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Ríos-Castillo B, Duque-Molina C, Borrayo-Sánchez G, Medina-Chávez JH, Pineda-Ruiz E, Rosales-Piñón A, Niebla-Fuentes MR, Santana-Ramírez AM, Treviño-Pérez SC, Avilés-Hernández R, Reyna-Sevilla A. Detection of anti-HCV antibodies and risk factors in a population with access to public healthcare in Mexico. REVISTA DE GASTROENTEROLOGIA DE MEXICO (ENGLISH) 2024; 89:379-388. [PMID: 39025775 DOI: 10.1016/j.rgmxen.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 01/24/2024] [Indexed: 07/20/2024]
Abstract
INTRODUCTION AND AIM Timely detection and diagnosis of hepatitis C virus (HCV) involves identifying the population that is predisposed to treatment and prevention, thus limiting complications and preventing infection. The aim of this study was to analyze and describe risk factors associated with anti-HCV antibody detection in a population with access to public healthcare that participated in a national screening program. MATERIAL AND METHODS An analytic cross-sectional study was conducted that utilized data related to rapid tests carried out between September 2021 and October 2022 in 26 of the 32 states of Mexico. Anti-HCV reactive tests were selected, according to age and sex, for analyzing and comparing possible risk factors through descriptive and inferential statistics. The geographic distribution and density of the screening program at the state and municipal levels was analyzed. RESULTS There were 75,185 anti-HCV antibody detections, 2,052 reactive tests, and mean participant age was 44.3 years (±15.1). Occupation: 32.3% were employees, 19% were housewives, and 18.2% were healthcare workers. Five out of every 10 cases had no indication of risk factors, but there was a 1.4 and 5-times greater likelihood of anti-HCV detection in men with a history of sharps injury or intravenous psychoactive substance use, compared with women. Regarding place of residence, 80% of the reactive tests were concentrated in the State of Mexico, Mexico City, and Guanajuato. CONCLUSIONS The evidence herein helps determine the population and risk factors that should be focused on in carrying out the HCV microelimination strategy of continuous screening, diagnosis, medical treatment access, and epidemiologic surveillance.
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Affiliation(s)
- B Ríos-Castillo
- División de Excelencia Clínica, Coordinación de Innovación en Salud, Unidad de Planeación e Innovación en Salud, Dirección de Prestaciones Médicas, Instituto Mexicano del Seguro Social, Cuauhtémoc, CDMX, Mexico
| | - C Duque-Molina
- Dirección de Prestaciones Médicas, Instituto Mexicano del Seguro Social, Cuauhtémoc, CDMX, Mexico
| | - G Borrayo-Sánchez
- Coordinación de Innovación en Salud, Unidad de Planeación e Innovación en Salud, Dirección de Prestaciones Médicas, Instituto Mexicano del Seguro Social, Cuauhtémoc, CDMX, Mexico
| | - J H Medina-Chávez
- División de Excelencia Clínica, Coordinación de Innovación en Salud, Unidad de Planeación e Innovación en Salud, Dirección de Prestaciones Médicas, Instituto Mexicano del Seguro Social, Cuauhtémoc, CDMX, Mexico
| | - E Pineda-Ruiz
- División de Promoción de la Salud, Coordinación de Unidades de Primer Nivel, Unidad de Atención Médica, Dirección de Prestaciones Médicas, Instituto Mexicano del Seguro Social, Cuauhtémoc, CDMX, Mexico
| | - A Rosales-Piñón
- División de Promoción de la Salud, Coordinación de Unidades de Primer Nivel, Unidad de Atención Médica, Dirección de Prestaciones Médicas, Instituto Mexicano del Seguro Social, Cuauhtémoc, CDMX, Mexico
| | - M R Niebla-Fuentes
- División de Promoción de la Salud, Coordinación de Unidades de Primer Nivel, Unidad de Atención Médica, Dirección de Prestaciones Médicas, Instituto Mexicano del Seguro Social, Cuauhtémoc, CDMX, Mexico
| | - A M Santana-Ramírez
- División de Promoción de la Salud, Coordinación de Unidades de Primer Nivel, Unidad de Atención Médica, Dirección de Prestaciones Médicas, Instituto Mexicano del Seguro Social, Cuauhtémoc, CDMX, Mexico
| | - S C Treviño-Pérez
- División de Excelencia Clínica, Coordinación de Innovación en Salud, Unidad de Planeación e Innovación en Salud, Dirección de Prestaciones Médicas, Instituto Mexicano del Seguro Social, Cuauhtémoc, CDMX, Mexico
| | - R Avilés-Hernández
- Unidad de Planeación e Innovación en Salud, Dirección de Prestaciones Médicas, Instituto Mexicano del Seguro Social, Cuauhtémoc, CDMX, Mexico
| | - A Reyna-Sevilla
- Coordinación de Innovación en Salud, Unidad de Planeación e Innovación en Salud, Dirección de Prestaciones Médicas, Instituto Mexicano del Seguro Social, Cuauhtémoc, CDMX, Mexico.
