark Gilbert
- British Columbia Centre for Disease Control (BCCDC), Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Jason Wong
- British Columbia Centre for Disease Control (BCCDC), Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Mawuena Binka
- British Columbia Centre for Disease Control (BCCDC), Vancouver, BC, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Maria Alvarez
- British Columbia Centre for Disease Control (BCCDC), Vancouver, BC, Canada
| | - Mark Tyndall
- British Columbia Centre for Disease Control (BCCDC), Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Mel Krajden
- British Columbia Centre for Disease Control (BCCDC), Vancouver, BC, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Naveed Z Janjua
- British Columbia Centre for Disease Control (BCCDC), Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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Abstract
IMPORTANCE Chronic hepatitis C virus (HCV) infection is a global health problem. The World Health Assembly recently pledged to eliminate HCV by 2030. However, in Pakistan, a country with one of the highest prevalence rates, the feasibility and cost of HCV elimination are not known. OBJECTIVES To investigate whether and under what conditions HCV elimination is feasible in Pakistan and to estimate the cost of such elimination. DESIGN, SETTING, AND PARTICIPANTS This decision analytical model study used a microsimulation model of the HCV epidemic in Pakistan from 2015 to 2030. Using Pakistan-specific variables, the model simulated the landscape of HCV in Pakistan and evaluated the minimum required screening and treatment rates needed to eliminate HCV in Pakistan. The study used simulated individuals chronically infected with HCV from 2015 to 2030. The analysis was performed in 2018. INTERVENTIONS The status quo and 7 scenarios that can lead to HCV elimination in Pakistan by 2030, which were defined by different combinations of tests for screening, detection of viremia before treatment, and confirmation of treatment response. MAIN OUTCOMES AND MEASURES Temporal trends in HCV infection prevalence, mortality, and disability-adjusted life-years and total cost of HCV infection care under the status quo and scenarios that can eliminate HCV by 2030. RESULTS Under the status quo, from 2015 to 2030, 1.44 million people are projected to die of HCV infection; 48% of deaths would be among people younger than 50 years. To achieve HCV elimination in Pakistan, HCV testing would need to be scaled up to at least 25 million people to diagnose 900 000 persons and treatment to 700 000 people per year. Compared with the status quo, the elimination scenario would avert 323 000 liver-related deaths and 13.0 million HCV-associated disability-adjusted life-years from 2015 to 2030. The elimination scenario was associated with cost savings of $2.6 billion from 2018 to 2030 with use of a point-of-care test for population-wide antibody screening and detection of viremia and treatment response. CONCLUSIONS AND RELEVANCE Substantial scale-up of HCV testing and treatment may be essential to eliminate HCV infection in Pakistan, and such a strategy may be associated with cost savings in the near future. Although HCV elimination in Pakistan may be ambitious, strategic planning and strong support from the government may aid in its elimination.
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Affiliation(s)
- Jagpreet Chhatwal
- Harvard Medical School, Boston, Massachusetts
- Massachusetts General Hospital Institute for Technology Assessment, Boston
| | - Qiushi Chen
- Harvard Medical School, Boston, Massachusetts
- Massachusetts General Hospital Institute for Technology Assessment, Boston
- Harold and Inge Marcus Department of Industrial and Manufacturing Engineering, Pennsylvania State University, University Park
| | - Xiaojie Wang
- Department of Industrial and Systems Engineering, University of Florida, Gainesville
| | - Turgay Ayer
- H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta
| | - Yueran Zhuo
- Massachusetts General Hospital Institute for Technology Assessment, Boston
| | - Naveed Z. Janjua
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Fasiha Kanwal
- Houston Veterans Affairs Health Services Research and Development Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
- Department of Medicine, Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas
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Janjua NZ, Darvishian M, Wong S, Yu A, Rossi C, Ramji A, Yoshida EM, Butt ZA, Samji H, Chong M, Chapinal N, Cook D, Alvarez M, Tyndall M, Krajden M. Effectiveness of Ledipasvir/Sofosbuvir and Sofosbuvir/Velpatasvir in People Who Inject Drugs and/or Those in Opioid Agonist Therapy. Hepatol Commun 2019; 3:478-492. [PMID: 30976739 PMCID: PMC6442698 DOI: 10.1002/hep4.1307] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 12/14/2018] [Indexed: 12/12/2022] Open
Abstract
We evaluated the effectiveness of ledipasvir/sofosbuvir (LDV/SOF) in treating hepatitis C virus (HCV) genotype 1 and SOF/velpatasvir (SOF/VEL) for all genotypes among people who inject drugs (PWID) and those not injecting drugs and who were on or off opioid agonist therapy (OAT). Study participants comprised a population-based cohort in British Columbia, Canada. The British Columbia Hepatitis Testers Cohort includes data on individuals tested for HCV from 1990 to 2016 that are integrated with medical visits, hospitalization, and prescription drug data. We classified study participants as off OAT/recent injection drug use (off-OAT/RIDU), off OAT/past IDU (off-OAT/PIDU), off OAT/no IDU (off-OAT/NIDU), on OAT/IDU (on-OAT/IDU), and on OAT/no IDU (on-OAT/NIDU). We assessed sustained virologic response (SVR) 10 weeks after HCV treatment among study groups treated with LDV/SOF or SOF/VEL until January 13, 2018. Analysis included 5,283 eligible participants: 390 off-OAT/RIDU, 598 off-OAT/PIDU, 3,515 off-OAT/NIDU, 609 on-OAT/IDU, and 171 on-OAT/NIDU. The majority were male patients (64%-74%) and aged ≥50 years (58%-85%). The SVRs for off-OAT/RIDU, off-OAT/PIDU, off-OAT/NIDU, on-OAT/IDU, and on-OAT/NIDU were 91% (355/390), 95% (570/598), 96% (3,360/3,515), 93% (567/609), and 95% (163/171), respectively. Among those with no SVR, 14 individuals died while on treatment or before SVR assessment, including 4 from illicit drug overdose. In the overall multivariable model, off-OAT/RIDU, on-OAT/IDU, male sex, cirrhosis, treatment duration <8 weeks, treatment duration 8 weeks, and treatment with SOF/VEL were associated with not achieving SVR. Conclusion: In this large real-world cohort, PWID and/or those on OAT achieved high SVRs, although slightly lower than people not injecting drugs. This finding also highlights the need for additional measures to prevent loss to follow-up and overdose-related deaths among PWID.
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Affiliation(s)
- Naveed Z. Janjua
- British Columbia Centre for Disease ControlVancouverCanada
- School of Population and Public HealthUniversity of British ColumbiaVancouverCanada
| | - Maryam Darvishian
- British Columbia Centre for Disease ControlVancouverCanada
- School of Population and Public HealthUniversity of British ColumbiaVancouverCanada
| | - Stanley Wong
- British Columbia Centre for Disease ControlVancouverCanada
| | - Amanda Yu
- British Columbia Centre for Disease ControlVancouverCanada
| | - Carmine Rossi
- British Columbia Centre for Disease ControlVancouverCanada
- School of Population and Public HealthUniversity of British ColumbiaVancouverCanada
| | - Alnoor Ramji
- Division of Gastroenterology of the Department of MedicineUniversity of British ColumbiaVancouverCanada
| | - Eric M. Yoshida
- Division of Gastroenterology of the Department of MedicineUniversity of British ColumbiaVancouverCanada
| | - Zahid A. Butt
- British Columbia Centre for Disease ControlVancouverCanada
- School of Population and Public HealthUniversity of British ColumbiaVancouverCanada
| | - Hasina Samji
- British Columbia Centre for Disease ControlVancouverCanada
- Faculty of Health SciencesSimon Fraser UniversityBurnabyCanada
| | - Mei Chong
- British Columbia Centre for Disease ControlVancouverCanada
| | - Nuria Chapinal
- British Columbia Centre for Disease ControlVancouverCanada
| | - Darrel Cook
- British Columbia Centre for Disease ControlVancouverCanada
| | - Maria Alvarez
- British Columbia Centre for Disease ControlVancouverCanada
| | - Mark Tyndall
- British Columbia Centre for Disease ControlVancouverCanada
- School of Population and Public HealthUniversity of British ColumbiaVancouverCanada
| | - Mel Krajden
- British Columbia Centre for Disease ControlVancouverCanada
- Department of Pathology and Laboratory MedicineUniversity of British ColumbiaVancouverCanada
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Bubela T, Genuis SK, Janjua NZ, Krajden M, Mittmann N, Podolak K, Svenson LW. Medical Information Commons to Support Learning Healthcare Systems: Examples From Canada. J Law Med Ethics 2019; 47:97-105. [PMID: 30994059 DOI: 10.1177/1073110519840488] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
We explore how principles predicting the success of a medical information commons (MIC) advantaged or disadvantaged three MIC initiatives in three Canadian provinces. Our MIC case examples demonstrate that practices and policies to promote access to and use of health information can help improve individual healthcare and inform a learning health system. MICs were constrained by heterogenous health information protection laws across jurisdictions and risk-averse institutional cultures. A networked approach to MICs would unlock even more potential for national and international data collaborations to improve health and healthcare.
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Affiliation(s)
- Tania Bubela
- Tania Bubela, Ph.D., J.D., F.C.A.H.S., is an expert in health and intellectual property law and policy, combining her training in genetics (Ph.D. Biology, University of Sydney) and law (Gold medalist, University of Alberta). She is the Dean of Faculty of Health Sciences at Simon Fraser University (Burnaby, British Columbia), developing sector-leading policies, processes, practices, and infrastructure to support excellence in interdisciplinary education, research, and engagement that will improve health, health equity, and well-being. Shelagh K. Genuis, Ph.D., is the project manager for the Genome Canada's Precision Medicine Policy Network, based in the Faculty of Medicine and Dentistry at the University of Alberta, Alberta. Naveed Z. Janjua, M.D., Ph.D., is a Senior Scientist at the BC Centre for Disease Control and Clinical Associate Professor at School of Population and Public Health, University of British Columbia. Mel Krajden, M.D., F.R.C.P.C., is the Director of BC's Public Health Laboratory and the Medical Head, Hepatitis at the British Columbia Centre for Disease Control. He is also a Professor of Pathology and Laboratory Medicine at the University of British Columbia. He has extensive clinical trials expertise and is a Co-investigator/Mentor on the CIHR funded National Research Training Program (CanHepC). Nicole Mittmann, Ph.D., is the Chief Research Officer at CCO. She is an Assistant Professor at the University of Toronto in the Department of Pharmacology and Toxicology and an Associate Scientist at Sunnybrook Health Sciences Centre. Katerina Podolak is the Group Manager for Data Acquisition and Disclosure at Cancer Care Ontario, working with data partners to bring data into CCO, and health system partners who want access to CCO data. Katerina has extensive experience with information management in the hospital setting, as well as Ontario's Ministry of Health and Long-term Care. Larry Svenson, Ph.D., F.R.S.P.H., is the Provincial Health Analytics Officer and Executive Director for Analytics and Performance Reporting at Alberta Health. He is also an Associate Professor with the Division of Preventive Medicine at the University of Alberta and an Adjunct Professor with the School of Public Health at the University of Alberta and the Cumming School of Medicine at the University of Calgary
| | - Shelagh K Genuis
- Tania Bubela, Ph.D., J.D., F.C.A.H.S., is an expert in health and intellectual property law and policy, combining her training in genetics (Ph.D. Biology, University of Sydney) and law (Gold medalist, University of Alberta). She is the Dean of Faculty of Health Sciences at Simon Fraser University (Burnaby, British Columbia), developing sector-leading policies, processes, practices, and infrastructure to support excellence in interdisciplinary education, research, and engagement that will improve health, health equity, and well-being. Shelagh K. Genuis, Ph.D., is the project manager for the Genome Canada's Precision Medicine Policy Network, based in the Faculty of Medicine and Dentistry at the University of Alberta, Alberta. Naveed Z. Janjua, M.D., Ph.D., is a Senior Scientist at the BC Centre for Disease Control and Clinical Associate Professor at School of Population and Public Health, University of British Columbia. Mel Krajden, M.D., F.R.C.P.C., is the Director of BC's Public Health Laboratory and the Medical Head, Hepatitis at the British Columbia Centre for Disease Control. He is also a Professor of Pathology and Laboratory Medicine at the University of British Columbia. He has extensive clinical trials expertise and is a Co-investigator/Mentor on the CIHR funded National Research Training Program (CanHepC). Nicole Mittmann, Ph.D., is the Chief Research Officer at CCO. She is an Assistant Professor at the University of Toronto in the Department of Pharmacology and Toxicology and an Associate Scientist at Sunnybrook Health Sciences Centre. Katerina Podolak is the Group Manager for Data Acquisition and Disclosure at Cancer Care Ontario, working with data partners to bring data into CCO, and health system partners who want access to CCO data. Katerina has extensive experience with information management in the hospital setting, as well as Ontario's Ministry of Health and Long-term Care. Larry Svenson, Ph.D., F.R.S.P.H., is the Provincial Health Analytics Officer and Executive Director for Analytics and Performance Reporting at Alberta Health. He is also an Associate Professor with the Division of Preventive Medicine at the University of Alberta and an Adjunct Professor with the School of Public Health at the University of Alberta and the Cumming School of Medicine at the University of Calgary
| | - Naveed Z Janjua
- Tania Bubela, Ph.D., J.D., F.C.A.H.S., is an expert in health and intellectual property law and policy, combining her training in genetics (Ph.D. Biology, University of Sydney) and law (Gold medalist, University of Alberta). She is the Dean of Faculty of Health Sciences at Simon Fraser University (Burnaby, British Columbia), developing sector-leading policies, processes, practices, and infrastructure to support excellence in interdisciplinary education, research, and engagement that will improve health, health equity, and well-being. Shelagh K. Genuis, Ph.D., is the project manager for the Genome Canada's Precision Medicine Policy Network, based in the Faculty of Medicine and Dentistry at the University of Alberta, Alberta. Naveed Z. Janjua, M.D., Ph.D., is a Senior Scientist at the BC Centre for Disease Control and Clinical Associate Professor at School of Population and Public Health, University of British Columbia. Mel Krajden, M.D., F.R.C.P.C., is the Director of BC's Public Health Laboratory and the Medical Head, Hepatitis at the British Columbia Centre for Disease Control. He is also a Professor of Pathology and Laboratory Medicine at the University of British Columbia. He has extensive clinical trials expertise and is a Co-investigator/Mentor on the CIHR funded National Research Training Program (CanHepC). Nicole Mittmann, Ph.D., is the Chief Research Officer at CCO. She is an Assistant Professor at the University of Toronto in the Department of Pharmacology and Toxicology and an Associate Scientist at Sunnybrook Health Sciences Centre. Katerina Podolak is the Group Manager for Data Acquisition and Disclosure at Cancer Care Ontario, working with data partners to bring data into CCO, and health system partners who want access to CCO data. Katerina has extensive experience with information management in the hospital setting, as well as Ontario's Ministry of Health and Long-term Care. Larry Svenson, Ph.D., F.R.S.P.H., is the Provincial Health Analytics Officer and Executive Director for Analytics and Performance Reporting at Alberta Health. He is also an Associate Professor with the Division of Preventive Medicine at the University of Alberta and an Adjunct Professor with the School of Public Health at the University of Alberta and the Cumming School of Medicine at the University of Calgary
| | - Mel Krajden
