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Athamneh RY, Abudalo R, Sallam M, Alqudah A, Alquran H, Amawi KF, Abu-Harirah HA. Sub-genotypes of hepatitis C virus in the Middle East and North Africa: Patterns of distribution and temporal changes. Infect Genet Evol 2023; 109:105412. [PMID: 36791585 DOI: 10.1016/j.meegid.2023.105412] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/27/2022] [Revised: 02/04/2023] [Accepted: 02/08/2023] [Indexed: 02/16/2023]
Abstract
Infection with the hepatitis C virus (HCV) remains a considerable public health concern in the Middle East and North Africa (MENA). The objectives of this study were to analyze the HCV genotype (GT) and sub-genotype (SGT) distribution in the MENA region and to assess the temporal change in the number of sequences within the MENA region. All HCV molecular sequences collected in the MENA region had been retrieved from GenBank as of 1 August 2022. The number of HCV sequences retrieved was 6740 representing sequences from a total of 17 MENA countries with a majority from Iran (n = 1969, 29.2%), Egypt (n = 1591, 23.6%), Tunisia (n = 1305, 19.4%) and Saudi Arabia (n = 1085, 16.1%). The determination of GT/SGT was based on the NCBI genotyping and Blast tool. Genotype 1 (GT1) dominated infections in the MENA (n = 2777, 41.2%), followed by GT4 (n = 2566, 39.0%). Additionally, SGT4a (1515/6393, 23.7%) was the most common SGT in the MENA, and SGT4a was dominant in Egypt and Saudi Arabia, followed by SGT1b (n = 1308, 20.5%), which was dominant in Morocco and Tunisia, while SGT1a (n = 1275, 19.9%) was common in Iran, Iraq and Palestine. Furthermore, significant temporal increase in the number of HCV MENA sequences was observed. On the SGT level, specific patterns of HCV genetic diversity were seen in the MENA region, with the most common SGT being 4a, in addition to increasing the availability of HCV sequences in the MENA region.
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Affiliation(s)
- Rabaa Y Athamneh
- Department of Medical Laboratories Sciences, Faculty of Allied Medical Sciences, Zarqa University, Zarqa, Jordan.
| | - Rawan Abudalo
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmaceutical Sciences, The Hashemite University, Zarqa, Jordan
| | - Malik Sallam
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman, Jordan; Department of Clinical Laboratories and Forensic Medicine, Jordan University Hospital, Amman, Jordan
| | - Abdelrahim Alqudah
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmaceutical Sciences, The Hashemite University, Zarqa, Jordan
| | - Hasan Alquran
- Department of Medical Laboratories Sciences, Faculty of Allied Medical Sciences, Zarqa University, Zarqa, Jordan
| | - Kawther Faisal Amawi
- Department of Medical Laboratories Sciences, Faculty of Allied Medical Sciences, Zarqa University, Zarqa, Jordan
| | - Hashem A Abu-Harirah
- Department of Medical Laboratories Sciences, Faculty of Allied Medical Sciences, Zarqa University, Zarqa, Jordan
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Ciupkeviciene E, Petkeviciene J, Sumskiene J, Dragunas G, Dabravalskis S, Kreivenaite E, Telksnys T, Urbonas G, Kupcinskas L. Hepatitis C Virus Epidemiology in Lithuania: Situation before Introduction of the National Screening Programme. Viruses 2022; 14:1192. [PMID: 35746663 PMCID: PMC9230764 DOI: 10.3390/v14061192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/26/2022] [Accepted: 05/26/2022] [Indexed: 12/20/2022] Open
Abstract
In 2022, the Lithuanian health authorities decided to pay general practitioners a fee for performing serological tests for hepatitis C virus (HCV) antibodies in the population born from 1945 to 1994 once per life and annual HCV testing for PWID and HIV infected patients. This study aimed to assess trends in HCV-related mortality in the country and the prevalence of HCV infection among patients with liver diseases and evaluate possibilities of screening for HCV infection at a primary health care center. Age-standardized mortality rates in 2010–2020 were calculated for deaths caused by chronic hepatitis C and some liver diseases. Data on HCV infection among patients with liver cirrhosis, cancer and transplant patients were collected from the tertiary care hospital Kauno Klinikos. The prevalence of anti-HCV and risk factors of HCV infection was assessed among patients registered with the health care center in Klaipeda, where a pilot study of screening was performed. No steady trend in mortality was observed. Analysis of medical documentation showed that 40.5% of patients with liver cirrhosis, 49.7% with cancers and 36.9% of transplant patients were HCV infected. Over the year, 4867 patients were screened in the primary health care center. Positive anti-HCV prevalence was 1.7% (2.1% in men and 1.3% in women). Blood transfusion and being a blood donor before 1993 also having tattoos were associated with higher odds of HCV infection. The study revealed the active participation of individuals in HCV screening.