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Schiano Moriello N, Pinchera B, Gentile I. Personalized care approaches to hepatitis C therapy: recent advances and future directions. Expert Rev Anti Infect Ther 2024; 22:139-151. [PMID: 38459735 DOI: 10.1080/14787210.2024.2328336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 03/05/2024] [Indexed: 03/10/2024]
Abstract
INTRODUCTION The introduction of direct-acting antivirals (DAAs) has significantly transformed the therapeutic landscape for chronic C hepatitis virus (HCV) infection. However, there is still room for further improvement in optimizing therapy efficacy and minimizing adverse effects. AREAS COVERED This review is devoted to the rationale for adopting a personalized approach to HCV therapy. Specifically, we explore the role of host-related factors, such as sex or the presence of comorbidities. We thoroughly examine the implications of commonly encountered comorbidities, including HIV infection, chronic renal disease, liver cirrhosis, and other chronic viral hepatitis infections. Additionally, we discuss the prevalent drug-to-drug interactions between DAAs and other medications, while providing guidance on their management. Finally, we investigate viral-related issues that can influence treatment outcomes, such as viral genotype, quasi-species, and the presence of resistance-associated mutations. EXPERT OPINION Despite pivotal trials demonstrating efficacy rates exceeding 90% for currently available DAA regimens, there are still opportunities to optimize therapy outcomes and tailor treatment to each patient. This can be achieved through a meticulous evaluation of the patient's specific clinical conditions and comorbidities, a vigilant approach to manage potential drug interactions, and diligent patient follow-up.
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Affiliation(s)
| | - Biagio Pinchera
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Ivan Gentile
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
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Katiyar H, Kamat M, Mandot AK, Goel A, Singh S, Mishra AK, Singh R, Tiwari P, Dhiman RK, Shah S. Sofosbuvir/Velpatasvir/Voxilaprevir for Hepatitis C Virus Retreatment in Difficult-to-treat Patients: A Real-life Observational Study from India. J Clin Exp Hepatol 2024; 14:101314. [PMID: 38261859 PMCID: PMC10792231 DOI: 10.1016/j.jceh.2023.101314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 12/03/2023] [Indexed: 01/25/2024] Open
Abstract
Background and aim Hepatitis C virus (HCV) treatment fails to achieve sustained virological response at 12 weeks (SVR12) in 5-10 % and requires retreatment with second-line drugs. We report our experience of sofosbuvir/velpatasvir/voxilaprevir use for HCV retreatment in a small cohort of difficult-to-treat Indian patients. Methods We reviewed our HCV databases to identify the patients who had failed to achieve SVR12 after treatment with sofosbuvir in combination with either daclatasvir, ledipasvir, or velpatasvir with/without ribavirin on one or more occasions. Participants were excluded if they had (i) decompensated cirrhosis, (ii) HIV coinfection or (iii) chronic kidney disease, or (iv) prior organ transplantation. All the participants were treated with sofosbuvir/velpatasvir/voxilaprevir plus ribavirin for 12 weeks. Treatment outcome was categorized as successful or failure if HCV RNA was undetectable or detectable at SVR12, respectively. Results Fifteen patients (male 67 %; genotype-3 80 %) were included in the analysis. Ten (67 %) had cirrhosis. Five, eight, and two participants had previously failed one, two, and three courses of pegylated-interferon free, sofosbuvir containing direct acting antiviral (DAA) regimens respectively. Fourteen participants had failed to at least one course of the sofosbuvir/velpatasvir combination. Fourteen patients achieved SVR12, and one patient was lost to follow-up. Treatment was successful in 100 % and 93.3 % of per-protocol (PP) and intention to treat (ITT) analyses, respectively. Conclusion Sofosbuvir/velpatasvir/voxilaprevir combination is an effective second-line therapy in India for difficult-to-treat HCV patients.