- Tania Bubela, Ph.D., J.D., F.C.A.H.S., is an expert in health and intellectual property law and policy, combining her training in genetics (Ph.D. Biology, University of Sydney) and law (Gold medalist, University of Alberta). She is the Dean of Faculty of Health Sciences at Simon Fraser University (Burnaby, British Columbia), developing sector-leading policies, processes, practices, and infrastructure to support excellence in interdisciplinary education, research, and engagement that will improve health, health equity, and well-being. Shelagh K. Genuis, Ph.D., is the project manager for the Genome Canada's Precision Medicine Policy Network, based in the Faculty of Medicine and Dentistry at the University of Alberta, Alberta. Naveed Z. Janjua, M.D., Ph.D., is a Senior Scientist at the BC Centre for Disease Control and Clinical Associate Professor at School of Population and Public Health, University of British Columbia. Mel Krajden, M.D., F.R.C.P.C., is the Director of BC's Public Health Laboratory and the Medical Head, Hepatitis at the British Columbia Centre for Disease Control. He is also a Professor of Pathology and Laboratory Medicine at the University of British Columbia. He has extensive clinical trials expertise and is a Co-investigator/Mentor on the CIHR funded National Research Training Program (CanHepC). Nicole Mittmann, Ph.D., is the Chief Research Officer at CCO. She is an Assistant Professor at the University of Toronto in the Department of Pharmacology and Toxicology and an Associate Scientist at Sunnybrook Health Sciences Centre. Katerina Podolak is the Group Manager for Data Acquisition and Disclosure at Cancer Care Ontario, working with data partners to bring data into CCO, and health system partners who want access to CCO data. Katerina has extensive experience with information management in the hospital setting, as well as Ontario's Ministry of Health and Long-term Care. Larry Svenson, Ph.D., F.R.S.P.H., is the Provincial Health Analytics Officer and Executive Director for Analytics and Performance Reporting at Alberta Health. He is also an Associate Professor with the Division of Preventive Medicine at the University of Alberta and an Adjunct Professor with the School of Public Health at the University of Alberta and the Cumming School of Medicine at the University of Calgary
| | - Nicole Mittmann
- Tania Bubela, Ph.D., J.D., F.C.A.H.S., is an expert in health and intellectual property law and policy, combining her training in genetics (Ph.D. Biology, University of Sydney) and law (Gold medalist, University of Alberta). She is the Dean of Faculty of Health Sciences at Simon Fraser University (Burnaby, British Columbia), developing sector-leading policies, processes, practices, and infrastructure to support excellence in interdisciplinary education, research, and engagement that will improve health, health equity, and well-being. Shelagh K. Genuis, Ph.D., is the project manager for the Genome Canada's Precision Medicine Policy Network, based in the Faculty of Medicine and Dentistry at the University of Alberta, Alberta. Naveed Z. Janjua, M.D., Ph.D., is a Senior Scientist at the BC Centre for Disease Control and Clinical Associate Professor at School of Population and Public Health, University of British Columbia. Mel Krajden, M.D., F.R.C.P.C., is the Director of BC's Public Health Laboratory and the Medical Head, Hepatitis at the British Columbia Centre for Disease Control. He is also a Professor of Pathology and Laboratory Medicine at the University of British Columbia. He has extensive clinical trials expertise and is a Co-investigator/Mentor on the CIHR funded National Research Training Program (CanHepC). Nicole Mittmann, Ph.D., is the Chief Research Officer at CCO. She is an Assistant Professor at the University of Toronto in the Department of Pharmacology and Toxicology and an Associate Scientist at Sunnybrook Health Sciences Centre. Katerina Podolak is the Group Manager for Data Acquisition and Disclosure at Cancer Care Ontario, working with data partners to bring data into CCO, and health system partners who want access to CCO data. Katerina has extensive experience with information management in the hospital setting, as well as Ontario's Ministry of Health and Long-term Care. Larry Svenson, Ph.D., F.R.S.P.H., is the Provincial Health Analytics Officer and Executive Director for Analytics and Performance Reporting at Alberta Health. He is also an Associate Professor with the Division of Preventive Medicine at the University of Alberta and an Adjunct Professor with the School of Public Health at the University of Alberta and the Cumming School of Medicine at the University of Calgary
| | - Katerina Podolak
- Tania Bubela, Ph.D., J.D., F.C.A.H.S., is an expert in health and intellectual property law and policy, combining her training in genetics (Ph.D. Biology, University of Sydney) and law (Gold medalist, University of Alberta). She is the Dean of Faculty of Health Sciences at Simon Fraser University (Burnaby, British Columbia), developing sector-leading policies, processes, practices, and infrastructure to support excellence in interdisciplinary education, research, and engagement that will improve health, health equity, and well-being. Shelagh K. Genuis, Ph.D., is the project manager for the Genome Canada's Precision Medicine Policy Network, based in the Faculty of Medicine and Dentistry at the University of Alberta, Alberta. Naveed Z. Janjua, M.D., Ph.D., is a Senior Scientist at the BC Centre for Disease Control and Clinical Associate Professor at School of Population and Public Health, University of British Columbia. Mel Krajden, M.D., F.R.C.P.C., is the Director of BC's Public Health Laboratory and the Medical Head, Hepatitis at the British Columbia Centre for Disease Control. He is also a Professor of Pathology and Laboratory Medicine at the University of British Columbia. He has extensive clinical trials expertise and is a Co-investigator/Mentor on the CIHR funded National Research Training Program (CanHepC). Nicole Mittmann, Ph.D., is the Chief Research Officer at CCO. She is an Assistant Professor at the University of Toronto in the Department of Pharmacology and Toxicology and an Associate Scientist at Sunnybrook Health Sciences Centre. Katerina Podolak is the Group Manager for Data Acquisition and Disclosure at Cancer Care Ontario, working with data partners to bring data into CCO, and health system partners who want access to CCO data. Katerina has extensive experience with information management in the hospital setting, as well as Ontario's Ministry of Health and Long-term Care. Larry Svenson, Ph.D., F.R.S.P.H., is the Provincial Health Analytics Officer and Executive Director for Analytics and Performance Reporting at Alberta Health. He is also an Associate Professor with the Division of Preventive Medicine at the University of Alberta and an Adjunct Professor with the School of Public Health at the University of Alberta and the Cumming School of Medicine at the University of Calgary
| | - Lawrence W Svenson
- Tania Bubela, Ph.D., J.D., F.C.A.H.S., is an expert in health and intellectual property law and policy, combining her training in genetics (Ph.D. Biology, University of Sydney) and law (Gold medalist, University of Alberta). She is the Dean of Faculty of Health Sciences at Simon Fraser University (Burnaby, British Columbia), developing sector-leading policies, processes, practices, and infrastructure to support excellence in interdisciplinary education, research, and engagement that will improve health, health equity, and well-being. Shelagh K. Genuis, Ph.D., is the project manager for the Genome Canada's Precision Medicine Policy Network, based in the Faculty of Medicine and Dentistry at the University of Alberta, Alberta. Naveed Z. Janjua, M.D., Ph.D., is a Senior Scientist at the BC Centre for Disease Control and Clinical Associate Professor at School of Population and Public Health, University of British Columbia. Mel Krajden, M.D., F.R.C.P.C., is the Director of BC's Public Health Laboratory and the Medical Head, Hepatitis at the British Columbia Centre for Disease Control. He is also a Professor of Pathology and Laboratory Medicine at the University of British Columbia. He has extensive clinical trials expertise and is a Co-investigator/Mentor on the CIHR funded National Research Training Program (CanHepC). Nicole Mittmann, Ph.D., is the Chief Research Officer at CCO. She is an Assistant Professor at the University of Toronto in the Department of Pharmacology and Toxicology and an Associate Scientist at Sunnybrook Health Sciences Centre. Katerina Podolak is the Group Manager for Data Acquisition and Disclosure at Cancer Care Ontario, working with data partners to bring data into CCO, and health system partners who want access to CCO data. Katerina has extensive experience with information management in the hospital setting, as well as Ontario's Ministry of Health and Long-term Care. Larry Svenson, Ph.D., F.R.S.P.H., is the Provincial Health Analytics Officer and Executive Director for Analytics and Performance Reporting at Alberta Health. He is also an Associate Professor with the Division of Preventive Medicine at the University of Alberta and an Adjunct Professor with the School of Public Health at the University of Alberta and the Cumming School of Medicine at the University of Calgary
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Butt ZA, Mak S, Gesink D, Gilbert M, Wong J, Yu A, Wong S, Alvarez M, Chong M, Buxton J, Tyndall M, Krajden M, Janjua NZ. Applying core theory and spatial analysis to identify hepatitis C virus infection "core areas" in British Columbia, Canada. J Viral Hepat 2019; 26:373-383. [PMID: 30447122 DOI: 10.1111/jvh.13043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 10/05/2018] [Accepted: 10/15/2018] [Indexed: 12/15/2022]
Abstract
"Core areas" of transmission for bacterial sexually transmitted infections have been identified. However, it is unclear whether core areas apply to viral infections, such as hepatitis C virus (HCV). We used geographic mapping and spatial analysis to identify distinct core areas of HCV infection in British Columbia (BC) using the BC Hepatitis Testers Cohort (BC-HTC), 1990-2013. The BC-HTC includes all BC residents tested for HCV (~1.5 million; 1990-2013). Core HCV infection areas were identified spatially and temporally for five time periods (1990-1993, 1994-1998, 1999-2003, 2004-2008 and 2009-2013) through thematic mapping, Kernel Density Estimation, Hotspot analysis and cluster analysis at the Census dissemination area level in ArcGIS and SatScan. HCV infection core areas were consistently identified. HCV core areas expanded from the downtown of major cities in different regions of BC (Metro Vancouver, Vancouver Island, and Northern BC; 1990-1998), to smaller cities in Metro Vancouver and Interior BC (2000 onwards). Statistically significant clusters, or hotspots, were also observed for downtown Vancouver, Northern BC (Prince George) and Vancouver Island from 1990 to 2008 with expansion to other urban areas in Metro Vancouver from 1990-2013. Statistically significant clusters persisted after adjustment for injection drug use, number of HCV tests, age, sex, material and social deprivation. Persistence of areas with high HCV diagnoses rates in Vancouver and Prince George supports the theory of core areas of HCV transmission. Identification of core areas can inform prevention, care and treatment programme interventions and evaluate their impact over time.
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Affiliation(s)
- Zahid A Butt
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sunny Mak
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Dionne Gesink
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Mark Gilbert
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.,British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Jason Wong
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.,British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Amanda Yu
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Stanley Wong
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Maria Alvarez
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Mei Chong
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Jane Buxton
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.,British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Mark Tyndall
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.,British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Mel Krajden
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.,British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.,BCCDC Public Health Laboratory, Vancouver, British Columbia, Canada
| | - Naveed Z Janjua
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.,British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
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72
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Abstract
In 2016, Canada signed on to the World Health Organization (WHO) 2030 hepatitis C virus (HCV) disease elimination targets. Most of Canada's HCV disease burden is among five disproportionately affected population groups: 1) Baby boomers, who are at increased risk of dying from decompensated cirrhosis and hepatocellular carcinoma and for whom one-time screening should be recommended to identify those undiagnosed; 2) People who inject drugs (PWID), whose mortality risks include HCV infection, HCV acquisition risks and co-morbid conditions. While HCV infection in PWID can be effectively cured with direct-acting antivirals, premature deaths from acquisition risks, now exacerbated by Canada's opioid crisis, will need to be addressed to achieve the full benefits of curative treatment. PWID require syndemic-based solutions (harm reduction, addictions and mental health support, and management of co-infections, including HIV); 3) Indigenous populations who will require wellness-based health promotion, prevention, care and treatment designed by Indigenous people to address their underlying health disparities; 4) Immigrants who will require culturally designed and linguistically appropriate services to enhance screening and engagement into care; and (5) For those incarcerated because of drug-related crimes, decriminalization and better access to harm reduction could help reduce the impact of HCV infections and premature mortality. A comprehensive prevention, care and treatment framework is needed for Canada's vulnerable populations, including those co-infected with HIV, if we are to achieve the WHO HCV elimination targets by 2030. The aim of this review is to describe the HCV epidemic in the Canadian context.
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Affiliation(s)
- Mel Krajden
- Clinical Prevention Services, BC Centre for Disease Control, Vancouver, British Columbia
- Dept. of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, British Columbia
| | - Darrel Cook
- Clinical Prevention Services, BC Centre for Disease Control, Vancouver, British Columbia
| | - Naveed Z Janjua
- Clinical Prevention Services, BC Centre for Disease Control, Vancouver, British Columbia
- School of Population and Public Health, University of British Columbia, Vancouver British Columbia
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73
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Darvishian M, Janjua NZ, Chong M, Cook D, Samji H, Butt ZA, Yu A, Alvarez M, Yoshida E, Ramji A, Wong J, Woods R, Tyndall M, Krajden M. Estimating the impact of early hepatitis C virus clearance on hepatocellular carcinoma risk. J Viral Hepat 2018; 25:1481-1492. [PMID: 30047609 DOI: 10.1111/jvh.12977] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 06/04/2018] [Accepted: 07/03/2018] [Indexed: 12/15/2022]
Abstract
Although achieving sustained virological response (SVR) through antiviral therapy could reduce the risk of hepatocellular carcinoma (HCC) attributable to hepatitis C virus (HCV) infection, the impact of early viral clearance on HCC is not well defined. In this study, we compared the risk of HCC among individuals who spontaneously cleared HCV (SC), the referent population, with the risk in untreated chronic HCV (UCHC), those achieved SVR, and those who failed interferon-based treatment (TF). The BC Hepatitis Testers Cohort (BC-HTC) includes individuals tested for HCV between 1990-2013, integrated with medical visits, hospitalizations, cancers, prescription drugs and mortality data. This analysis included all HCV-positive patients with at least one valid HCV RNA by PCR on or after HCV diagnosis. Of 46 666 HCV-infected individuals, there were 12 527 (26.8%) SC; 24 794 (53.1%) UCHC; 5355 (11.5%) SVR and 3990 (8.5%) TF. HCC incidence was lowest (0.3/1000 person-years (PY)) in the SC group and highest in the TF group (7.7/1000 PY). In a multivariable model, compared to SC, TF had the highest HCC risk (hazard ratio (HR):14.52, 95% confidence interval (CI): 9.83-21.47), followed by UCHC (HR: 5.85; 95% CI: 4.07-8.41). Earlier treatment-based viral clearance similar to SC could decrease HCC incidence by 69.4% (95% CI: 57.5-78.0), 30% (95% CI: 10.8-45.1) and 77.5% (95% CI: 69.4-83.5) among UCHC, SVR and TF patients, respectively. In conclusion, using SC as a real-world comparator group, it showed that substantial reduction in HCC risk could be achieved with earlier treatment initiation. These analyses should be replicated in patients who have been treated with direct acting antiviral therapies.