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Johannesson JM, Fridriksdottir RH, Löve TJ, Runarsdottir V, Hansdóttir I, Löve A, Thordardottir M, Hernandez UB, Olafsson S, Gottfredsson M. HIGH RATE OF HCV REINFECTION AMONG RECENTLY INJECTING DRUG USERS: RESULTS FROM THE TRAP HEP C PROGRAM - A PROSPECTIVE NATIONWIDE, POPULATION-BASED STUDY. Clin Infect Dis 2022; 75:1732-1739. [PMID: 35438144 DOI: 10.1093/cid/ciac272] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 11/23/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The Treatment as Prevention for Hepatitis C program started in 2016 in Iceland, offering treatment with direct-acting antivirals to hepatitis C virus (HCV)-infected individuals. Reinfections through injection drug use (IDU) can hamper elimination efforts. We determined reinfection rates (RIR) of HCV among patients in the program. METHODS Clinical data were gathered prospectively. The study cohort consisted of HCV-cured patients with an estimated sustained virologic response between February 1st 2016 and November 20th 2018, with follow-up until November 20th 2019. The observation period and time until reinfection was estimated using a single random point imputation method coupled with Monte Carlo simulation. The RIR was expressed as reinfections/100 person-years (PYs). RESULTS 640 treatments of 614 patients (417 males, mean age 44.3 years) resulted in cure, with 52 reinfections subsequently confirmed in 50 patients (37 males). Follow-up was 672.1 PYs with median time to reinfection of 231.7 days. History of IDU was reported by 523 patients (84.8%) and recent IDU with 220 (34.4%) treatments. Stimulants were the preferred injected drug in 85.5% of patients with history of IDU. The RIR was 7.7/100 PYs. Using multivariate Cox proportional hazards models for interval-censored data, age (HR 0.96, 95% CI 0.94-0.99) and recent IDU (HR 2.91, 95% CI 1.48-5.76) were significantly associated with reinfection risk. CONCLUSIONS The RIR is high in a setting of widespread stimulant use, particularly in young people with recent IDU. Regular follow up is important among high-risk populations to diagnose reinfections early and reduce transmission.
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Affiliation(s)
- Jon M Johannesson
- Department of Internal Medicine, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - Ragnheidur H Fridriksdottir
- Department of Gastroenterology and Hepatology, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - Thorvardur J Löve
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland.,Department of Science, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | | | | | - Arthur Löve
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland.,Department of Clinical Microbiology, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - Marianna Thordardottir
- Center for Health Security and Communicable Disease Control, Directorate of Health, Reykjavik, Iceland
| | - Ubaldo B Hernandez
- Department of Science, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - Sigurdur Olafsson
- Department of Gastroenterology and Hepatology, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland.,Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Magnus Gottfredsson
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland.,Department of Science, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland.,Department of Infectious Diseases, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
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Flisiak R, Zarębska-michaluk D, Ciupkeviciene E, Drazilova S, Frankova S, Grgurevic I, Hunyady B, Jarcuska P, Kupčinskas L, Makara M, Saulite-vanaga G, Simonova M, Sperl J, Tolmane I, Vince A. HCV Elimination in Central Europe with Particular Emphasis on Microelimination in Prisons. Viruses 2022; 14:482. [PMID: 35336889 PMCID: PMC8952509 DOI: 10.3390/v14030482] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/13/2022] [Accepted: 02/25/2022] [Indexed: 11/16/2022] Open
Abstract
In 2016, the WHO announced a plan to eliminate viral hepatitis as a public health threat by 2030. In this narrative review, experts from Bulgaria, Croatia, the Czech Republic, Hungary, Latvia, Lithuania, Poland and Slovakia assessed the feasibility of achieving the WHO 2030 target for HCV infections in Central Europe. They focused mainly on HCV micro-elimination in prisons, where the highest incidence of HCV infections is usually observed, and the impact of the COVID-19 pandemic on the detection and treatment of HCV infections. According to the presented estimates, almost 400,000 people remain infected with HCV in the analyzed countries. Interferon-free therapies are available ad libitum, but the number of patients treated annually in the last two years has halved compared to 2017–2019, mainly due to the COVID-19 pandemic. None of the countries analyzed had implemented a national HCV screening program or a prison screening program. The main reason is a lack of will at governmental and prison levels. None of the countries analyzed see any chance of meeting the WHO targets for removing viral hepatitis from the public threat list by 2030, unless barriers such as a lack of political will and a lack of screening programs are removed quickly.
