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Chromy D, Bauer DJM, Simbrunner B, Jachs M, Hartl L, Schwabl P, Schwarz C, Rieger A, Grabmeier‐Pfistershammer K, Trauner M, Ferenci P, Mandorfer M, Gschwantler M, Reiberger T. The 'Viennese epidemic' of acute HCV in the era of direct-acting antivirals. J Viral Hepat 2022; 29:385-394. [PMID: 35274399 PMCID: PMC9415118 DOI: 10.1111/jvh.13665] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 02/15/2022] [Indexed: 01/01/2023]
Abstract
The recently reported epidemic of acute hepatitis C virus (HCV) infections -observed predominantly among men who have sex with men (MSM)-may now decline due to wide availability of direct-acting antivirals (DAAs). This study aimed to investigate the current trends of acute hepatitis C in Vienna. Patients presenting with acute hepatitis C between 01/2007 and12/2020 at the Vienna General Hospital were retrospectively enrolled and followed after virologic clearance/eradication. The introduction of unrestricted DAA access after 09/17 defined the 'DAA era', as compared to the 'pre-DAA era' prior to 09/17. We identified 134 acute hepatitis C cases in 119 patients with a mean age of 39 ± 9 years at inclusion. The majority of patients were male (92%), HIV-positive (88%) and MSM (85%). In the DAA era, a history of prior chronic HCV infection at inclusion was found in 24% (11/46) compared to 7% (5/73) in the pre-DAA era (p = .012). The annual rate of acute hepatitis C cases increased in the DAA era (17.11 per year) compared to the pre-DAA era (7.76 per year). The DAA era included an AHC-genotype-2 cluster and more HIV-negative acute hepatitis C cases (0% (0/73) vs. 30% (14/46), p < .001). Patients were followed after spontaneous clearance or sustained virologic treatment response (SVR) for a total of 251.88 patient-years (median 1.39 years per patient). In the DAA era, we recorded 15 acute hepatitis C-reinfections - corresponding to an incidence rate of 5.96 (95% CI: 3.57-9.66) reinfections per 100-patient-years. We continue to observe a high incidence of acute hepatitis C in Vienna in the DAA era-primarily among HIV-positive MSM, but increasingly also in HIV-negative MSM.
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Affiliation(s)
- David Chromy
- Division of Gastroenterology and HepatologyDepartment of Internal Medicine IIIMedical University of ViennaViennaAustria
- Vienna HIV & Liver Study GroupViennaAustria
- Department of DermatologyMedical University of ViennaViennaAustria
| | - David J. M. Bauer
- Division of Gastroenterology and HepatologyDepartment of Internal Medicine IIIMedical University of ViennaViennaAustria
- Vienna HIV & Liver Study GroupViennaAustria
| | - Benedikt Simbrunner
- Division of Gastroenterology and HepatologyDepartment of Internal Medicine IIIMedical University of ViennaViennaAustria
- Vienna HIV & Liver Study GroupViennaAustria
| | - Matthias Jachs
- Division of Gastroenterology and HepatologyDepartment of Internal Medicine IIIMedical University of ViennaViennaAustria
- Vienna HIV & Liver Study GroupViennaAustria
| | - Lukas Hartl
- Division of Gastroenterology and HepatologyDepartment of Internal Medicine IIIMedical University of ViennaViennaAustria
- Vienna HIV & Liver Study GroupViennaAustria
| | - Philipp Schwabl
- Division of Gastroenterology and HepatologyDepartment of Internal Medicine IIIMedical University of ViennaViennaAustria
- Vienna HIV & Liver Study GroupViennaAustria
| | - Caroline Schwarz
- Division of Gastroenterology and HepatologyDepartment of Internal Medicine IIIMedical University of ViennaViennaAustria
- Vienna HIV & Liver Study GroupViennaAustria
- Department of Internal Medicine IVWilhelminenspitalWiener Gesundheitsverbund (WiGeV) der Stadt WienViennaAustria
| | - Armin Rieger
- Vienna HIV & Liver Study GroupViennaAustria
- Department of DermatologyMedical University of ViennaViennaAustria