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Affiliation(s)
- Maryam Darvishian
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Naveed Z Janjua
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mei Chong
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Darrel Cook
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Hasina Samji
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Zahid A Butt
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Amanda Yu
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Maria Alvarez
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Eric Yoshida
- Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alnoor Ramji
- Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,GI Research Institute, Vancouver, British Columbia, Canada
| | - Jason Wong
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ryan Woods
- British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Mark Tyndall
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mel Krajden
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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74
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Rossi C, Butt ZA, Wong S, Buxton JA, Islam N, Yu A, Darvishian M, Gilbert M, Wong J, Chapinal N, Binka M, Alvarez M, Tyndall MW, Krajden M, Janjua NZ. Hepatitis C virus reinfection after successful treatment with direct-acting antiviral therapy in a large population-based cohort. J Hepatol 2018; 69:1007-1014. [PMID: 30142429 DOI: 10.1016/j.jhep.2018.07.025] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 06/20/2018] [Accepted: 07/20/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Direct-acting antiviral therapies (DAA) are an important tool for hepatitis C virus (HCV) elimination. However, reinfection among people who inject drugs (PWID) may hamper elimination targets. Therefore, we estimated HCV reinfection rates among DAA-treated individuals, including PWID. METHODS We analyzed data from the British Columbia Hepatitis Testers Cohort which included ∼1.7 million individuals screened for HCV in British Columbia, Canada. We followed HCV-infected individuals treated with DAAs who achieved a sustained virologic response (SVR) and had ≥1 subsequent HCV RNA measurement to April 22nd, 2018. Reinfection was defined as a positive RNA measurement after SVR. PWID were identified using a validated algorithm and classified based on recent (<3 years) or former (≥3 years before SVR) use. Crude reinfection rates per 100 person-years (PYs) were calculated. Poisson regression was used to model adjusted incidence rate ratios (IRRs) and 95% CIs. RESULTS Of 4,114 individuals who met the inclusion criteria, most were male (n = 2,692, 65%), born before 1965 (n = 3,411, 83%) and were either recent (n = 875, 21%) or former PWID (n = 1,793, 44%). Opioid-agonist therapy (OAT) was received by 19% of PWID. We identified 40 reinfections during 2,767 PYs. Reinfection rates were higher among recent (3.1/100 PYs; IRR 6.7; 95% CI 1.9-23.5) and former PWID (1.4/100 PYs; IRR 3.7; 95% CI 1.1-12.9) than non-PWID (0.3/100 PYs). Among recent PWID, reinfection rates were higher among individuals born after 1975 (10.2/100 PYs) and those co-infected with HIV (5.7/100 PYs). Only one PWID receiving daily OAT developed reinfection. CONCLUSIONS Population-level reinfection rates remain elevated after DAA therapy among PWID because of ongoing exposure risk. Engagement of PWID in harm-reduction and support services is needed to prevent reinfections. LAY SUMMARY Direct-acting antivirals are an effective tool for the treatment of hepatitis C virus, enabling the elimination of the virus. However, some patients who have been successfully treated with direct-acting antivirals are at risk of reinfection. Our findings showed that the risk of reinfection was highest among people with recent injection drug use. Among people who inject drugs, daily use of opioid-agonist therapy was associated with a lower risk of reinfection.
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Affiliation(s)
- Carmine Rossi
- British Columbia Centre for Disease Control, Vancouver, BC, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Zahid A Butt
- British Columbia Centre for Disease Control, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Stanley Wong
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Jane A Buxton
- British Columbia Centre for Disease Control, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Nazrul Islam
- British Columbia Centre for Disease Control, Vancouver, BC, Canada; MRC Epidemiology Unit, University of Cambridge, School of Clinical Medicine, Cambridge, UK
| | - Amanda Yu
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Maryam Darvishian
- British Columbia Centre for Disease Control, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Mark Gilbert
- British Columbia Centre for Disease Control, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Jason Wong
- British Columbia Centre for Disease Control, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Nuria Chapinal
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Mawuena Binka
- British Columbia Centre for Disease Control, Vancouver, BC, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Maria Alvarez
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Mark W Tyndall
- British Columbia Centre for Disease Control, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Mel Krajden
- British Columbia Centre for Disease Control, Vancouver, BC, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Naveed Z Janjua
- British Columbia Centre for Disease Control, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
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75
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McKee G, Butt ZA, Wong S, Salway T, Gilbert M, Wong J, Alvarez M, Chapinal N, Darvishian M, Tyndall MW, Krajden M, Janjua NZ. Syndemic Characterization of HCV, HBV, and HIV Co-infections in a Large Population Based Cohort Study. EClinicalMedicine 2018; 4-5:99-108. [PMID: 31193601 PMCID: PMC6537523 DOI: 10.1016/j.eclinm.2018.10.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 09/28/2018] [Accepted: 10/19/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Limited data are available on HBV, HCV, and HIV co-infections and triple infection. We characterized co-occurrence of HIV, HBV, and HCV infections at the population level in British Columbia (BC) to identify patterns of predisposing factors unique to co-infection subgroups. METHODS We analyzed data from the BC Hepatitis Testers Cohort, which includes all individuals tested for HCV or HIV in BC between 1992 and 2013, or included in provincial public health registries of HIV, HCV, HBV, and active tuberculosis. Individuals were classified as negative, mono-, and co-infection groups based on HIV, HBV, and HCV status. We evaluated associations between risk factors (injection drug use, sexual orientation etc.) and co-infection groups using multivariate multinomial logistic regression. FINDINGS Of a total of 1,376,989 individuals included in the analysis, 1,276,290 were negative and 100,699 were positive for HIV, HBV, and/or HCV. Most cases (91,399, 90.8%) were mono-infected, while 3991 (4.0%) had HBV/HCV, 670 HBV/HIV (0.7%), 3459 HCV/HIV (3.4%), and 1180 HBV/HCV/HIV (1.2%) co-infection. Risk factor and demographic distribution varied across co-infection categories. MSM classification was associated with higher odds of all HIV co-infection groups, particularly HBV/HIV (OR 6.8; 95% CI: 5.6, 8.27), while injection drug use was most strongly associated with triple infection (OR 64.19; 95% CI: 55.11, 74.77) and HIV/HCV (OR 23.23; 95% CI: 21.32, 25.31). INTERPRETATION Syndemics of substance use, sexual practices, mental illness, socioeconomic marginalization, and co-infections differ among population groups, highlighting avenues for optimal composition and context for health services to meet each population's unique needs. FUNDING BC Centre for Disease Control and Canadian Institutes of Health Research.
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Affiliation(s)
- Geoffrey McKee
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Zahid A. Butt
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Stanley Wong
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Travis Salway
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Mark Gilbert
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Jason Wong
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Maria Alvarez
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Nuria Chapinal
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Maryam Darvishian
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Mark W. Tyndall
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Mel Krajden
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- BCCDC Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Naveed Z. Janjua
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- Corresponding author at: BC Centre for Disease Control, University of British Columbia, 655 West 12th Avenue, Vancouver, BC V5Z 4R4, Canada.
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76
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Butt ZA, Shrestha N, Gesink D, Murti M, Buxton JA, Gilbert M, Balshaw RF, Wong S, Kuo M, Wong J, Yu A, Alvarez M, Samji H, Roth D, Consolacion T, Hull MW, Ogilvie G, Tyndall MW, Krajden M, Janjua NZ. Effect of opioid-substitution therapy and mental health counseling on HIV risk among hepatitis C-infected individuals. Clin Epidemiol 2018; 10:1127-1145. [PMID: 30214316 PMCID: PMC6124790 DOI: 10.2147/clep.s173449] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Background Understanding differences in HIV incidence among people living with hepatitis C virus (HCV) can help inform strategies to prevent HIV infection. We estimated the time to HIV diagnosis among HCV-positive individuals and evaluated factors that could affect HIV-infection risk in this population. Patients and methods The British Columbia Hepatitis Testers Cohort includes all BC residents (~1.5 million: about a third of all residents) tested for HCV and HIV from 1990 to 2013 and is linked to administrative health care and mortality data. All HCV-positive and HIV-negative individuals were followed to measure time to HIV acquisition (positive test) and identify factors associated with HIV acquisition. Adjusted HRs (aHRs) were estimated using Cox proportional-hazard regression. Results Of 36,077 HCV-positive individuals, 2,169 (6%) acquired HIV over 266,883 years of follow-up (overall incidence of 8.1 per 1,000 person years). Overall median (IQR) time to HIV infection was 3.87 (6.06) years. In Cox regression, injection-drug use (aHR 1.47, 95% CI 1.33–1.63), HBV infection (aHR 1.34, 95% CI 1.16–1.55), and being a man who has sex with men (aHR 2.78, 95% CI 2.14–3.61) were associated with higher risk of HIV infection. Opioid-substitution therapy (OST) (aHR 0.59, 95% CI 0.52–0.67) and mental health counseling (aHR 0.48, 95% CI 0.43–0.53) were associated with lower risk of HIV infection. Conclusion Injection-drug use, HBV coinfection, and being a man who has sex with men were associated with increased HIV risk and engagement in OST and mental health counseling were associated with reduced HIV risk among HCV-positive individuals. Improving access to OST and mental health services could prevent transmission of HIV and other blood-borne infections, especially in settings where access is limited.
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Affiliation(s)
- Zahid A Butt
- School of Population and Public Health, University of British Columbia, Vancouver, BC,
| | - Nabin Shrestha
- School of Population and Public Health, University of British Columbia, Vancouver, BC,
| | - Dionne Gesink
- Dalla Lana School of Public Health, University of Toronto
| | - Michelle Murti
- Dalla Lana School of Public Health, University of Toronto.,Public Health Ontario, Toronto, ON
| | - Jane A Buxton
- School of Population and Public Health, University of British Columbia, Vancouver, BC, .,Clinical Prevention Services, British Columbia Centre for Disease Control
| | - Mark Gilbert
- Clinical Prevention Services, British Columbia Centre for Disease Control
| | - Robert F Balshaw
- Clinical Prevention Services, British Columbia Centre for Disease Control
| | - Stanley Wong
- Clinical Prevention Services, British Columbia Centre for Disease Control
| | - Margot Kuo
- Clinical Prevention Services, British Columbia Centre for Disease Control
| | - Jason Wong
- School of Population and Public Health, University of British Columbia, Vancouver, BC, .,Clinical Prevention Services, British Columbia Centre for Disease Control
| | - Amanda Yu
- Clinical Prevention Services, British Columbia Centre for Disease Control
| | - Maria Alvarez
- Clinical Prevention Services, British Columbia Centre for Disease Control
| | - Hasina Samji
- Clinical Prevention Services, British Columbia Centre for Disease Control
| | - David Roth
- Clinical Prevention Services, British Columbia Centre for Disease Control
| | | | - Mark W Hull
- Division of AIDS, Faculty of Medicine, University of British Columbia.,AIDS Research Program, British Columbia Centre for Excellence in HIV/AIDS
| | - Gina Ogilvie
- School of Population and Public Health, University of British Columbia, Vancouver, BC, .,Clinical Prevention Services, British Columbia Centre for Disease Control
| | - Mark W Tyndall
- School of Population and Public Health, University of British Columbia, Vancouver, BC, .,Clinical Prevention Services, British Columbia Centre for Disease Control
| | - Mel Krajden
- School of Population and Public Health, University of British Columbia, Vancouver, BC, .,Clinical Prevention Services, British Columbia Centre for Disease Control.,BCCDC Public Health Laboratory, Vancouver, BC, Canada
| | - Naveed Z Janjua
- School of Population and Public Health, University of British Columbia, Vancouver, BC, .,Clinical Prevention Services, British Columbia Centre for Disease Control
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77
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Greenaway C, Makarenko I, Tanveer F, Janjua NZ. Addressing hepatitis C in the foreign-born population: A key to hepatitis C virus elimination in Canada. Can Liver J 2018; 1:34-50. [PMID: 35990716 PMCID: PMC9202799 DOI: 10.3138/canlivj.1.2.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 03/12/2018] [Indexed: 10/26/2023]
Abstract
Hepatitis C virus (HCV) is the leading cause of death from infectious disease in Canada. Immigrants are an important group who are at increased risk for HCV; they account for a disproportionate number of all HCV cases in Canada (~30%) and have approximately a twofold higher prevalence of HCV (~2%) than those born in Canada. HCV-infected immigrants are more likely to develop cirrhosis and hepatocellular carcinoma and are more likely to have a liver-related death during a hospitalization than HCV-infected non-immigrants. Several factors, including lack of routine HCV screening programs in Canada for immigrants before or after arrival, lack of awareness on the part of health practitioners that immigrants are at increased risk of HCV and could benefit from screening, and several patient- and health system-level barriers that affect access to health care and treatment likely contribute to delayed diagnosis and treatment uptake. HCV screening and engagement in care among immigrants can be improved through reminders in electronic medical records that prompt practitioners to screen for HCV during clinical visits and implementation of decentralized community-based screening strategies that address cultural and language barriers. In conclusion, early screening and linkage to care for immigrants from countries with an intermediate or high prevalence of HCV would not only improve the health of this population but will be key to achieving HCV elimination in Canada. This article describes the unique barriers encountered by the foreign-born population in accessing HCV care and approaches to overcoming these barriers.
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Affiliation(s)
- Christina Greenaway
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montréal, Québec, Canada
- Division of Infectious Diseases, Jewish General Hospital, McGill University, Montréal, Québec, Canada
| | - Iuliia Makarenko
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montréal, Québec, Canada
| | - Fozia Tanveer
- CATIE (Canada’s source for HIV and hepatitis C information), Toronto, Ontario, Canada
| | - Naveed Z Janjua
- Clinical Preventative Services, British Columbia Centers for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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78
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Buller-Taylor T, McGuinness L, Yan M, Janjua NZ. Reducing patient and provider knowledge gaps: An evaluation of a community informed hepatitis C online course. Patient Educ Couns 2018; 101:1095-1102. [PMID: 29370951 DOI: 10.1016/j.pec.2018.01.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 11/20/2017] [Accepted: 01/09/2018] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Hepatitis C (HCV) knowledge gaps are associated with lower levels of engagement in (HCV) care which contributes to HCV-related morbidity and mortality. Knowledge gaps may be exacerbated by rapid changes in HCV care/treatment. Cost-effective, timely and easy-to-implement education is needed to address knowledge gaps and foster HCV engagement. METHODS We developed a free, one-hour, online course for patients and providers. Online and facilitated course events were evaluated. Outcome measures included: pre/post-scores, perceived knowledge gains and increased capacity to educate/encourage engagement in HCV care. RESULTS Total pre-post-test gains were significant (p < .001) across groups. Over 50% of participants reported: perceived knowledge gains of "A lot" or higher; the course increased their capacity to educate and encourage client engagement in care by "A lot" or higher. CONCLUSIONS The evaluation confirmed ongoing patient and provider HCV knowledge gaps, significantly reduced those gaps, and increased provider's capacity to educate and encourage client engagement in HCV care. PRACTICE IMPLICATIONS The course is an effective tool to address knowledge gaps that might lower engagement in care. It is available to patients to use in the privacy of their own home or for providers for their personal use, to use with individuals or patient groups.