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Khalsa JH, Mathur P. Hepatitis C Virus Infection in Persons Who Inject Drugs in the Middle East and North Africa: Intervention Strategies. Viruses 2021; 13:1363. [PMID: 34372569 PMCID: PMC8310161 DOI: 10.3390/v13071363] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/04/2021] [Accepted: 07/11/2021] [Indexed: 12/12/2022] Open
Abstract
There is a high incidence and prevalence of hepatitis C viral infection in persons with or without substance use disorders (SUDs) in the Middle East and North Africa (MENA) region, but only a small number receive comprehensive care. Highly effective direct-acting antiviral (DAA) medications are available at substantially lower costs; however, complete elimination of the hepatitis C virus (HCV) can only be achieved if integrated care strategies target those at highest risk for HCV infection and transmission and improve access to care. Due to the high prevalence of SUD in the MENA region, strategies to eliminate HCV must focus on integrated healthcare across multiple subspecialties, including addiction medicine, psychiatry, infectious diseases, hepatology, and social work. In this invited manuscript, we review the epidemiology of HCV in the MENA region and highlight intervention strategies to attain the WHO's goal of HCV eradication by 2030.
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Affiliation(s)
- Jag H. Khalsa
- Medical Consequences of Drug Abuse and Infections Branch, Division of Therapeutics and Medical Consequences, National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD 20892, USA
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
| | - Poonam Mathur
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
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Olafsson S, Fridriksdottir RH, Love TJ, Tyrfingsson T, Runarsdottir V, Hansdottir I, Bergmann OM, Björnsson ES, Johannsson B, Sigurdardottir B, Löve A, Baldvinsdottir GE, Hernandez UB, Gudnason T, Heimisdottir M, Hellard M, Gottfredsson M. Cascade of care during the first 36 months of the treatment as prevention for hepatitis C (TraP HepC) programme in Iceland: a population-based study. Lancet Gastroenterol Hepatol 2021; 6:628-637. [PMID: 34171267 DOI: 10.1016/s2468-1253(21)00137-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 01/05/2021] [Revised: 03/31/2021] [Accepted: 04/07/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND WHO has set targets to eliminate hepatitis C virus (HCV) infection as a global health threat by 2030 through a 65% reduction in HCV-related deaths and 80% reduction in HCV incidence. To achieve these goals, WHO set service coverage targets of 90% of the infected population being diagnosed and 80% of eligible patients being treated. In February, 2016, Iceland initiated a nationwide HCV elimination programme known as treatment as prevention for hepatitis C (TraP HepC), which aimed to maximise diagnosis and treatment access. This analysis reports on the HCV cascade of care in the first 3 years of the programme. METHODS This population-based study was done between Feb 10, 2016, and Feb 10, 2019. Participants aged 18 years or older with permanent residence in Iceland and PCR-confirmed HCV were offered direct-acting antiviral (DAA) therapy. The programme used a multidisciplinary team approach in which people who inject drugs were prioritised. Nationwide awareness campaigns, improved access to testing, and harm reduction services were scaled up simultaneously. The number of infected people in the national HCV registry was used in combination with multiple other data sources, including screening of low-risk groups and high-risk groups, to estimate the total number of HCV infections. The number of people diagnosed, linked to care, initiated on treatment, and cured were recorded during the study. This study is registered with ClinicalTrials.gov, NCT02647879. FINDINGS In February, 2016, at the onset of the programme, 760 (95% CI 690-851) individuals were estimated to have HCV infection, with 75 (95% CI 6-166) individuals undiagnosed. 682 individuals were confirmed to be HCV PCR positive. Over the next 3 years, 183 new infections (including 42 reinfections) were diagnosed, for a total of 865 infections in 823 individuals. It was estimated that more than 90% of all domestic HCV infections had been diagnosed as early as January, 2017. During the 3 years, 824 (95·3%) of diagnosed infections were linked to care, and treatment was initiated for 795 (96·5%) of infections linked to care. Cure was achieved for 717 (90·2%) of 795 infections. INTERPRETATION By using a multidisciplinary public health approach, involving tight integration with addiction treatment services, the core service coverage targets for 2030 set by WHO have been reached. These achievements position Iceland to be among the first nations to subsequently achieve the WHO goal of eliminating HCV as a public health threat. FUNDING The Icelandic Government and Gilead Sciences.