| | - Katharina Grabmeier‐Pfistershammer
- Vienna HIV & Liver Study GroupViennaAustria
- Center for Pathophysiology, Infectiology and ImmunologyInstitute of ImmunologyMedical University ViennaViennaAustria
| | - Michael Trauner
- Division of Gastroenterology and HepatologyDepartment of Internal Medicine IIIMedical University of ViennaViennaAustria
- Vienna HIV & Liver Study GroupViennaAustria
| | - Peter Ferenci
- Division of Gastroenterology and HepatologyDepartment of Internal Medicine IIIMedical University of ViennaViennaAustria
| | - Mattias Mandorfer
- Division of Gastroenterology and HepatologyDepartment of Internal Medicine IIIMedical University of ViennaViennaAustria
- Vienna HIV & Liver Study GroupViennaAustria
| | - Michael Gschwantler
- Vienna HIV & Liver Study GroupViennaAustria
- Department of Internal Medicine IVWilhelminenspitalWiener Gesundheitsverbund (WiGeV) der Stadt WienViennaAustria
| | - Thomas Reiberger
- Division of Gastroenterology and HepatologyDepartment of Internal Medicine IIIMedical University of ViennaViennaAustria
- Vienna HIV & Liver Study GroupViennaAustria
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Mazzucco W, Chiara di Maio V, Bronte F, Fabeni L, Pipitone RM, Grimaudo S, Ferraro D, Marotta C, Aragri M, Macaluso M, Vitale F, Di Raimondo F, Ceccherini-Silberstein F, Di Marco V. Phylogenetic analysis in the clinical risk management of an outbreak of hepatitis C virus infection among transfused thalassaemia patients in Italy. J Hosp Infect 2021; 115:51-58. [PMID: 34171407 DOI: 10.1016/j.jhin.2021.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/15/2021] [Accepted: 06/17/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Occurrence of hepatitis C virus (HCV) infection is reduced by effective risk management procedures, but patient-to-patient transmission continues to be reported in healthcare settings. AIM To report the use of phylogenetic analysis in the clinical risk management of an HCV outbreak among 128 thalassaemia outpatients followed at a thalassaemia centre of an Italian hospital. METHODS Epidemiological investigation and root-cause analysis were performed. All patients with acute hepatitis and known chronic infection were tested for HCV RNA, HCV genotyping, and NS3, NS5A, and NS5B HCV genomic region sequencing. To identify transmission clusters, phylogenetic trees were built for each gene employing Bayesian methods. FINDINGS All patients with acute hepatitis were infected with HCV genotype 1b. Root-cause analysis, including a lookback procedure, excluded blood donors as the source of HCV transmission. The phylogenetic analysis, conducted on seven patients with acute infection and eight patients with chronic infection, highlighted four transmission clusters including at least one patient with chronic and one patient with acute HCV infection. All patients in the same cluster received a blood transfusion during the same day. Two patients with acute hepatitis spontaneously cleared HCV within four weeks and nine patients received ledipasvir plus sofosbuvir for six weeks, all achieving a sustained virological response. CONCLUSION Combined use of root-cause analysis and molecular epidemiology was effective in ascertaining the origin of the HCV outbreak. Antiviral therapy avoided the chronic progression of the infection and further spread in care units and in the family environment.
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Affiliation(s)
- W Mazzucco
- Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) Department, University of Palermo, Palermo, Italy; Clinical Epidemiology and Cancer Registry Unit, COVID-19 Western Sicilian Regional Reference Laboratory, Palermo University Hospital (AOUP) 'P. Giaccone', Palermo, Italy; Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital, Cincinnati, OH, USA.