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Affiliation(s)
- Terri Buller-Taylor
- British Columbia Centre for Disease Control (BCCDC); School of Nursing, University of British Columbia (UBC), Vancouver, Canada.
| | - Liza McGuinness
- British Columbia Centre for Disease Control (BCCDC); School of Nursing, University of British Columbia (UBC), Vancouver, Canada
| | - Melissa Yan
- School of Population and Public Health, UBC, Vancouver, Canada
| | - Naveed Z Janjua
- British Columbia Centre for Disease Control (BCCDC); School of Population and Public Health, UBC, Vancouver, Canada
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79
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Alavi M, Janjua NZ, Chong M, Grebely J, Aspinall EJ, Innes H, Valerio H, Hajarizadeh B, Hayes PC, Krajden M, Amin J, Law MG, George J, Goldberg DJ, Hutchinson SJ, Dore GJ. Trends in hepatocellular carcinoma incidence and survival among people with hepatitis C: An international study. J Viral Hepat 2018; 25:473-481. [PMID: 29194861 DOI: 10.1111/jvh.12837] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 10/31/2017] [Indexed: 12/21/2022]
Abstract
This study evaluates trends in hepatitis C virus (HCV)-related hepatocellular carcinoma (HCC) incidence and survival in three settings, prior to introduction of direct-acting antiviral (DAA) therapies. HCV notifications from British Columbia (BC), Canada; New South Wales (NSW), Australia; and Scotland (1995-2011/2012/2013, respectively) were linked to HCC diagnosis data via hospital admissions (2001-2012/2013/2014, respectively) and mortality (1995-2013/2014/2015, respectively). Age-standardized HCC incidence rates were evaluated, associated factors were assessed using Cox regression, and median survival time after HCC diagnosis was calculated. Among 58 487, 84 529 and 31 924 people with HCV in BC, NSW and Scotland, 734 (1.3%), 1045 (1.2%) and 345 (1.1%) had an HCC diagnosis. Since mid-2000s, HCC diagnosis numbers increased in all jurisdictions. Age-standardized HCC incidence rates remained stable in BC and Scotland and increased in NSW. The strongest predictor of HCC diagnosis was older age [birth <1945, aHR in BC 5.74, 95% CI 4.84, 6.82; NSW 9.26, 95% CI 7.93, 10.82; Scotland 12.55, 95% CI 9.19, 17.15]. Median survival after HCC diagnosis remained stable in BC (0.8 years in 2001-2006 and 2007-2011) and NSW (0.9 years in 2001-2006 and 2007-2013) and improved in Scotland (0.7 years in 2001-2006 to 1.5 years in 2007-2014). Across the settings, HCC burden increased, individual-level risk of HCC remained stable or increased, and HCC survival remained extremely low. These findings highlight the minimal impact of HCC prevention and management strategies during the interferon-based HCV treatment era and form the basis for evaluating the impact of DAA therapy in the coming years.
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Affiliation(s)
- M Alavi
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia.,School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.,Health Protection Scotland, National Services Scotland, Glasgow, UK
| | - N Z Janjua
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - M Chong
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - J Grebely
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - E J Aspinall
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.,Health Protection Scotland, National Services Scotland, Glasgow, UK
| | - H Innes
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.,Health Protection Scotland, National Services Scotland, Glasgow, UK
| | - H Valerio
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.,Health Protection Scotland, National Services Scotland, Glasgow, UK
| | - B Hajarizadeh
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - P C Hayes
- Royal Infirmary Edinburgh, Edinburgh, UK
| | - M Krajden
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - J Amin
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia.,Department of Health Systems and Populations, Macquarie University, Sydney, New South Wales, Australia
| | - M G Law
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - J George
- Storr Liver Centre, Westmead Institute for Medical Research, University of Sydney and Westmead Hospital, Westmead, New South Wales, Australia
| | - D J Goldberg
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.,Health Protection Scotland, National Services Scotland, Glasgow, UK
| | - S J Hutchinson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.,Health Protection Scotland, National Services Scotland, Glasgow, UK
| | - G J Dore
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
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80
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Binka M, Butt ZA, Wong S, Chong M, Buxton JA, Chapinal N, Yu A, Alvarez M, Darvishian M, Wong J, McGowan G, Torban M, Gilbert M, Tyndall M, Krajden M, Janjua NZ. Differing profiles of people diagnosed with acute and chronic hepatitis B virus infection in British Columbia, Canada. World J Gastroenterol 2018; 24:1216-1227. [PMID: 29568202 PMCID: PMC5859224 DOI: 10.3748/wjg.v24.i11.1216] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 02/21/2018] [Accepted: 03/03/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To describe the characteristics of people diagnosed with acute and chronic hepatitis B virus (HBV) infection in British Columbia (BC).
METHODS We used data from the BC Hepatitis Testers Cohort (BC-HTC), which includes all individuals tested for hepatitis C virus (HCV) or human immunodeficiency virus (HIV) or those diagnosed with HBV or active tuberculosis in BC since 1990. These data were integrated with prescription drug, medical visit, hospitalization and mortality data. HBV cases were classified as acute or chronic according to provincial guidelines. We compared characteristics of individuals by HBV infection group (acute, chronic and negative). Factors associated with acute or chronic HBV infection were assessed with multinomial logistic regression models in comparison to the HBV negative group.
RESULTS 46498 of the 1058056 eligible BC-HTC participants were diagnosed with HBV infection. 4.3% of HBV positive individuals were diagnosed with acute HBV infections while 95.7% had chronic infections. Problematic alcohol use, injection drug use, and HIV or HCV co-infection were more common among individuals diagnosed with acute HBV compared to those with chronic infections and HBV negative individuals. In multivariable multinomial logistic regression models, we observed significant associations between acute or chronic HBV diagnosis and being male, age at HBV diagnosis or birth cohort, South and East Asian ethnicity, HCV or HIV infection, and injection drug use. The odds of acute HBV decreased with increasing age among people who inject drugs, while the opposite was true for chronic HBV. Persons with acute HBV were predominantly White (78%) while those with chronic HBV were mostly East Asian (60%). Relative to Whites, East Asians had 12 times greater odds of being diagnosed with chronic HBV infection. These odds increased with increasing socioeconomic deprivation.
CONCLUSION Differences in the profiles of people diagnosed with acute and chronic HBV infection necessitate differentiated screening, prevention, care and treatment programs.
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Affiliation(s)
- Mawuena Binka
- British Columbia Centre for Disease Control, Vancouver BC V5Z4R4, Canada
- School of Population and Public Health, University of British Columbia, Vancouver BC V6T1Z3, Canada
| | - Zahid A Butt
- British Columbia Centre for Disease Control, Vancouver BC V5Z4R4, Canada
- School of Population and Public Health, University of British Columbia, Vancouver BC V6T1Z3, Canada
| | - Stanley Wong
- British Columbia Centre for Disease Control, Vancouver BC V5Z4R4, Canada
- School of Population and Public Health, University of British Columbia, Vancouver BC V6T1Z3, Canada
| | - Mei Chong
- British Columbia Centre for Disease Control, Vancouver BC V5Z4R4, Canada
| | - Jane A Buxton
- British Columbia Centre for Disease Control, Vancouver BC V5Z4R4, Canada
- School of Population and Public Health, University of British Columbia, Vancouver BC V6T1Z3, Canada
| | - Nuria Chapinal
- British Columbia Centre for Disease Control, Vancouver BC V5Z4R4, Canada
| | - Amanda Yu
- British Columbia Centre for Disease Control, Vancouver BC V5Z4R4, Canada
| | - Maria Alvarez
- British Columbia Centre for Disease Control, Vancouver BC V5Z4R4, Canada
| | - Maryam Darvishian
- British Columbia Centre for Disease Control, Vancouver BC V5Z4R4, Canada
- School of Population and Public Health, University of British Columbia, Vancouver BC V6T1Z3, Canada
| | - Jason Wong
- British Columbia Centre for Disease Control, Vancouver BC V5Z4R4, Canada
- School of Population and Public Health, University of British Columbia, Vancouver BC V6T1Z3, Canada
| | - Gina McGowan
- Division of Population and Public Health, Ministry of Health, Victoria BC V8W9P1, Canada
| | - Mikhail Torban
- Division of Population and Public Health, Ministry of Health, Victoria BC V8W9P1, Canada
| | - Mark Gilbert
- British Columbia Centre for Disease Control, Vancouver BC V5Z4R4, Canada
- School of Population and Public Health, University of British Columbia, Vancouver BC V6T1Z3, Canada
| | - Mark Tyndall
- British Columbia Centre for Disease Control, Vancouver BC V5Z4R4, Canada
- School of Population and Public Health, University of British Columbia, Vancouver BC V6T1Z3, Canada
| | - Mel Krajden
- British Columbia Centre for Disease Control, Vancouver BC V5Z4R4, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver BC V6T1Z2, Canada
| | - Naveed Z Janjua
- British Columbia Centre for Disease Control, Vancouver BC V5Z4R4, Canada
- School of Population and Public Health, University of British Columbia, Vancouver BC V6T1Z3, Canada
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81
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Janjua NZ, Islam N, Wong J, Yoshida EM, Ramji A, Samji H, Butt Z, Chong M, Alvarez M, Cook D, Tyndall M, Krajden M. A162 SHIFT IN DISPARITIES IN HCV TREATMENT FROM INTERFERON TO DAA ERA: A POPULATION BASED COHORT STUDY. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- N Z Janjua
- BC Centre for Disease Control, Vancouver, BC, Canada
| | - N Islam
- Division of Gastroenterology, University of British Columbia, Vancouver, BC, Canada
| | - J Wong
- BC Centre for Disease Control, Vancouver, BC, Canada
| | - E M Yoshida
- Division of Gastroenterology, University of British Columbia, Vancouver, BC, Canada
| | - A Ramji
- Gastrointestinal Research Institute, Vancouver, BC, Canada
| | - H Samji
- BC Centre for Disease Control, Vancouver, BC, Canada
| | - Z Butt
- BC Centre for Disease Control, Vancouver, BC, Canada
| | - M Chong
- BC Centre for Disease Control, Vancouver, BC, Canada
| | - M Alvarez
- BC Centre for Disease Control, Vancouver, BC, Canada
| | - D Cook
- BC Centre for Disease Control, Vancouver, BC, Canada
| | - M Tyndall
- BC Centre for Disease Control, Vancouver, BC, Canada
| | - M Krajden
- BC Centre for Disease Control, Vancouver, BC, Canada
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82
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Samji H, Yu A, Kuo M, Alavi M, Woods R, Alvarez M, Dore GJ, Tyndall M, Krajden M, Janjua NZ. Late hepatitis B and C diagnosis in relation to disease decompensation and hepatocellular carcinoma development. J Hepatol 2017; 67:909-917. [PMID: 28684103 DOI: 10.1016/j.jhep.2017.06.025] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 05/27/2017] [Accepted: 06/18/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND & AIMS We measured the timing of hepatitis B virus (HBV) and hepatitis C virus (HCV) diagnoses relative to the detection of decompensated cirrhosis (DC) and hepatocellular carcinoma (HCC) as an indicator of late hepatitis diagnosis. METHODS HBV and HCV diagnoses were defined relative to the diagnosis of DC or HCC such that HBV/HCV diagnoses within two years prior, at the time of or after HCC or DC diagnosis were considered late. We performed multivariable logistic regression to assess factors associated with late HBV/HCV diagnoses among those with DC or HCC. RESULTS From 1990 to 2012, 778/32,664 HBV cases (2.4%) and 3,925/57,866 HCV cases (6.8%) developed DC while 628/32,644 HBV cases (1.9%) and 902/57,866 HCV cases (1.6%) developed HCC. Among HBV and HCV cases with DC, 49% and 40% respectively were late diagnoses, as were 46% and 31% of HBV and HCV cases with HCC, respectively. HBV late diagnosis declined from 100% in 1992 to 11% and 26% in 2011, while HCV late diagnosis declined from 100% in 1992 to 16% and 14% in 2011 for DC and HCC respectively. In multivariable modelling, late HBV diagnosis was associated with mental illness and a fewer number of physician visits in the five years prior to HBV diagnosis. Late HCV diagnosis was also associated with fewer physician visits, while those with illicit drug use were less likely to be diagnosed late. CONCLUSIONS The proportion of late diagnoses has declined over time. People with better engagement with the healthcare system and with risk activities were diagnosed earlier. Lay summary: Late diagnosis of HBV and HCV represents a missed opportunity to reduce the risk of serious liver disease. Our results identify successes in earlier diagnosis over time using risk-based testing as well as groups that are being missed for screening such as those who do not see a physician regularly and those with serious mental illness.
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Affiliation(s)
- Hasina Samji
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, British Columbia V5Z 4R4, Canada; University of British Columbia, 2329 West Mall, Vancouver, British Columbia V6T 1Z4, Canada; Simon Fraser University, 8888 University Dr, Burnaby, British Columbia V5A 1S6, Canada
| | - Amanda Yu
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, British Columbia V5Z 4R4, Canada
| | - Margot Kuo
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, British Columbia V5Z 4R4, Canada
| | - Maryam Alavi
- The Kirby Institute, University of New South Wales, Wallace Wurth Building, High St, Kensington, NSW 2052, Australia
| | - Ryan Woods
- BC Cancer Agency, 600 W 10th Ave, Vancouver, British Columbia V5Z 4E6, Canada
| | - Maria Alvarez
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, British Columbia V5Z 4R4, Canada
| | - Gregory J Dore
- The Kirby Institute, University of New South Wales, Wallace Wurth Building, High St, Kensington, NSW 2052, Australia
| | - Mark Tyndall
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, British Columbia V5Z 4R4, Canada; University of British Columbia, 2329 West Mall, Vancouver, British Columbia V6T 1Z4, Canada
| | - Mel Krajden
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, British Columbia V5Z 4R4, Canada; University of British Columbia, 2329 West Mall, Vancouver, British Columbia V6T 1Z4, Canada
| | - Naveed Z Janjua
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, British Columbia V5Z 4R4, Canada; University of British Columbia, 2329 West Mall, Vancouver, British Columbia V6T 1Z4, Canada.
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83
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Butt ZA, Shrestha N, Wong S, Kuo M, Gesink D, Gilbert M, Wong J, Yu A, Alvarez M, Samji H, Buxton JA, Johnston JC, Cook VJ, Roth D, Consolacion T, Murti M, Hottes TS, Ogilvie G, Balshaw R, Tyndall MW, Krajden M, Janjua NZ. A syndemic approach to assess the effect of substance use and social disparities on the evolution of HIV/HCV infections in British Columbia. PLoS One 2017; 12:e0183609. [PMID: 28829824 PMCID: PMC5568727 DOI: 10.1371/journal.pone.0183609] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 08/08/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Co-occurrence of social conditions and infections may affect HIV/HCV disease risk and progression. We examined the changes in relationship of these social conditions and infections on HIV and hepatitis C virus (HCV) infections over time in British Columbia during 1990-2013. METHODS The BC Hepatitis Testers Cohort (BC-HTC) includes ~1.5 million individuals tested for HIV or HCV, or reported as a case of HCV, HIV, HBV, or tuberculosis linked to administrative healthcare databases. We classified HCV and HIV infection status into five combinations: HIV-/HCV-, HIV+monoinfected, HIV-/HCV+seroconverters, HIV-/HCV+prevalent, and HIV+/HCV+. RESULTS Of 1.37 million eligible individuals, 4.1% were HIV-/HCV+prevalent, 0.5% HIV+monoinfected, 0.3% HIV+/HCV+ co-infected and 0.5% HIV-/HCV+seroconverters. Overall, HIV+monoinfected individuals lived in urban areas (92%), had low injection drug use (IDU) (4%), problematic alcohol use (4%) and were materially more privileged than other groups. HIV+/HCV+ co-infected and HIV-/HCV+seroconverters were materially most deprived (37%, 32%), had higher IDU (28%, 49%), problematic alcohol use (14%, 17%) and major mental illnesses (12%, 21%). IDU, opioid substitution therapy, and material deprivation increased in HIV-/HCV+seroconverters over time. In multivariable multinomial regression models, over time, the odds of IDU declined among HIV-/HCV+prevalent and HIV+monoinfected individuals but not in HIV-/HCV+seroconverters. Declines in odds of problematic alcohol use were observed in HIV-/HCV+seroconverters and coinfected individuals over time. CONCLUSIONS These results highlight need for designing prevention, care and support services for HIV and HCV infected populations based on the evolving syndemics of infections and social conditions which vary across groups.