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Affiliation(s)
- Harshita Katiyar
- Department of Hepatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Mrunal Kamat
- Department of Hepatology, Institute of Liver Diseases, Hepato-Pancreato-Biliary Surgery and Transplant, Global Hospitals, Mumbai, India
| | - Ameet K. Mandot
- Department of Hepatology, Institute of Liver Diseases, Hepato-Pancreato-Biliary Surgery and Transplant, Global Hospitals, Mumbai, India
| | - Amit Goel
- Department of Hepatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Surender Singh
- Department of Hepatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Ajay K. Mishra
- Department of Hepatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Rajani Singh
- Department of Hepatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Prachi Tiwari
- Department of Hepatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Radha K. Dhiman
- Department of Hepatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Samir Shah
- Department of Hepatology, Institute of Liver Diseases, Hepato-Pancreato-Biliary Surgery and Transplant, Global Hospitals, Mumbai, India
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Goel A, Katiyar H, Mayank, Tiwari P, Rungta S, Verma A, Deep A, Sana A, Rai P, Aggarwal R. Hepatitis C Retreatment With First-Line Direct Acting Antiviral Drugs. J Clin Exp Hepatol 2023; 13:736-741. [PMID: 37693269 PMCID: PMC10482998 DOI: 10.1016/j.jceh.2023.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 03/17/2023] [Indexed: 09/12/2023] Open
Abstract
Background and Aims Sofosbuvir (S), daclatasvir (D), ledipasvir, or velpatasvir (V) containing first-line hepatitis C virus (HCV) treatment regimens fail to cure viremia in 5-10%. We report our experience of HCV retreatment using these first-line drugs, in a setting where second-line anti-HCV drugs are not available. Methods Adults, who had relapsed after first complete course of a sofosbuvir-containing first-line, pegylated interferon free, anti-HCV treatment regimen with or without ribavirin (Riba) were included. Retreatment regimen, tailored to the failed anti-HCV regimen, was based on principle of using first-line drugs for 24 weeks with ribavirin and swapping between pangenotypic and genotype-specific regimens. Retreatment outcome was categorized as successful (achieved undetectable HCV RNA at the end of treatment [ETR] and sustained viral response at week 12 [SVR12]), non-responder (failed to achieve ETR), or relapse (achieved ETR but not achieved SVR12). Results Twelve patients (9 male; 7 cirrhosis; all genotype 3) who had relapsed to prior anti-HCV treatment (4 SD12, 4 SD24, 1 SDRiba12, 1 SDRiba24, 2 SV12) were included. Following retreatment (2 SDRiba24, 10 SVRiba24), all achieved ETR but only 9 (75%) achieved SVR12. Two among three, in whom retreatment failed, achieved SVR12 following another course of sofosbuvir/velpatasvir/ribavirin for 24 weeks. Overall, 11/12 (92%) patients achieved SVR12 following retreatment with the first-line anti-HCV drugs. Conclusion HCV retreatment could be a treatment option if second-line anti-HCV drugs are not available. Successful retreatment could be achieved, in a large proportion, with the use of first-line drugs for 24 weeks with ribavirin and swapping of pangenotypic/genotype-specific regimens (NCT03483987).