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Affiliation(s)
- Sigurdur Olafsson
- Department of Gastroenterology and Hepatology, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland; Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavík, Iceland.
| | - Ragnheidur H Fridriksdottir
- Department of Gastroenterology and Hepatology, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - Thorvardur J Love
- Department of Science, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland; Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavík, Iceland
| | | | | | - Ingunn Hansdottir
- Faculty of Psychology, School of Health Sciences, University of Iceland, Reykjavík, Iceland; SAA National Center for Addiction Medicine, Reykjavik, Iceland
| | - Ottar M Bergmann
- Department of Gastroenterology and Hepatology, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - Einar S Björnsson
- Department of Gastroenterology and Hepatology, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland; Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavík, Iceland
| | - Birgir Johannsson
- Department of Infectious Diseases, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - Bryndis Sigurdardottir
- Department of Infectious Diseases, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - Arthur Löve
- Department of Virology, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland; Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavík, Iceland
| | - Gudrun E Baldvinsdottir
- Department of Virology, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - Ubaldo Benitez Hernandez
- Department of Science, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | | | - Maria Heimisdottir
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavík, Iceland; Icelandic Health Insurance, Reykjavik, Iceland
| | - Margaret Hellard
- Burnet Institute, Melbourne, VIC, Australia; Department of Infectious Diseases, The Alfred Hospital, Melbourne, VIC, Australia
| | - Magnus Gottfredsson
- Department of Infectious Diseases, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland; Department of Science, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland; Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavík, Iceland
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Suenaga R, Suka M, Hirao T, Hidaka I, Sakaida I, Ishida H. Cost-effectiveness of a "treat-all" strategy using Direct-Acting Antivirals (DAAs) for Japanese patients with chronic hepatitis C genotype 1 at different fibrosis stages. PLoS One 2021; 16:e0248748. [PMID: 33793594 PMCID: PMC8016275 DOI: 10.1371/journal.pone.0248748] [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: 09/29/2020] [Accepted: 03/04/2021] [Indexed: 11/26/2022] Open
Abstract
Aim To evaluate the cost-effectiveness of therapeutic strategies initiated at different stages of liver fibrosis using three direct-acting antivirals (DAAs), sofosbuvir-ledipasvir (SL), glecaprevir-pibrentasvir (GP), and elbasvir plus grazoprevir (E/G), for Japanese patients with chronic hepatitis C (CHC) genotype 1. Methods We created an analytical decision model reflecting the progression of liver fibrosis stages to evaluate the cost-effectiveness of alternative therapeutic strategies applied at different fibrosis stages. We compared six treatment strategies: treating all patients regardless of fibrosis stage (TA), treating individual patients with one of four treatments starting at four respective stages of liver fibrosis progression (F1S: withholding treatment at stage F0 and starting treatment from stage F1 or higher, and three successive options, F2S, F3S, and F4S), and administering no antiviral treatment (NoRx). We adopted a lifetime horizon and Japanese health insurance payers’ perspective. Results The base case analysis showed that the incremental quality-adjusted life years (QALY) gain of TA by SL, GP, and E/G compared with the strategies of starting treatments for patients with the advanced fibrosis stage, F2S, varied from 0.32 to 0.33, and the incremental cost-effectiveness ratios (ICERs) were US$24,320, US$18,160 and US$17,410 per QALY, respectively. On the cost-effectiveness acceptability curve, TA was most likely to be cost-effective, with the three DAAs at the willingness to pay thresholds of US$50,000. Conclusions Our results suggested that administration of DAA treatment for all Japanese patients with genotype 1 CHC regardless of their liver fibrosis stage would be cost-effective under ordinary conditions.