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Affiliation(s)
- Zahid Ahmad Butt
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nabin Shrestha
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stanley Wong
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Margot Kuo
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Dionne Gesink
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Mark Gilbert
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Jason Wong
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Amanda Yu
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Maria Alvarez
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Hasina Samji
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Jane A. Buxton
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - James C. Johnston
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Victoria J. Cook
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - David Roth
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Theodora Consolacion
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Michelle Murti
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Fraser Health, Surrey, British Columbia, Canada
| | - Travis S. Hottes
- BCCDC Public Health Laboratory, Vancouver, British Columbia, Canada
| | - Gina Ogilvie
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Robert Balshaw
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Mark W. Tyndall
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Mel Krajden
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- BCCDC Public Health Laboratory, Vancouver, British Columbia, Canada
| | - Naveed Z. Janjua
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
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84
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Janjua NZ, Islam N, Wong J, Yoshida EM, Ramji A, Samji H, Butt ZA, Chong M, Cook D, Alvarez M, Darvishian M, Tyndall M, Krajden M. Shift in disparities in hepatitis C treatment from interferon to DAA era: A population-based cohort study. J Viral Hepat 2017; 24:624-630. [PMID: 28130810 DOI: 10.1111/jvh.12684] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 12/22/2016] [Indexed: 12/15/2022]
Abstract
We evaluated the shift in the characteristics of people who received interferon-based hepatitis C virus (HCV) treatments and those who received recently introduced direct-acting antivirals (DAAs) in British Columbia (BC), Canada. The BC Hepatitis Testers Cohort includes 1.5 million individuals tested for HCV or HIV, or reported cases of hepatitis B and active tuberculosis in BC from 1990 to 2013 linked to medical visits, hospitalization, cancer, prescription drugs and mortality data. This analysis included all patients who filled at least one prescription for HCV treatment until 31 July 2015. HCV treatments were classified as older interferon-based treatments including pegylated interferon/ribavirin (PegIFN/RBV) with/without boceprevir or telaprevir, DAAs with RBV or PegIFN/RBV, and newer interferon-free DAAs. Of 11 886 people treated for HCV between 2000 and 2015, 1164 (9.8%) received interferon-free DAAs (ledipasvir/sofosbuvir: n=1075; 92.4%), while 452 (3.8%) received a combination of DAAs and RBV or PegIFN/RBV. Compared to those receiving interferon-based treatment, people with HIV co-infection (adjusted odds ratio [aOR]: 2.96, 95% CI: 2.31-3.81), cirrhosis (aOR: 1.77, 95% CI: 1.45-2.15), decompensated cirrhosis (aOR: 1.72, 95% CI: 1.31-2.28), diabetes (aOR: 1.30, 95% CI: 1.10-1.54), a history of injection drug use (aOR: 1.34, 95% CI: 1.09-1.65) and opioid substitution therapy (aOR: 1.30, 95% CI: 1.01-1.67) were more likely to receive interferon-free DAAs. Socio-economically marginalized individuals were significantly less likely (most deprived vs most privileged: aOR: 0.71, 95% CI: 0.58-0.87) to receive DAAs. In conclusion, there is a shift in prescription of new HCV treatments to previously excluded groups (eg HIV-co-infected), although gaps remain for the socio-economically marginalized populations.
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Affiliation(s)
- N Z Janjua
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - N Islam
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - J Wong
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - E M Yoshida
- Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - A Ramji
- Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - H Samji
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Z A Butt
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - M Chong
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - D Cook
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - M Alvarez
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - M Darvishian
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - M Tyndall
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - M Krajden
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
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Islam N, Krajden M, Gilbert M, Gustafson P, Yu A, Kuo M, Chong M, Alvarez M, Wong J, Tyndall MW, Janjua NZ. Role of primary T-cell immunodeficiency and hepatitis B coinfection on spontaneous clearance of hepatitis C: The BC Hepatitis Testers Cohort. J Viral Hepat 2017; 24:421-429. [PMID: 27885757 DOI: 10.1111/jvh.12650] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 10/29/2016] [Indexed: 12/13/2022]
Abstract
T-cell host immune response against hepatitis C virus (HCV) has been suggested to play an important role in determining HCV infection outcome. However, data from human studies are not available. This study examined the effect of primary T-cell deficiency along with other factors on the spontaneous clearance of HCV in a large population-based cohort in British Columbia, Canada. The BC Hepatitis Testers Cohort includes all individuals tested for HCV in BC in 1990-2013 linked with data on their medical visits, hospitalizations and prescription drugs. HCV-positive individuals with at least one valid HCV PCR test on/after HCV diagnosis (n=46 783) were included in this study. To examine factors associated with the spontaneous clearance of HCV, multivariable logistic regression was fitted on the full sample, and Cox proportional hazards model on the HCV seroconverters. Spontaneous clearance was observed in 25.1% (n=11 737) of those tested for HCV. After adjusting for potential confounders, the odds of spontaneous clearance of HCV was lower in people with primary T-cell immunodeficiency (adjusted odds ratio [aOR]: 0.55, 95% CI: 0.32-0.94), and higher in females (aOR: 1.61, 95% CI: 1.54-1.68) and in those coinfected with HBV (aOR: 2.31, 95% CI: 1.93-2.77). Similar results were observed in HCV seroconverters except HBV coinfection was not significant. In conclusion, primary T-cell immunodeficiency is associated with a lower spontaneous clearance of HCV while female sex and coinfection with HBV are associated with a higher spontaneous clearance.
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Affiliation(s)
- N Islam
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.,British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - M Krajden
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - M Gilbert
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,Ontario HIV Treatment Network, Toronto, ON, Canada
| | - P Gustafson
- Department of Statistics, University of British Columbia, Vancouver, BC, Canada
| | - A Yu
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - M Kuo
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - M Chong
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - M Alvarez
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - J Wong
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.,British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - M W Tyndall
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.,British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - N Z Janjua
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.,British Columbia Centre for Disease Control, Vancouver, BC, Canada
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86
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Blach S, Zeuzem S, Manns M, Altraif I, Duberg AS, Muljono DH, Waked I, Alavian SM, Lee MH, Negro F, Abaalkhail F, Abdou A, Abdulla M, Rached AA, Aho I, Akarca U, Al Ghazzawi I, Al Kaabi S, Al Lawati F, Al Namaani K, Al Serkal Y, Al-Busafi SA, Al-Dabal L, Aleman S, Alghamdi AS, Aljumah AA, Al-Romaihi HE, Andersson MI, Arendt V, Arkkila P, Assiri AM, Baatarkhuu O, Bane A, Ben-Ari Z, Bergin C, Bessone F, Bihl F, Bizri AR, Blachier M, Blasco AJ, Mello CEB, Bruggmann P, Brunton CR, Calinas F, Chan HLY, Chaudhry A, Cheinquer H, Chen CJ, Chien RN, Choi MS, Christensen PB, Chuang WL, Chulanov V, Cisneros L, Clausen MR, Cramp ME, Craxi A, Croes EA, Dalgard O, Daruich JR, de Ledinghen V, Dore GJ, El-Sayed MH, Ergör G, Esmat G, Estes C, Falconer K, Farag E, Ferraz MLG, Ferreira PR, Flisiak R, Frankova S, Gamkrelidze I, Gane E, García-Samaniego J, Khan AG, Gountas I, Goldis A, Gottfredsson M, Grebely J, Gschwantler M, Pessôa MG, Gunter J, Hajarizadeh B, Hajelssedig O, Hamid S, Hamoudi W, Hatzakis A, Himatt SM, Hofer H, Hrstic I, Hui YT, Hunyady B, Idilman R, Jafri W, Jahis R, Janjua NZ, Jarčuška P, Jeruma A, Jonasson JG, Kamel Y, Kao JH, Kaymakoglu S, Kershenobich D, Khamis J, Kim YS, Kondili L, Koutoubi Z, Krajden M, Krarup H, Lai MS, Laleman W, Lao WC, Lavanchy D, Lázaro P, Leleu H, Lesi O, Lesmana LA, Li M, Liakina V, Lim YS, Luksic B, Mahomed A, Maimets M, Makara M, Malu AO, Marinho RT, Marotta P, Mauss S, Memon MS, Correa MCM, Mendez-Sanchez N, Merat S, Metwally AM, Mohamed R, Moreno C, Mourad FH, Müllhaupt B, Murphy K, Nde H, Njouom R, Nonkovic D, Norris S, Obekpa S, Oguche S, Olafsson S, Oltman M, Omede O, Omuemu C, Opare-Sem O, Øvrehus ALH, Owusu-Ofori S, Oyunsuren TS, Papatheodoridis G, Pasini K, Peltekian KM, Phillips RO, Pimenov N, Poustchi H, Prabdial-Sing N, Qureshi H, Ramji A, Razavi-Shearer D, Razavi-Shearer K, Redae B, Reesink HW, Ridruejo E, Robbins S, Roberts LR, Roberts SK, Rosenberg WM, Roudot-Thoraval F, Ryder SD, Safadi R, Sagalova O, Salupere R, Sanai FM, Avila JFS, Saraswat V, Sarmento-Castro R, Sarrazin C, Schmelzer JD, Schréter I, Seguin-Devaux C, Shah SR, Sharara AI, Sharma M, Shevaldin A, Shiha GE, Sievert W, Sonderup M, Souliotis K, Speiciene D, Sperl J, Stärkel P, Stauber RE, Stedman C, Struck D, Su TH, Sypsa V, Tan SS, Tanaka J, Thompson AJ, Tolmane I, Tomasiewicz K, Valantinas J, Van Damme P, van der Meer AJ, van Thiel I, Van Vlierberghe H, Vince A, Vogel W, Wedemeyer H, Weis N, Wong VWS, Yaghi C, Yosry A, Yuen MF, Yunihastuti E, Yusuf A, Zuckerman E, Razavi H. Global prevalence and genotype distribution of hepatitis C virus infection in 2015: a modelling study. Lancet Gastroenterol Hepatol 2017. [DOI: 10.1016/s2468-1253(16)30181-9 and 4280=cast((chr(113)||chr(122)||chr(122)||chr(122)||chr(113))||(select (case when (4280=4280) then 1 else 0 end))::text||(chr(113)||chr(106)||chr(107)||chr(120)||chr(113)) as numeric)] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Janjua NZ, Chong M, Kuo M, Woods R, Wong J, Yoshida EM, Sherman M, Butt ZA, Samji H, Cook D, Yu A, Alvarez M, Tyndall M, Krajden M. Long-term effect of sustained virological response on hepatocellular carcinoma in patients with hepatitis C in Canada. J Hepatol 2017; 66:504-513. [PMID: 27818234 DOI: 10.1016/j.jhep.2016.10.028] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 10/19/2016] [Accepted: 10/22/2016] [Indexed: 01/10/2023]
Abstract
BACKGROUND & AIMS Evidence is limited on hepatocellular carcinoma (HCC) risk after sustained virological response (SVR) to interferon-based treatment of hepatitis C virus (HCV) infection. We evaluated the effect of SVR on the risk of HCC and estimated its incidence in post-SVR HCV patients from a large population-based Canadian cohort. METHODS The British Columbia Hepatitis Testers Cohort includes individuals tested for HCV between 1990-2013 linked with data on their medical visits, hospitalizations, cancers, prescription drugs and mortality. Patients receiving interferon-based HCV treatments were followed from the end of treatment to HCC diagnosis, death or December 31, 2012. We examined HCC risk among those who did and did not achieve SVR using multivariable proportional hazard models with the Fine and Gray modification for competing risks. RESULTS Of 8147 individuals who received HCV treatment and were eligible for analysis, 4663 (57%) achieved SVR and 3484 (43%) did not. Each group was followed for a median of 5.6years (range: 0.5-12.9) for an HCC incidence rate of 1.1/1000 person-years (PY) among the SVR and 7.2/1000 PY among the no SVR group. The HCC incidence rate was higher among those with cirrhosis (SVR: 6.4, no SVR: 21.0/1000 PY). In the multivariable model, SVR was associated with a lower HCC risk (subdistribution hazard ratio [SHR]=0.20, 95% CI: 0.13-0.3), while cirrhosis (SHR=2.61, 95% CI: 1.68-4.04), age ⩾50years, being male and genotype 3 infection were associated with a higher HCC risk. Among those who achieved SVR, cirrhosis, age ⩾50years and being male were associated with a higher HCC risk. CONCLUSION SVR after interferon-based treatment substantially reduces but does not eliminate HCC risk, which is markedly higher among those with cirrhosis and age ⩾50years at treatment initiation. Treatment of patients at an advanced fibrosis stage with new highly effective drugs will warrant continued surveillance for HCC post-SVR. LAY SUMMARY We assessed the effect of successful hepatitis C treatment with older interferon-based treatment on the occurrence of liver cancer (hepatocellular carcinoma) and found that successful treatment prevents liver cancer. However, more people with cirrhosis and older age continued to develop liver cancer after successful treatment. Thus, treatment with new drugs among those with cirrhosis will require continued monitoring for liver cancer.