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Affiliation(s)
- Amit Goel
- Department of Hepatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Harshita Katiyar
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Mayank
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Prachi Tiwari
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Sumit Rungta
- Department of Gastroenterology, King George's Medical University, Lucknow, India
| | - Abhai Verma
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Amar Deep
- Department of Gastroenterology, King George's Medical University, Lucknow, India
| | - Asari Sana
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Praveer Rai
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Rakesh Aggarwal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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Awasthi A, Katiyar H, Rungta S, Deep A, Kumar V, Kumar A, Tiwari P, Goel A. Eight versus twelve weeks of sofosbuvir-velpatasvir in treatment-naïve non-cirrhotic patients with chronic hepatitis C virus infection: Study protocol for a multicentric, open labelled, randomized, non-inferiority trial (RESOLVE trial). PLoS One 2023; 18:e0285725. [PMID: 37200346 DOI: 10.1371/journal.pone.0285725] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 04/25/2023] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) is a common cause of liver cirrhosis and hepatocellular carcinoma. Globally, nearly 71 million people have chronic HCV infection, and approximately 399,000 dies annually. In patients without cirrhosis, HCV infection is treated with 12 weeks of sofosbuvir/velpatasvir combination. Results from available small, single-centre observational studies suggest that the sofosbuvir/velpatasvir combination given for 8 weeks may be as effective as the standard 12 weeks of treatment. We propose to compare the treatment response of 12 weeks versus 8 weeks of sofosbuvir/velpatasvir in non-cirrhotic people with chronic HCV infection. METHODS This multicentric, randomized, open-label, non-inferiority trial will include 880 (2 arms x 440) treatment naïve, viraemic (HCV RNA >10,000 IU/mL), non-cirrhotic adults (age >18 years) with chronic hepatitis C. People who are at high-risk for HCV reinfection such as haemophiliacs, people who inject drugs, those on maintenance hemodialysis or having HIV will be excluded. The presence or absence of cirrhosis will be determined with a combination of history, examination, ultrasound, liver stiffness measured with transient elastography, APRI, FIB-4, and esophagogastroduodenoscopy. Participants will be randomized to receive either 8- or 12-week sofosbuvir/velpatasvir treatment. A blood specimen will be collected before starting the treatment (to determine the HCV genotype), after 4 weeks of treatment (for early virological response), and at 12 weeks after treatment discontinuation for SVR12. DISCUSSION The study will provide data on the efficacy of 8 weeks of treatment as compared to the standard of care (12 weeks) in non-cirrhotic patients with chronic HCV infection. Treatment for a shorter duration may improve treatment compliance, reduce the cost of treatment, and ease the treatment implementation from a public health perspective. TRIAL REGISTRATION Registered with Clinical Trial Registry of India (http://ctri.nic.in) Registration No. CTRI/2022/03/041368 [Registered on: 24/03/2022]-Trial Registered Prospectively.
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Affiliation(s)
- Ashish Awasthi
- Centre for Chronic Disease Control, New Delhi, India
- Centre for Chronic Conditions and, Injuries, Public Health Foundation of India, Gurgaon, India
| | - Harshita Katiyar
- Department of Hepatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Sumit Rungta
- Department of Gastroenterology, King George Medical University, Lucknow, India
| | - Amar Deep
- Department of Gastroenterology, King George Medical University, Lucknow, India
| | - Vinod Kumar
- Department of Gastroenterology, Institute of Medical Sciences, Banaras Hindu University, Lucknow, India
| | - Ajay Kumar
- Department of Gastroenterology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Prachi Tiwari
- Department of Gastroenterology, King George Medical University, Lucknow, India
| | - Amit Goel
- Department of Hepatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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De A, Duseja A, Sood A. Who to Screen for Hepatitis C: That is the Question. J Clin Exp Hepatol 2022; 12:1406-1407. [PMID: 36340301 PMCID: PMC9630029 DOI: 10.1016/j.jceh.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Arka De
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajay Duseja
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajit Sood
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, India
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