| | - V Chiara di Maio
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - F Bronte
- Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) Department, University of Palermo, Palermo, Italy
| | - L Fabeni
- Laboratory of Virology, 'Lazzaro Spallanzani' National Institute for Infectious Diseases, IRCCS, Rome, Italy
| | - R M Pipitone
- Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) Department, University of Palermo, Palermo, Italy
| | - S Grimaudo
- Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) Department, University of Palermo, Palermo, Italy
| | - D Ferraro
- Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) Department, University of Palermo, Palermo, Italy
| | - C Marotta
- General Directorate of Health Prevention, Ministry of Health, Rome, Italy
| | - M Aragri
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - M Macaluso
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - F Vitale
- Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) Department, University of Palermo, Palermo, Italy; Clinical Epidemiology and Cancer Registry Unit, COVID-19 Western Sicilian Regional Reference Laboratory, Palermo University Hospital (AOUP) 'P. Giaccone', Palermo, Italy
| | - F Di Raimondo
- Division of Hematology, Azienda Ospedaliero-Universitaria Policlinico, Department of Surgery and Medical Specialties, University of Catania, Catania, Italy
| | | | - V Di Marco
- Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) Department, University of Palermo, Palermo, Italy
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Chromy D, Mandorfer M, Bucsics T, Schwabl P, Scheiner B, Schmidbauer C, Aichelburg MC, Ferenci P, Trauner M, Peck-Radosavljevic M, Reiberger T. High efficacy of interferon-free therapy for acute hepatitis C in HIV-positive patients. United European Gastroenterol J 2019; 7:507-516. [PMID: 31065368 PMCID: PMC6488804 DOI: 10.1177/2050640619835394] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 01/02/2019] [Indexed: 12/19/2022] Open
Abstract
Background The treatment of acute hepatitis C (AHC) with direct-acting antiviral agents (DAAs) is considered a cornerstone of hepatitis C virus (HCV) elimination strategies, especially in human immunodeficiency virus (HIV)-infected individuals at high risk of onward transmission. Objective Optimal treatment regimens and duration for AHC in HIV-coinfected patients remain to be established. Thus, we aimed to evaluate the efficacy and safety of DAA treatment regimens in the setting of AHC. Methods All HIV-positive patients with a diagnosis of AHC according to the European AIDS Treatment Network (NEAT) consensus attending our clinic after 2014 were included. DAA treatment regimens and duration were based on current recommendations for chronic hepatitis C (CHC) at treatment initiation. Results Thirty-eight HIV/AHC patients (median age 42.0 years), mostly men who have sex with men (92%), were started on interferon-free regimens. HCV-genotype (GT) was predominately GT-1a (65%). The following DAA regimens were prescribed: ombitasvir/paritaprevir/ritonavir/dasabuvir (42%; 16/38), glecaprevir/pibrentasvir (29%; 11/38), sofosbuvir/ledipasvir (13%; 5/38), ombitasvir/paritaprevir/ritonavir (5%; 2/38), grazoprevir/elbasvir (5%; 2/38) and sofosbuvir/velpatasvir (5%; 2/38). All HIV/AHC patients achieved sustained virologic response 12 weeks after end of treatment (SVR12) (100%; 38/38). DAA-related adverse events were rare. Conclusion Interferon-free DAA regimens (including 34% pan-genotypic regimens) yielded 100% SVR12 in HIV/AHC individuals if treatment durations similar to CHC are applied.