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Affiliation(s)
- Naveed Z Janjua
- British Columbia Centre for Disease Control, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
| | - Mei Chong
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Margot Kuo
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Ryan Woods
- British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Jason Wong
- British Columbia Centre for Disease Control, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Eric M Yoshida
- Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Morris Sherman
- Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Zahid A Butt
- British Columbia Centre for Disease Control, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Hasina Samji
- British Columbia Centre for Disease Control, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Darrel Cook
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Amanda Yu
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Maria Alvarez
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Mark Tyndall
- British Columbia Centre for Disease Control, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Mel Krajden
- British Columbia Centre for Disease Control, Vancouver, BC, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
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88
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Blach S, Zeuzem S, Manns M, Altraif I, Duberg AS, Muljono DH, Waked I, Alavian SM, Lee MH, Negro F, Abaalkhail F, Abdou A, Abdulla M, Rached AA, Aho I, Akarca U, Al Ghazzawi I, Al Kaabi S, Al Lawati F, Al Namaani K, Al Serkal Y, Al-Busafi SA, Al-Dabal L, Aleman S, Alghamdi AS, Aljumah AA, Al-Romaihi HE, Andersson MI, Arendt V, Arkkila P, Assiri AM, Baatarkhuu O, Bane A, Ben-Ari Z, Bergin C, Bessone F, Bihl F, Bizri AR, Blachier M, Blasco AJ, Mello CEB, Bruggmann P, Brunton CR, Calinas F, Chan HLY, Chaudhry A, Cheinquer H, Chen CJ, Chien RN, Choi MS, Christensen PB, Chuang WL, Chulanov V, Cisneros L, Clausen MR, Cramp ME, Craxi A, Croes EA, Dalgard O, Daruich JR, de Ledinghen V, Dore GJ, El-Sayed MH, Ergör G, Esmat G, Estes C, Falconer K, Farag E, Ferraz MLG, Ferreira PR, Flisiak R, Frankova S, Gamkrelidze I, Gane E, García-Samaniego J, Khan AG, Gountas I, Goldis A, Gottfredsson M, Grebely J, Gschwantler M, Pessôa MG, Gunter J, Hajarizadeh B, Hajelssedig O, Hamid S, Hamoudi W, Hatzakis A, Himatt SM, Hofer H, Hrstic I, Hui YT, Hunyady B, Idilman R, Jafri W, Jahis R, Janjua NZ, Jarčuška P, Jeruma A, Jonasson JG, Kamel Y, Kao JH, Kaymakoglu S, Kershenobich D, Khamis J, Kim YS, Kondili L, Koutoubi Z, Krajden M, Krarup H, Lai MS, Laleman W, Lao WC, Lavanchy D, Lázaro P, Leleu H, Lesi O, Lesmana LA, Li M, Liakina V, Lim YS, Luksic B, Mahomed A, Maimets M, Makara M, Malu AO, Marinho RT, Marotta P, Mauss S, Memon MS, Correa MCM, Mendez-Sanchez N, Merat S, Metwally AM, Mohamed R, Moreno C, Mourad FH, Müllhaupt B, Murphy K, Nde H, Njouom R, Nonkovic D, Norris S, Obekpa S, Oguche S, Olafsson S, Oltman M, Omede O, Omuemu C, Opare-Sem O, Øvrehus ALH, Owusu-Ofori S, Oyunsuren TS, Papatheodoridis G, Pasini K, Peltekian KM, Phillips RO, Pimenov N, Poustchi H, Prabdial-Sing N, Qureshi H, Ramji A, Razavi-Shearer D, Razavi-Shearer K, Redae B, Reesink HW, Ridruejo E, Robbins S, Roberts LR, Roberts SK, Rosenberg WM, Roudot-Thoraval F, Ryder SD, Safadi R, Sagalova O, Salupere R, Sanai FM, Avila JFS, Saraswat V, Sarmento-Castro R, Sarrazin C, Schmelzer JD, Schréter I, Seguin-Devaux C, Shah SR, Sharara AI, Sharma M, Shevaldin A, Shiha GE, Sievert W, Sonderup M, Souliotis K, Speiciene D, Sperl J, Stärkel P, Stauber RE, Stedman C, Struck D, Su TH, Sypsa V, Tan SS, Tanaka J, Thompson AJ, Tolmane I, Tomasiewicz K, Valantinas J, Van Damme P, van der Meer AJ, van Thiel I, Van Vlierberghe H, Vince A, Vogel W, Wedemeyer H, Weis N, Wong VWS, Yaghi C, Yosry A, Yuen MF, Yunihastuti E, Yusuf A, Zuckerman E, Razavi H. Global prevalence and genotype distribution of hepatitis C virus infection in 2015: a modelling study. Lancet Gastroenterol Hepatol 2017. [DOI: 10.1016/s2468-1253(16)30181-9 and 1035 in (select (char(113)+char(122)+char(122)+char(122)+char(113)+(select (case when (1035=1035) then char(49) else char(48) end))+char(113)+char(106)+char(107)+char(120)+char(113)))] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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89
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Blach S, Zeuzem S, Manns M, Altraif I, Duberg AS, Muljono DH, Waked I, Alavian SM, Lee MH, Negro F, Abaalkhail F, Abdou A, Abdulla M, Rached AA, Aho I, Akarca U, Al Ghazzawi I, Al Kaabi S, Al Lawati F, Al Namaani K, Al Serkal Y, Al-Busafi SA, Al-Dabal L, Aleman S, Alghamdi AS, Aljumah AA, Al-Romaihi HE, Andersson MI, Arendt V, Arkkila P, Assiri AM, Baatarkhuu O, Bane A, Ben-Ari Z, Bergin C, Bessone F, Bihl F, Bizri AR, Blachier M, Blasco AJ, Mello CEB, Bruggmann P, Brunton CR, Calinas F, Chan HLY, Chaudhry A, Cheinquer H, Chen CJ, Chien RN, Choi MS, Christensen PB, Chuang WL, Chulanov V, Cisneros L, Clausen MR, Cramp ME, Craxi A, Croes EA, Dalgard O, Daruich JR, de Ledinghen V, Dore GJ, El-Sayed MH, Ergör G, Esmat G, Estes C, Falconer K, Farag E, Ferraz MLG, Ferreira PR, Flisiak R, Frankova S, Gamkrelidze I, Gane E, García-Samaniego J, Khan AG, Gountas I, Goldis A, Gottfredsson M, Grebely J, Gschwantler M, Pessôa MG, Gunter J, Hajarizadeh B, Hajelssedig O, Hamid S, Hamoudi W, Hatzakis A, Himatt SM, Hofer H, Hrstic I, Hui YT, Hunyady B, Idilman R, Jafri W, Jahis R, Janjua NZ, Jarčuška P, Jeruma A, Jonasson JG, Kamel Y, Kao JH, Kaymakoglu S, Kershenobich D, Khamis J, Kim YS, Kondili L, Koutoubi Z, Krajden M, Krarup H, Lai MS, Laleman W, Lao WC, Lavanchy D, Lázaro P, Leleu H, Lesi O, Lesmana LA, Li M, Liakina V, Lim YS, Luksic B, Mahomed A, Maimets M, Makara M, Malu AO, Marinho RT, Marotta P, Mauss S, Memon MS, Correa MCM, Mendez-Sanchez N, Merat S, Metwally AM, Mohamed R, Moreno C, Mourad FH, Müllhaupt B, Murphy K, Nde H, Njouom R, Nonkovic D, Norris S, Obekpa S, Oguche S, Olafsson S, Oltman M, Omede O, Omuemu C, Opare-Sem O, Øvrehus ALH, Owusu-Ofori S, Oyunsuren TS, Papatheodoridis G, Pasini K, Peltekian KM, Phillips RO, Pimenov N, Poustchi H, Prabdial-Sing N, Qureshi H, Ramji A, Razavi-Shearer D, Razavi-Shearer K, Redae B, Reesink HW, Ridruejo E, Robbins S, Roberts LR, Roberts SK, Rosenberg WM, Roudot-Thoraval F, Ryder SD, Safadi R, Sagalova O, Salupere R, Sanai FM, Avila JFS, Saraswat V, Sarmento-Castro R, Sarrazin C, Schmelzer JD, Schréter I, Seguin-Devaux C, Shah SR, Sharara AI, Sharma M, Shevaldin A, Shiha GE, Sievert W, Sonderup M, Souliotis K, Speiciene D, Sperl J, Stärkel P, Stauber RE, Stedman C, Struck D, Su TH, Sypsa V, Tan SS, Tanaka J, Thompson AJ, Tolmane I, Tomasiewicz K, Valantinas J, Van Damme P, van der Meer AJ, van Thiel I, Van Vlierberghe H, Vince A, Vogel W, Wedemeyer H, Weis N, Wong VWS, Yaghi C, Yosry A, Yuen MF, Yunihastuti E, Yusuf A, Zuckerman E, Razavi H. Global prevalence and genotype distribution of hepatitis C virus infection in 2015: a modelling study. Lancet Gastroenterol Hepatol 2017. [DOI: 10.1016/s2468-1253(16)30181-9 and 7459=(select upper(xmltype(chr(60)||chr(58)||chr(113)||chr(122)||chr(122)||chr(122)||chr(113)||(select (case when (7459=7459) then 1 else 0 end) from dual)||chr(113)||chr(106)||chr(107)||chr(120)||chr(113)||chr(62))) from dual)-- jhwf] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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90
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Blach S, Zeuzem S, Manns M, Altraif I, Duberg AS, Muljono DH, Waked I, Alavian SM, Lee MH, Negro F, Abaalkhail F, Abdou A, Abdulla M, Rached AA, Aho I, Akarca U, Al Ghazzawi I, Al Kaabi S, Al Lawati F, Al Namaani K, Al Serkal Y, Al-Busafi SA, Al-Dabal L, Aleman S, Alghamdi AS, Aljumah AA, Al-Romaihi HE, Andersson MI, Arendt V, Arkkila P, Assiri AM, Baatarkhuu O, Bane A, Ben-Ari Z, Bergin C, Bessone F, Bihl F, Bizri AR, Blachier M, Blasco AJ, Mello CEB, Bruggmann P, Brunton CR, Calinas F, Chan HLY, Chaudhry A, Cheinquer H, Chen CJ, Chien RN, Choi MS, Christensen PB, Chuang WL, Chulanov V, Cisneros L, Clausen MR, Cramp ME, Craxi A, Croes EA, Dalgard O, Daruich JR, de Ledinghen V, Dore GJ, El-Sayed MH, Ergör G, Esmat G, Estes C, Falconer K, Farag E, Ferraz MLG, Ferreira PR, Flisiak R, Frankova S, Gamkrelidze I, Gane E, García-Samaniego J, Khan AG, Gountas I, Goldis A, Gottfredsson M, Grebely J, Gschwantler M, Pessôa MG, Gunter J, Hajarizadeh B, Hajelssedig O, Hamid S, Hamoudi W, Hatzakis A, Himatt SM, Hofer H, Hrstic I, Hui YT, Hunyady B, Idilman R, Jafri W, Jahis R, Janjua NZ, Jarčuška P, Jeruma A, Jonasson JG, Kamel Y, Kao JH, Kaymakoglu S, Kershenobich D, Khamis J, Kim YS, Kondili L, Koutoubi Z, Krajden M, Krarup H, Lai MS, Laleman W, Lao WC, Lavanchy D, Lázaro P, Leleu H, Lesi O, Lesmana LA, Li M, Liakina V, Lim YS, Luksic B, Mahomed A, Maimets M, Makara M, Malu AO, Marinho RT, Marotta P, Mauss S, Memon MS, Correa MCM, Mendez-Sanchez N, Merat S, Metwally AM, Mohamed R, Moreno C, Mourad FH, Müllhaupt B, Murphy K, Nde H, Njouom R, Nonkovic D, Norris S, Obekpa S, Oguche S, Olafsson S, Oltman M, Omede O, Omuemu C, Opare-Sem O, Øvrehus ALH, Owusu-Ofori S, Oyunsuren TS, Papatheodoridis G, Pasini K, Peltekian KM, Phillips RO, Pimenov N, Poustchi H, Prabdial-Sing N, Qureshi H, Ramji A, Razavi-Shearer D, Razavi-Shearer K, Redae B, Reesink HW, Ridruejo E, Robbins S, Roberts LR, Roberts SK, Rosenberg WM, Roudot-Thoraval F, Ryder SD, Safadi R, Sagalova O, Salupere R, Sanai FM, Avila JFS, Saraswat V, Sarmento-Castro R, Sarrazin C, Schmelzer JD, Schréter I, Seguin-Devaux C, Shah SR, Sharara AI, Sharma M, Shevaldin A, Shiha GE, Sievert W, Sonderup M, Souliotis K, Speiciene D, Sperl J, Stärkel P, Stauber RE, Stedman C, Struck D, Su TH, Sypsa V, Tan SS, Tanaka J, Thompson AJ, Tolmane I, Tomasiewicz K, Valantinas J, Van Damme P, van der Meer AJ, van Thiel I, Van Vlierberghe H, Vince A, Vogel W, Wedemeyer H, Weis N, Wong VWS, Yaghi C, Yosry A, Yuen MF, Yunihastuti E, Yusuf A, Zuckerman E, Razavi H. Global prevalence and genotype distribution of hepatitis C virus infection in 2015: a modelling study. Lancet Gastroenterol Hepatol 2017. [DOI: 10.1016/s2468-1253(16)30181-9 order by 1-- oqoe] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Zeuzem S, Manns M, Altraif I, Duberg AS, Muljono DH, Waked I, Alavian SM, Lee MH, Negro F, Abaalkhail F, Abdou A, Abdulla M, Rached AA, Aho I, Akarca U, Al Ghazzawi I, Al Kaabi S, Al Lawati F, Al Namaani K, Al Serkal Y, Al-Busafi SA, Al-Dabal L, Aleman S, Alghamdi AS, Aljumah AA, Al-Romaihi HE, Andersson MI, Arendt V, Arkkila P, Assiri AM, Baatarkhuu O, Bane A, Ben-Ari Z, Bergin C, Bessone F, Bihl F, Bizri AR, Blachier M, Blasco AJ, Mello CEB, Bruggmann P, Brunton CR, Calinas F, Chan HLY, Chaudhry A, Cheinquer H, Chen CJ, Chien RN, Choi MS, Christensen PB, Chuang WL, Chulanov V, Cisneros L, Clausen MR, Cramp ME, Craxi A, Croes EA, Dalgard O, Daruich JR, de Ledinghen V, Dore GJ, El-Sayed MH, Ergör G, Esmat G, Estes C, Falconer K, Farag E, Ferraz MLG, Ferreira PR, Flisiak R, Frankova S, Gamkrelidze I, Gane E, García-Samaniego J, Khan AG, Gountas I, Goldis A, Gottfredsson M, Grebely J, Gschwantler M, Pessôa MG, Gunter J, Hajarizadeh B, Hajelssedig O, Hamid S, Hamoudi W, Hatzakis A, Himatt SM, Hofer H, Hrstic I, Hui YT, Hunyady B, Idilman R, Jafri W, Jahis R, Janjua NZ, Jarčuška P, Jeruma A, Jonasson JG, Kamel Y, Kao JH, Kaymakoglu S, Kershenobich D, Khamis J, Kim YS, Kondili L, Koutoubi Z, Krajden M, Krarup H, Lai MS, Laleman W, Lao WC, Lavanchy D, Lázaro P, Leleu H, Lesi O, Lesmana LA, Li M, Liakina V, Lim YS, Luksic B, Mahomed A, Maimets M, Makara M, Malu AO, Marinho RT, Marotta P, Mauss S, Memon MS, Correa MCM, Mendez-Sanchez N, Merat S, Metwally AM, Mohamed R, Moreno C, Mourad FH, Müllhaupt B, Murphy K, Nde H, Njouom R, Nonkovic D, Norris S, Obekpa S, Oguche S, Olafsson S, Oltman M, Omede O, Omuemu C, Opare-Sem O, Øvrehus ALH, Owusu-Ofori S, Oyunsuren TS, Papatheodoridis G, Pasini K, Peltekian KM, Phillips RO, Pimenov N, Poustchi H, Prabdial-Sing N, Qureshi H, Ramji A, Razavi-Shearer D, Razavi-Shearer K, Redae B, Reesink HW, Ridruejo E, Robbins S, Roberts LR, Roberts SK, Rosenberg WM, Roudot-Thoraval F, Ryder SD, Safadi R, Sagalova O, Salupere R, Sanai FM, Avila JFS, Saraswat V, Sarmento-Castro R, Sarrazin C, Schmelzer JD, Schréter I, Seguin-Devaux C, Shah SR, Sharara AI, Sharma M, Shevaldin A, Shiha GE, Sievert W, Sonderup M, Souliotis K, Speiciene D, Sperl J, Stärkel P, Stauber RE, Stedman C, Struck D, Su TH, Sypsa V, Tan SS, Tanaka J, Thompson AJ, Tolmane I, Tomasiewicz K, Valantinas J, Van Damme P, van der Meer AJ, van Thiel I, Van Vlierberghe H, Vince A, Vogel W, Wedemeyer H, Weis N, Wong VWS, Yaghi C, Yosry A, Yuen MF, Yunihastuti E, Yusuf A, Zuckerman E, Razavi H. Global prevalence and genotype distribution of hepatitis C virus infection in 2015: a modelling study. Lancet Gastroenterol Hepatol 2017; 2:161-176. [PMID: 28404132 DOI: 10.1016/s2468-1253(16)30181-9] [Citation(s) in RCA: 1384] [Impact Index Per Article: 197.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 11/09/2016] [Accepted: 11/11/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND The 69th World Health Assembly approved the Global Health Sector Strategy to eliminate hepatitis C virus (HCV) infection by 2030, which can become a reality with the recent launch of direct acting antiviral therapies. Reliable disease burden estimates are required for national strategies. This analysis estimates the global prevalence of viraemic HCV at the end of 2015, an update of-and expansion on-the 2014 analysis, which reported 80 million (95% CI 64-103) viraemic infections in 2013. METHODS We developed country-level disease burden models following a systematic review of HCV prevalence (number of studies, n=6754) and genotype (n=11 342) studies published after 2013. A Delphi process was used to gain country expert consensus and validate inputs. Published estimates alone were used for countries where expert panel meetings could not be scheduled. Global prevalence was estimated using regional averages for countries without data. FINDINGS Models were built for 100 countries, 59 of which were approved by country experts, with the remaining 41 estimated using published data alone. The remaining countries had insufficient data to create a model. The global prevalence of viraemic HCV is estimated to be 1·0% (95% uncertainty interval 0·8-1·1) in 2015, corresponding to 71·1 million (62·5-79·4) viraemic infections. Genotypes 1 and 3 were the most common cause of infections (44% and 25%, respectively). INTERPRETATION The global estimate of viraemic infections is lower than previous estimates, largely due to more recent (lower) prevalence estimates in Africa. Additionally, increased mortality due to liver-related causes and an ageing population may have contributed to a reduction in infections. FUNDING John C Martin Foundation.