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Affiliation(s)
- Riichiro Suenaga
- Japanese Red Cross Yamaguchi Hospital, Yamaguchi, Yamaguchi, Japan
| | - Machi Suka
- Department of Public Health and Environmental Medicine, The Jikei University of Medicine, Minato-ku, Tokyo, Japan
| | - Tomohiro Hirao
- Department of Public Health, Faculty of Medicine, Kagawa University, Kita-gun, Kagawa, Japan
| | - Isao Hidaka
- Department of Gastroenterology & Hepatology, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Isao Sakaida
- Department of Gastroenterology & Hepatology, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Haku Ishida
- Department of Medical Informatics & Decision Sciences, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
- * E-mail:
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Merat S. SD1000: High Sustained Viral Response Rate in 1361 Patients With Hepatitis C Genotypes 1, 2, 3, and 4 Using a Low-cost, Fixed-dose Combination Tablet of Generic Sofosbuvir and Daclatasvir: A Multicenter, Phase III Clinical Trial. Clin Infect Dis 2021; 70:2206-2212. [PMID: 31504303 DOI: 10.1093/cid/ciz628] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 07/09/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The combination of sofosbuvir and daclatasvir is a potent, pangenotypic regimen suitable for mass-scale hepatitis C treatment, especially in resource-limited countries where newer, expensive combinations are not available. This combination has been widely tested on genotype 4. However, Phase III trials of this combination in other genotypes have been cost prohibitive. With the introduction of generic, low-cost sofosbuvir and daclatasvir, large-scale studies in resource-limited countries are now possible. METHODS Sofosbuvir at 400 mg and daclatasvir at 60 mg were coformulated into a fixed-dose combination (FDC) tablet (Sovodak, Rojan Pharma, Tehran, Iran). Patients from 46 centers were dosed for 12 or 24 weeks with or without ribavirin, in line with existing guidelines. Responses to treatment were evaluated 12 weeks after the end of treatment (for a sustained virological response at Week 12; SVR12). RESULTS There were 1361 patients recruited. Overall, the patients were 21% female, with a mean age of 50 years; 39% were cirrhotic; 22% were treatment-experienced; 47% were genotype 1, 41% were genotype 3, and 2% were other genotypes. The genotype was not known in 10% of the patients. The intention-to-treat and per-protocol SVR12 rates were 94.7% and 98.8%, respectively. The safety profile was unremarkable, treatment was well tolerated, and compliance with the single-tablet regimen was excellent. CONCLUSIONS The treatment with FDC of sofosbuvir and daclatasvir achieved high SVR12 rates, equivalent to those seen in Phase III trials of other pangenotypic options, and has been conducted at a similar scale in a representative, real-world population at a cost of under $100 per patient, which makes this combination suitable for elimination protocols in resource-limited countries. CLINICAL TRIALS REGISTRATION NCT03200184.