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Affiliation(s)
- David Chromy
- Division of Gastroenterology and
Hepatology, Department of Internal Medicine III, Medical University of Vienna,
Vienna, Austria
- Vienna HIV & Liver Study Group,
Vienna, Austria
| | - Mattias Mandorfer
- Division of Gastroenterology and
Hepatology, Department of Internal Medicine III, Medical University of Vienna,
Vienna, Austria
- Vienna HIV & Liver Study Group,
Vienna, Austria
| | - Theresa Bucsics
- Division of Gastroenterology and
Hepatology, Department of Internal Medicine III, Medical University of Vienna,
Vienna, Austria
- Vienna HIV & Liver Study Group,
Vienna, Austria
| | - Philipp Schwabl
- Division of Gastroenterology and
Hepatology, Department of Internal Medicine III, Medical University of Vienna,
Vienna, Austria
- Vienna HIV & Liver Study Group,
Vienna, Austria
| | - Bernhard Scheiner
- Division of Gastroenterology and
Hepatology, Department of Internal Medicine III, Medical University of Vienna,
Vienna, Austria
- Vienna HIV & Liver Study Group,
Vienna, Austria
| | - Caroline Schmidbauer
- Division of Gastroenterology and
Hepatology, Department of Internal Medicine III, Medical University of Vienna,
Vienna, Austria
- Vienna HIV & Liver Study Group,
Vienna, Austria
- Department of Internal Medicine IV,
Wilhelminenspital, Wiener Krankenanstaltenverbund (KAV) der Stadt Wien, Vienna,
Austria
| | - MC Aichelburg
- Vienna HIV & Liver Study Group,
Vienna, Austria
- Division of Immunology, Allergy and
Infectious Diseases, Department of Dermatology, Medical University of Vienna,
Vienna, Austria
| | - Peter Ferenci
- Division of Gastroenterology and
Hepatology, Department of Internal Medicine III, Medical University of Vienna,
Vienna, Austria
| | - Michael Trauner
- Division of Gastroenterology and
Hepatology, Department of Internal Medicine III, Medical University of Vienna,
Vienna, Austria
| | - Markus Peck-Radosavljevic
- Vienna HIV & Liver Study Group,
Vienna, Austria
- Department of Internal Medicine and
Gastroenterology, Klinikum Klagenfurt am Wörthersee, Klagenfurt, Austria
| | - Thomas Reiberger
- Division of Gastroenterology and
Hepatology, Department of Internal Medicine III, Medical University of Vienna,
Vienna, Austria
- Vienna HIV & Liver Study Group,
Vienna, Austria
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Henry Z, Gonzales Zamora JA. Evolution of Pretreatment Assessment and Direct Acting Antiviral Regimens in Accordance with Upgrading Guidelines: A Retrospective Study in HIV/HCV Coinfected Patients. Med Sci (Basel) 2018; 6:medsci6040081. [PMID: 30241397 PMCID: PMC6313430 DOI: 10.3390/medsci6040081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 09/16/2018] [Accepted: 09/18/2018] [Indexed: 12/17/2022] Open
Abstract
Since the advent of new direct acting antivirals (DAA), substantial changes in hepatitis C (HCV) treatment guidelines have occurred. However, little is known about how these recommendations have been adopted into clinical practice. We conducted a retrospective review of human immunodeficiency virus (HIV)/HCV coinfected patients treated with DAAs at the Ryan White Clinic of the Jackson Health System in Miami, FL, USA. Our aim was to determine changes in HCV evaluation and treatment patterns in the use of DAAs over a four-year period from January 2014 to December 2017. Data were divided into two periods: period 1 (2014⁻2015) and period 2 (2016⁻2017). In comparison with the rest of the cohort, patients in period 2 had a lower frequency of advanced liver disease (24.4% vs. 48.6%, p = 0.026) and underwent more elastography (34.1% vs. 2.7%, p < 0.001) and less ultrasound (78.0% vs. 97.3%, p = 0.011). They were more often treated with ledipasvir/sofosbuvir (85.4% vs. 56.8%, p = 0.005) and less often with simeprevir/sofosbuvir (0% vs. 32.4%, p < 0.001). Gastrointestinal side effects were reported less frequently (2.4% vs. 18.9%, p = 0.017) in this period. In accordance with the updated guidelines, our study demonstrated a growing preference for non-invasive methods to assess fibrosis in recent years. Regarding treatment, there was a clear preference for second generation DAAs in 2016⁻2017, along with initiation of treatment in the early stages of liver disease.
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Affiliation(s)
- Zachary Henry
- Division of Infectious Diseases, Department of Medicine, University of Miami, Miller School of Medicine, Miami, FL 33136, USA.
| | - Jose Armando Gonzales Zamora
- Division of Infectious Diseases, Department of Medicine, University of Miami, Miller School of Medicine, Miami, FL 33136, USA.
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