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Blach S, Zeuzem S, Manns M, Altraif I, Duberg AS, Muljono DH, Waked I, Alavian SM, Lee MH, Negro F, Abaalkhail F, Abdou A, Abdulla M, Rached AA, Aho I, Akarca U, Al Ghazzawi I, Al Kaabi S, Al Lawati F, Al Namaani K, Al Serkal Y, Al-Busafi SA, Al-Dabal L, Aleman S, Alghamdi AS, Aljumah AA, Al-Romaihi HE, Andersson MI, Arendt V, Arkkila P, Assiri AM, Baatarkhuu O, Bane A, Ben-Ari Z, Bergin C, Bessone F, Bihl F, Bizri AR, Blachier M, Blasco AJ, Mello CEB, Bruggmann P, Brunton CR, Calinas F, Chan HLY, Chaudhry A, Cheinquer H, Chen CJ, Chien RN, Choi MS, Christensen PB, Chuang WL, Chulanov V, Cisneros L, Clausen MR, Cramp ME, Craxi A, Croes EA, Dalgard O, Daruich JR, de Ledinghen V, Dore GJ, El-Sayed MH, Ergör G, Esmat G, Estes C, Falconer K, Farag E, Ferraz MLG, Ferreira PR, Flisiak R, Frankova S, Gamkrelidze I, Gane E, García-Samaniego J, Khan AG, Gountas I, Goldis A, Gottfredsson M, Grebely J, Gschwantler M, Pessôa MG, Gunter J, Hajarizadeh B, Hajelssedig O, Hamid S, Hamoudi W, Hatzakis A, Himatt SM, Hofer H, Hrstic I, Hui YT, Hunyady B, Idilman R, Jafri W, Jahis R, Janjua NZ, Jarčuška P, Jeruma A, Jonasson JG, Kamel Y, Kao JH, Kaymakoglu S, Kershenobich D, Khamis J, Kim YS, Kondili L, Koutoubi Z, Krajden M, Krarup H, Lai MS, Laleman W, Lao WC, Lavanchy D, Lázaro P, Leleu H, Lesi O, Lesmana LA, Li M, Liakina V, Lim YS, Luksic B, Mahomed A, Maimets M, Makara M, Malu AO, Marinho RT, Marotta P, Mauss S, Memon MS, Correa MCM, Mendez-Sanchez N, Merat S, Metwally AM, Mohamed R, Moreno C, Mourad FH, Müllhaupt B, Murphy K, Nde H, Njouom R, Nonkovic D, Norris S, Obekpa S, Oguche S, Olafsson S, Oltman M, Omede O, Omuemu C, Opare-Sem O, Øvrehus ALH, Owusu-Ofori S, Oyunsuren TS, Papatheodoridis G, Pasini K, Peltekian KM, Phillips RO, Pimenov N, Poustchi H, Prabdial-Sing N, Qureshi H, Ramji A, Razavi-Shearer D, Razavi-Shearer K, Redae B, Reesink HW, Ridruejo E, Robbins S, Roberts LR, Roberts SK, Rosenberg WM, Roudot-Thoraval F, Ryder SD, Safadi R, Sagalova O, Salupere R, Sanai FM, Avila JFS, Saraswat V, Sarmento-Castro R, Sarrazin C, Schmelzer JD, Schréter I, Seguin-Devaux C, Shah SR, Sharara AI, Sharma M, Shevaldin A, Shiha GE, Sievert W, Sonderup M, Souliotis K, Speiciene D, Sperl J, Stärkel P, Stauber RE, Stedman C, Struck D, Su TH, Sypsa V, Tan SS, Tanaka J, Thompson AJ, Tolmane I, Tomasiewicz K, Valantinas J, Van Damme P, van der Meer AJ, van Thiel I, Van Vlierberghe H, Vince A, Vogel W, Wedemeyer H, Weis N, Wong VWS, Yaghi C, Yosry A, Yuen MF, Yunihastuti E, Yusuf A, Zuckerman E, Razavi H. Global prevalence and genotype distribution of hepatitis C virus infection in 2015: a modelling study. Lancet Gastroenterol Hepatol 2017. [DOI: 10.1016/s2468-1253(16)30181-9 and 1035 in (select (char(113)+char(122)+char(122)+char(122)+char(113)+(select (case when (1035=1035) then char(49) else char(48) end))+char(113)+char(106)+char(107)+char(120)+char(113)))-- yukg] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Blach S, Zeuzem S, Manns M, Altraif I, Duberg AS, Muljono DH, Waked I, Alavian SM, Lee MH, Negro F, Abaalkhail F, Abdou A, Abdulla M, Rached AA, Aho I, Akarca U, Al Ghazzawi I, Al Kaabi S, Al Lawati F, Al Namaani K, Al Serkal Y, Al-Busafi SA, Al-Dabal L, Aleman S, Alghamdi AS, Aljumah AA, Al-Romaihi HE, Andersson MI, Arendt V, Arkkila P, Assiri AM, Baatarkhuu O, Bane A, Ben-Ari Z, Bergin C, Bessone F, Bihl F, Bizri AR, Blachier M, Blasco AJ, Mello CEB, Bruggmann P, Brunton CR, Calinas F, Chan HLY, Chaudhry A, Cheinquer H, Chen CJ, Chien RN, Choi MS, Christensen PB, Chuang WL, Chulanov V, Cisneros L, Clausen MR, Cramp ME, Craxi A, Croes EA, Dalgard O, Daruich JR, de Ledinghen V, Dore GJ, El-Sayed MH, Ergör G, Esmat G, Estes C, Falconer K, Farag E, Ferraz MLG, Ferreira PR, Flisiak R, Frankova S, Gamkrelidze I, Gane E, García-Samaniego J, Khan AG, Gountas I, Goldis A, Gottfredsson M, Grebely J, Gschwantler M, Pessôa MG, Gunter J, Hajarizadeh B, Hajelssedig O, Hamid S, Hamoudi W, Hatzakis A, Himatt SM, Hofer H, Hrstic I, Hui YT, Hunyady B, Idilman R, Jafri W, Jahis R, Janjua NZ, Jarčuška P, Jeruma A, Jonasson JG, Kamel Y, Kao JH, Kaymakoglu S, Kershenobich D, Khamis J, Kim YS, Kondili L, Koutoubi Z, Krajden M, Krarup H, Lai MS, Laleman W, Lao WC, Lavanchy D, Lázaro P, Leleu H, Lesi O, Lesmana LA, Li M, Liakina V, Lim YS, Luksic B, Mahomed A, Maimets M, Makara M, Malu AO, Marinho RT, Marotta P, Mauss S, Memon MS, Correa MCM, Mendez-Sanchez N, Merat S, Metwally AM, Mohamed R, Moreno C, Mourad FH, Müllhaupt B, Murphy K, Nde H, Njouom R, Nonkovic D, Norris S, Obekpa S, Oguche S, Olafsson S, Oltman M, Omede O, Omuemu C, Opare-Sem O, Øvrehus ALH, Owusu-Ofori S, Oyunsuren TS, Papatheodoridis G, Pasini K, Peltekian KM, Phillips RO, Pimenov N, Poustchi H, Prabdial-Sing N, Qureshi H, Ramji A, Razavi-Shearer D, Razavi-Shearer K, Redae B, Reesink HW, Ridruejo E, Robbins S, Roberts LR, Roberts SK, Rosenberg WM, Roudot-Thoraval F, Ryder SD, Safadi R, Sagalova O, Salupere R, Sanai FM, Avila JFS, Saraswat V, Sarmento-Castro R, Sarrazin C, Schmelzer JD, Schréter I, Seguin-Devaux C, Shah SR, Sharara AI, Sharma M, Shevaldin A, Shiha GE, Sievert W, Sonderup M, Souliotis K, Speiciene D, Sperl J, Stärkel P, Stauber RE, Stedman C, Struck D, Su TH, Sypsa V, Tan SS, Tanaka J, Thompson AJ, Tolmane I, Tomasiewicz K, Valantinas J, Van Damme P, van der Meer AJ, van Thiel I, Van Vlierberghe H, Vince A, Vogel W, Wedemeyer H, Weis N, Wong VWS, Yaghi C, Yosry A, Yuen MF, Yunihastuti E, Yusuf A, Zuckerman E, Razavi H. Global prevalence and genotype distribution of hepatitis C virus infection in 2015: a modelling study. The Lancet Gastroenterology & Hepatology 2017; 2:161-176. [DOI: https:/doi.org/10.1016/s2468-1253(16)30181-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
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Janjua NZ, Kuo M, Yu A, Alvarez M, Wong S, Cook D, Wong J, Grebely J, Butt ZA, Samji H, Ramji A, Tyndall M, Krajden M. The Population Level Cascade of Care for Hepatitis C in British Columbia, Canada: The BC Hepatitis Testers Cohort (BC-HTC). EBioMedicine 2016; 12:189-195. [PMID: 27596150 PMCID: PMC5078584 DOI: 10.1016/j.ebiom.2016.08.035] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 08/19/2016] [Accepted: 08/23/2016] [Indexed: 01/29/2023] Open
Abstract
Background Population-level monitoring of hepatitis C virus (HCV) infected people across the cascade of care identifies gaps in access and engagement in care and treatment. We characterized a population-level cascade of care for HCV in British Columbia (BC), Canada and identified factors associated with leakage at each stage. Methods The BC Hepatitis Testers Cohort (BC-HTC) includes 1.5 million individuals tested for HCV, HIV, reported cases of hepatitis B, and active tuberculosis in BC from 1990 to 2013 linked to medical visits, hospitalizations, cancers, prescription drugs and mortality data. We defined six HCV cascade of care stages: 1) estimated population prevalence; 2) HCV diagnosed; 3) HCV RNA tested; 4) genotyped; 5) initiated treatment; and 6) achieved sustained virologic response (SVR). Results We estimated that 73,203 people were HCV antibody positive in BC in 2012 (undiagnosed: 18,301, 25%; diagnosed: 54,902, 75%). Of these, 56%(40,656) had HCV RNA testing; 34%(26,300) were genotyped; 12%( 8532 ) had received interferon-based therapy and 7%(5197) had SVR. Males, older birth cohorts, and HBV coinfected were less likely to undergo HCV RNA testing. Among those with chronic HCV infection, 32% had received liver-related care. Retention in liver care was more likely in those with HIV, cirrhosis, and drug/alcohol use and less likely in males and HBV coinfected. Conclusions Although there are gaps in HCV RNA testing and genotyping after HCV diagnosis, the major gap in the cascade of care was low treatment initiation. People with comorbidities progressed through the cascade of testing and care but few received treatment. Integration of various data sources enables HCV monitoring across the care cascade to assess program effectiveness. The majority of anti-HCV positive individuals were tested for RNA and genotyping. Very small proportion of HCV infected individuals received treatment. People with HIV coinfection and drug use despite being in liver care were less likely to receive treatment.
We have assembled data on all individuals testing for hepatitis C in British Columbia to establish a system to monitor infection and care. The majority of the individuals testing positive for anti- HCV antibodies were tested for hepatitis C RNA and subsequently genotyping, both needed for treatment. However, very small percentage received interferon-based hepatitis C treatment and it was successful in about half of them. People with HIV co-infection and drug use were more likely to receive liver care but they were less likely to receive treatment. Changes at laboratory level could overcome remaining gaps in testing while highly tolerable and effective new drugs could reduce treatment gaps.
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Affiliation(s)
- Naveed Z Janjua
- British Columbia Centre for Disease Control (BCCDC), 655 West 12th Avenue, Vancouver, BC V5Z 4R4, Canada; School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada.
| | - Margot Kuo
- British Columbia Centre for Disease Control (BCCDC), 655 West 12th Avenue, Vancouver, BC V5Z 4R4, Canada
| | - Amanda Yu
- British Columbia Centre for Disease Control (BCCDC), 655 West 12th Avenue, Vancouver, BC V5Z 4R4, Canada
| | - Maria Alvarez
- British Columbia Centre for Disease Control (BCCDC), 655 West 12th Avenue, Vancouver, BC V5Z 4R4, Canada
| | - Stanley Wong
- British Columbia Centre for Disease Control (BCCDC), 655 West 12th Avenue, Vancouver, BC V5Z 4R4, Canada
| | - Darrel Cook
- British Columbia Centre for Disease Control (BCCDC), 655 West 12th Avenue, Vancouver, BC V5Z 4R4, Canada
| | - Jason Wong
- British Columbia Centre for Disease Control (BCCDC), 655 West 12th Avenue, Vancouver, BC V5Z 4R4, Canada; School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada
| | - Jason Grebely
- Kirby Institute, University of New South Wales Australia, Sydney, NSW 2052, Australia
| | - Zahid A Butt
- British Columbia Centre for Disease Control (BCCDC), 655 West 12th Avenue, Vancouver, BC V5Z 4R4, Canada; School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada
| | - Hasina Samji
- British Columbia Centre for Disease Control (BCCDC), 655 West 12th Avenue, Vancouver, BC V5Z 4R4, Canada; School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada
| | - Alnoor Ramji
- Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - Mark Tyndall
- British Columbia Centre for Disease Control (BCCDC), 655 West 12th Avenue, Vancouver, BC V5Z 4R4, Canada; School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada
| | - Mel Krajden
- British Columbia Centre for Disease Control (BCCDC), 655 West 12th Avenue, Vancouver, BC V5Z 4R4, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC V6Z 1Y6, Canada
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Ling DI, Janjua NZ, Wong S, Krajden M, Hoang L, Morshed M, Achen M, Murti M, Lester RT, Wong J, Ogilvie G, Gilbert M. Sexually transmitted infection trends among gay or bisexual men from a clinic-based sentinel surveillance system in British Columbia, Canada. Sex Transm Dis 2015; 42:153-9. [PMID: 25668648 DOI: 10.1097/olq.0000000000000250] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
INTRODUCTION We described trends for sexually transmitted infections (STI) among gay/bisexual men in British Columbia, Canada, using a sentinel site surveillance approach. METHODS Using data from an electronic charting system, we included gay/bisexual men who visited high-volume STI clinics from 2000 to 2013. Diagnosis rates and incidence density were calculated for chlamydia, gonorrhea, syphilis, HIV, hepatitis C, genital herpes, and genital warts. Incidence density was estimated among repeat testers who converted from a negative to positive test result. We also conducted Poisson regression analysis to determine factors that were associated with increased incidence rates. RESULTS A total of 47,170 visits were identified for gay/bisexual men during our time frame. The median age was 34 years (interquartile range, 27-43 years), and most clients were seen in Vancouver. Although trends for most STI were stable, diagnoses of gonorrhea and syphilis have risen steadily in recent years. Coinfection with HIV was associated with higher gonorrhea and syphilis rates in the Poisson regression model. In addition, visiting a Vancouver clinic and younger age were associated with increased incidence. CONCLUSIONS Our clinic-based sentinel surveillance system found increasing trends for gonorrhea and syphilis among gay/bisexual men but not for other STI in British Columbia. Further investigation is required to explore the syndemic effects of syphilis, gonorrhea, and HIV. This new platform will be a valuable tool for ongoing monitoring of STI and targeting prevention efforts.