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Affiliation(s)
- Shahin Merat
- Liver and Pancreatobiliary Diseases Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Shariati Hospital, Iran
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Ajlan AA, Al-Gain R, Ahmed M, Abu-Riash T, Alquaiz M, Alkhail FA, Alashgar H, Alkhairallah T, Alkortas D, Al-Jedai A. Developing a multidisciplinary HCV direct-acting antivirals utilization management and assessment program. J Am Pharm Assoc (2003) 2020; 61:e159-e170. [PMID: 33309191 DOI: 10.1016/j.japh.2020.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/17/2020] [Accepted: 11/13/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND The introduction of direct-acting antivirals (DAAs) for the treatment of hepatitis C virus (HCV) infections has revolutionized outcomes for patients with HCV. Cost-effective use of these antivirals in addition to ensuring patient adherence is of paramount importance. OBJECTIVES The goal of this article is to describe the processes by which a tertiary care, multisite institution managed the complexities involved in administering DAA treatment and managing the increased cost of therapy. Specifically, the objectives of this article are to describe the development of a multidisciplinary HCV management program and the role of pharmacists in this program, including formulary management strategies and monitoring of DAAs use in our institution, development of guidelines, electronic prescribing protocols and order sets, and specific outcomes based on a concurrent medication use evaluation. PRACTICE DESCRIPTION King Faisal Specialist Hospital and Research Centre is a tertiary care referral hospital. As a tertiary referral hospital, it offers primary and highly specialized inpatient and outpatient medical care. The process of selecting and developing institutional HCV management program is described. PRACTICE INNOVATION This article provides key details regarding how a multidisciplinary HCV program using DAAs can be implemented successfully at a tertiary care facility. Key facets of our innovation include establishing formulary guidelines, setting up eligibility criteria for patients, and establishing an HCV taskforce and multidisciplinary HCV program clinic. EVALUATION Medication use evaluations were regularly conducted to monitor sustained virologic response rates, adherence to guidelines, adverse reactions, and drug interactions. METHODS Formulary guidelines, setting up an eligibility criterion for patients, and an HCV taskforce and multidisciplinary HCV program clinic were established. RESULTS The involvement of pharmacists in a multidisciplinary HCV program in outpatient settings resulted in improved formulary decision making, reduction of costs, and improvement of adherence to institutional guidelines. PRACTICE IMPLICATIONS The role of a pharmacist in the management of patients with HCV with DAAs is important. Pharmacists play an integral part in medication management and overall reduction in health care expenditure. Many disease management programs can be complemented with pharmacists to improve patient care and reduce cost. CONCLUSION HCV treatment is challenging, and a multidisciplinary approach to treat HCV is critical. It is a rapidly evolving field; therefore, it requires dynamic formulary management and collaborative practice approaches to monitor pharmacotherapy carefully and efficiently. Clinical pharmacists play a pivotal role within the multidisciplinary team by providing support to both patients and health care providers with regard to the treatment of HCV.
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Hellard M, Schroeder SE, Pedrana A, Doyle J, Aitken C. The Elimination of Hepatitis C as a Public Health Threat. Cold Spring Harb Perspect Med 2020; 10:a036939. [PMID: 31712223 DOI: 10.1101/cshperspect.a036939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Hepatitis C virus is a global public health threat, affecting 71 million people worldwide. Increasing recognition of the impact of this epidemic and recent advances in biomedical and technical approaches to hepatitis C prevention and cure have provided impetus for the World Health Organization (WHO) to call for global elimination of hepatitis C as a public health threat by 2030. This work reviews the feasibility of hepatitis C elimination and pathways to overcome existing and potential future barriers to elimination. Drawing on cost-effectiveness modeling and providing examples of successful implementation efforts across the globe, we highlight the resources and strategies needed to achieve hepatitis C elimination. A timely, multipronged response is required if the 2030 WHO elimination targets are to be achieved. Importantly, achieving hepatitis C elimination will also benefit the community well beyond 2030.