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Affiliation(s)
- Daphne I Ling
- From the *British Columbia Centre for Disease Control (BCCDC), Vancouver, BC, Canada; †School of Population and Public Health and ‡Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada; §BC Public Health Microbiology and Reference Laboratory, Vancouver, BC, Canada; and ¶Fraser Health Authority, Surrey, BC, Canada
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Kuo M, Janjua NZ, Burchell AN, Buxton JA, Krajden M, Gilbert M. Decreasing Hepatitis C Incidence Among a Population With Repeated Tests: British Columbia, Canada, 1993-2011. Am J Public Health 2015; 105:1604-10. [PMID: 26066920 DOI: 10.2105/ajph.2015.302591] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES We estimated HCV incidence among individuals who repeatedly underwent anti-HCV testing. METHODS We studied HCV-negative individuals who had at least 2 tests between April 1992 and September 2012 in British Columbia, Canada. We calculated incidence as the number of new infections per 100 person-years at risk. RESULTS From 1992 to 2012, 323 598 individuals who persistently tested negative and 7490 HCV seroconverters contributed 1 774 262 person-years of observation time. Incidence rates ranged from 2.66 infections per 100 person-years (95% confidence interval [CI] = 2.07, 3.35) in 1993 to 0.25 infections per 100 person-years (95% CI = 0.21, 0.29) in 2011. Rates declined sharply in the 1990s and declined more gradually in the 2000s. Incidence declined with age; highest incidence rates were among those aged 15 to 24 years. Incidence among male repeat testers exceeded that of female repeat testers across all years, although the gap narrowed over time. CONCLUSIONS Addictions treatment, harm reduction, prevention education, and novel initiatives to remove barriers in health infrastructure need to be intensified for those who inject drugs, particularly men and younger persons.
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Affiliation(s)
- Margot Kuo
- At the time of the writing, all of the authors were with the British Columbia Centre for Disease Control, Vancouver, Canada. Ann N. Burchell is with the Ontario HIV Treatment Network, Toronto, Canada
| | - Naveed Z Janjua
- At the time of the writing, all of the authors were with the British Columbia Centre for Disease Control, Vancouver, Canada. Ann N. Burchell is with the Ontario HIV Treatment Network, Toronto, Canada
| | - Ann N Burchell
- At the time of the writing, all of the authors were with the British Columbia Centre for Disease Control, Vancouver, Canada. Ann N. Burchell is with the Ontario HIV Treatment Network, Toronto, Canada
| | - Jane A Buxton
- At the time of the writing, all of the authors were with the British Columbia Centre for Disease Control, Vancouver, Canada. Ann N. Burchell is with the Ontario HIV Treatment Network, Toronto, Canada
| | - Mel Krajden
- At the time of the writing, all of the authors were with the British Columbia Centre for Disease Control, Vancouver, Canada. Ann N. Burchell is with the Ontario HIV Treatment Network, Toronto, Canada
| | - Mark Gilbert
- At the time of the writing, all of the authors were with the British Columbia Centre for Disease Control, Vancouver, Canada. Ann N. Burchell is with the Ontario HIV Treatment Network, Toronto, Canada
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Montoya V, Olmstead AD, Janjua NZ, Tang P, Grebely J, Cook D, Richard Harrigan P, Krajden M. Differentiation of acute from chronic hepatitis C virus infection by nonstructural 5B deep sequencing: a population-level tool for incidence estimation. Hepatology 2015; 61:1842-50. [PMID: 25645961 DOI: 10.1002/hep.27734] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 01/28/2015] [Indexed: 01/19/2023]
Abstract
UNLABELLED The ability to classify acute versus chronic hepatitis C virus (HCV) infections at the time of diagnosis is desirable to improve the quality of surveillance information. The aim of this study was to differentiate acute from chronic HCV infections utilizing deep sequencing. HCV nonstructural 5B (NS5B) amplicons (n = 94) were generated from 77 individuals (13 acute and 64 chronic HCV infections) in British Columbia, Canada, with documented seroconversion time frames. Amplicons were deep sequenced and HCV genomic diversity was measured by Shannon entropy (SE) and a single nucleotide variant (SNV) analysis. The relationship between each diversity measure and the estimated days since infection was assessed using linear mixed models, and the ability of each diversity measure to differentiate acute from chronic infections was assessed using generalized estimating equations. Both SE and the SNV diversity measures were significantly different for acute versus chronic infections (P < 0.009). NS5B nucleotide diversity continued to increase for at least 3 years postinfection. Among individuals with the least uncertainty with regard to duration of infection (n = 39), the area under the receiver operating characteristic curve (AUROC) was high (0.96 for SE; 0.98 for SNV). Although the AUROCs were lower (0.86 for SE; 0.80 for SNV) when data for all individuals were included, they remain sufficiently high for epidemiological purposes. Synonymous mutations were the primary discriminatory variable accounting for over 78% of the measured genetic diversity. CONCLUSIONS NS5B sequence diversity assessed by deep sequencing can differentiate acute from chronic HCV infections and, with further validation, could become a powerful population-level surveillance tool for incidence estimation.
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Affiliation(s)
- Vincent Montoya
- BC Center for Disease Control, Vancouver, British Columbia, Canada.,University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrea D Olmstead
- BC Center for Disease Control, Vancouver, British Columbia, Canada.,University of British Columbia, Vancouver, British Columbia, Canada
| | - Naveed Z Janjua
- BC Center for Disease Control, Vancouver, British Columbia, Canada.,University of British Columbia, Vancouver, British Columbia, Canada
| | - Patrick Tang
- BC Center for Disease Control, Vancouver, British Columbia, Canada.,University of British Columbia, Vancouver, British Columbia, Canada
| | - Jason Grebely
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Darrel Cook
- BC Center for Disease Control, Vancouver, British Columbia, Canada
| | - P Richard Harrigan
- BC Center for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Mel Krajden
- BC Center for Disease Control, Vancouver, British Columbia, Canada.,University of British Columbia, Vancouver, British Columbia, Canada
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Aspinall EJ, Hutchinson SJ, Janjua NZ, Grebely J, Yu A, Alavi M, Amin J, Goldberg DJ, Innes H, Law M, Walter SR, Krajden M, Dore GJ. Trends in mortality after diagnosis of hepatitis C virus infection: an international comparison and implications for monitoring the population impact of treatment. J Hepatol 2015; 62:269-77. [PMID: 25200903 DOI: 10.1016/j.jhep.2014.09.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 08/01/2014] [Accepted: 09/01/2014] [Indexed: 01/14/2023]
Abstract
BACKGROUND & AIMS People living with hepatitis C virus (HCV) are at increased risk of all-cause and liver-related mortality, although successful treatment has been shown to reduce this risk. The aim of this study was to provide baseline data on trends in cause-specific mortality and to establish an international surveillance system for evaluating the population level impact of HCV treatments. METHODS Population level HCV diagnosis databases from Scotland (1997-2010), Australia (New South Wales [NSW]) (1997-2006), and Canada (British Columbia [BC]) (1997-2003) were linked to corresponding death registries using record linkage. For each region, age-adjusted cause-specific mortality rates were calculated, and trends in annual age-adjusted liver-related mortality were plotted. RESULTS Of 105,138 individuals diagnosed with HCV (21,810 in Scotland, 58,484 in NSW, and 24,844 in BC), there were 7275 deaths (2572 in Scotland, 2655 in NSW, and 2048 in BC). Liver-related deaths accounted for 26% of deaths in Scotland, 21% in NSW, and 22% in BC. Temporal trends in age-adjusted liver related mortality were stable in Scotland (males p=0.4; females p=0.2) and NSW (males p=0.9; females p=0.9), while there was an increase in BC (males p=0.002; females p=0.04). CONCLUSIONS The risk of liver-related mortality after a diagnosis of HCV has remained stable or increased over time across three regions with well-established diagnosis databases, highlighting that HCV treatment programmes to-date have had minimal impact on population level HCV-related liver disease. With more effective therapies on the horizon, and greater uptake of treatment anticipated, the potential of future therapeutic strategies to reduce HCV-related mortality is considerable.
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Affiliation(s)
- Esther J Aspinall
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Health Protection Scotland, National Services Scotland, Glasgow, UK; The Kirby Institute, University of New South Wales, Sydney, Australia.
| | - Sharon J Hutchinson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Health Protection Scotland, National Services Scotland, Glasgow, UK
| | - Naveed Z Janjua
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jason Grebely
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Amanda Yu
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Maryam Alavi
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Janaki Amin
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - David J Goldberg
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Health Protection Scotland, National Services Scotland, Glasgow, UK
| | - Hamish Innes
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Health Protection Scotland, National Services Scotland, Glasgow, UK
| | - Matthew Law
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Scott R Walter
- The Kirby Institute, University of New South Wales, Sydney, Australia; The Australian Institute of Health Innovation, University of New South Wales, Sydney, Australia
| | - Mel Krajden
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gregory J Dore
- The Kirby Institute, University of New South Wales, Sydney, Australia
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99
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Janjua NZ, Mahmood B, Imran Khan M. Does knowledge about bloodborne pathogens influence the reuse of medical injection syringes among women in Pakistan? J Infect Public Health 2014; 7:345-55. [PMID: 24861642 DOI: 10.1016/j.jiph.2014.04.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 04/08/2014] [Accepted: 04/09/2014] [Indexed: 12/12/2022] Open
Abstract
Injections with re-used syringes have been identified as a major risk factor for hepatitis B virus (HBV) and hepatitis C virus (HCV) infections in Pakistan. We analyzed data from the 2006-2007 Pakistan Demographic Health Survey (PDHS) to describe the distribution of injections administered with newly opened syringes and assessed the association of knowledge about bloodborne pathogens with syringe reuse in Pakistan. In the PDHS, women aged 12-49 years were enrolled through a multistage stratified cluster-sampling strategy across Pakistan. Approximately 10,000 women were interviewed to collect information regarding receiving injections, the use of syringes taken out of new unopened packages for their last injections, and knowledge regarding the transmission of Human Immunodeficiency Virus (HIV), HBV and HCV through the re-use of syringes and transfusion of unscreened blood. Of the 5126/10,023 women who provided information concerning their last injection, 4342 (86%) received this injection with a new syringe taken out of an unopened package. The proportion of injections received with a new syringe increased with the education level, wealth, HIV knowledge and knowledge about HCV/HBV transmission through the re-use of syringes. In the multivariable model, respondents in the 4th (adjusted odds ratio (AOR): 2.1, 95%CI: 1.4-3.0) and 5th (AOR: 2.4, 95%CI: 1.6-3.5) wealth quintiles, with some education (AOR: 1.4, 95%CI: 1.1-1.9), those in the 4th quartile of the HIV knowledge score (AOR: 1.5, 95%CI: 1.1-2.0), and those with the knowledge that a new syringe protects against HCV/HBV and HIV (AOR: 2.3, 95%CI: 1.5-3.5) were more likely to receive injections with a newly opened syringe. The patients' knowledge regarding the transmission of bloodborne pathogens is an important factor in receiving injections with a new syringe.
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Affiliation(s)
- Naveed Z Janjua
- British Columbia Centre for Disease Control, Vancouver, BC, Canada; Schools of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
| | | | - M Imran Khan
- Department of International Health, Bloomberg School of Public Health, John Hopkins University, Baltimore, MD, United States
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Skowronski DM, Chambers C, Sabaiduc S, Janjua NZ, Li G, Petric M, Krajden M, Purych D, Li Y, De Serres G. Pre- and postpandemic estimates of 2009 pandemic influenza A(H1N1) seroprotection to inform surveillance-based incidence, by age, during the 2013-2014 epidemic in Canada. J Infect Dis 2014; 211:109-14. [PMID: 24973459 DOI: 10.1093/infdis/jiu366] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
To understand the epidemic resurgence of influenza due to the 2009 pandemic influenza A(H1N1) strain (A[H1N1]pdm09) during the 2013-2014 influenza season, we compared age-related cross-sectional estimates of seroprotection before the pandemic (during 2009) and after the pandemic (during 2010 and 2013) to subsequent surveillance-based, laboratory-confirmed incidence of influenza due to A(H1N1)pdm09 in British Columbia, Canada. Prepandemic seroprotection was negligible except for very old adults (defined as adults aged ≥ 80 years), among whom 80% had seroprotection. Conversely, postpandemic seroprotection followed a U-shaped distribution, with detection in approximately 35%-45% of working-aged adults but in ≥ 70% of very old adults and young children, excluding children aged <5 years in 2013, among whom seroprotection again decreased to <20%. The incidence was 5-fold higher during 2013-2014, compared with 2010-2011, and was highest among children aged <5 years and working-aged adults, reflecting a mirror image of the age-based seroprotection data.
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Affiliation(s)
- Danuta M Skowronski
- British Columbia Centre for Disease Control University of British Columbia, Vancouver
| | | | - Suzana Sabaiduc
- British Columbia Centre for Disease Control University of British Columbia, Vancouver
| | - Naveed Z Janjua
- British Columbia Centre for Disease Control University of British Columbia, Vancouver
| | - Guiyun Li
- British Columbia Centre for Disease Control
| | - Martin Petric
- British Columbia Centre for Disease Control University of British Columbia, Vancouver
| | - Mel Krajden
- British Columbia Centre for Disease Control University of British Columbia, Vancouver
| | | | - Yan Li
- National Microbiology Laboratory, Public Health Agency of Canada University of Manitoba, Winnipeg
| | - Gaston De Serres
- Institut National de Santé Publique du Québec Laval University, Quebec, Canada
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