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Bonacini M, Kim Y, Pitney C, McKoin L, Tran M, Landis C. Wirelessly Observed Therapy to Optimize Adherence and Target Interventions for Oral Hepatitis C Treatment: Observational Pilot Study. J Med Internet Res 2020; 22:e15532. [PMID: 32352385 PMCID: PMC7226036 DOI: 10.2196/15532] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 10/07/2019] [Accepted: 10/20/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND A fixed-dose combination of ledipasvir/sofosbuvir (LDV/SOF) is efficacious in treating chronic hepatitis C virus (HCV) infection; however, objective adherence to prescribed regimens in real-world clinical settings has not been well studied. OBJECTIVE This study aimed to evaluate adherence and virologic outcomes in patients with chronic HCV infection treated with LDV/SOF using a novel digital medicine program that directly measures drug ingestion adherence. METHODS This prospective, observational, open-label, single-arm pilot study was conducted at 2 clinical research sites and followed patients with HCV infection who were prescribed LDV/SOF along with an ingestible sensor. Patients were treated for 8 or 12 weeks. The main outcomes were ingestion adherence, medical interventions, virologic response, safety, and patient satisfaction. RESULTS Of the 28 patients (mean 59 years, SD 7), 61% (17/28) were male, 61% (17/28) were non-Caucasian, and 93% (26/28) were treatment naïve. All 28 had genotype 1 HCV, and of these, 27 completed an 8- or 12-week treatment. Patients used the digital medicine program for 92% of the expected days; the overall mean ingestion adherence rate was 97%. Providers used the digital medicine program data for same-day medication therapy management in 39% (11/28) of patients. End-of-treatment response was achieved in all the available 21 of 28 patients. Sustained virologic response at 12 weeks or more was achieved in 26 of 28 patients; of the 2 patients who relapsed, one had less than 90% adherence and the other had greater than or equal to 95% adherence, lending insights into reasons for treatment failure. A total of 4 subjects reported nonserious adverse events, which were resolved. CONCLUSIONS Conclusions: The findings of this study suggest that digital medicines can be used for wirelessly observed therapy to support adherence to antiviral HCV therapy, reduce unnecessary medication wastage and retreatment costs, and potentially optimize sustained virologic response rates, especially in populations at high risk for nonadherence.
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Affiliation(s)
- Maurizio Bonacini
- Mission Gastroenterology and Hepatology, san francisco, CA, United States
| | - Yoona Kim
- Proteus Digital Health, Redwood City, CA, United States
| | - Caroline Pitney
- Paul G. Allen School of Computer Science and Engineering, University of Washington, Seattle, WA, United States
| | - Lee McKoin
- Paul G. Allen School of Computer Science and Engineering, University of Washington, Seattle, WA, United States
| | - Melody Tran
- Proteus Digital Health, Redwood City, CA, United States
| | - Charles Landis
- Paul G. Allen School of Computer Science and Engineering, University of Washington, Seattle, WA, United States
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12
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Trickey A, Hiebert L, Perfect C, Thomas C, El Kaim JL, Vickerman P, Schȕtte C, Hecht R. Hepatitis C virus elimination in Indonesia: Epidemiological, cost and cost-effectiveness modelling to advance advocacy and strategic planning. Liver Int 2020; 40:286-297. [PMID: 31454466 DOI: 10.1111/liv.14232] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 08/01/2019] [Accepted: 08/21/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUNDS & AIMS In Indonesia 1.9 million people are chronically infected with hepatitis C virus (HCV), but a national strategic plan for elimination has not yet been developed, despite the availability of low-cost treatments which could save many lives. We used epidemiological and cost modelling to estimate targets and resource requirements of a national elimination program and explore the potential impact and cost-effectiveness. METHODS To model the HCV epidemic, we used a dynamic model, parameterised with Indonesia-specific data, accounting for disease progression, injecting drug use and demographics. Future scale-up scenarios were designed for 2018-2050 to capture possible policy choices. Costs of an initial 5-year national strategy and of long-term elimination were estimated for the most feasible scenario, as agreed with government and local partners. Cost savings from reduced drug and diagnostics prices were also estimated. The cost-effectiveness of baseline predictions and those with drug price reductions were compared to the no treatment scenario. RESULTS Elimination by 2045, considered the most feasible path to scale-up, would prevent 739 000 new infections and avert 158 000 HCV-related deaths. The costs would be $5.6 billion (USD) using baseline prices but could fall to $2.7 billion if price reductions for HCV drugs and diagnostics are secured. With these price reductions, the incremental cost-effectiveness ratio for a 2045 elimination program would be cost-effective at $300 (USD) per year of life saved vs the no treatment scenario. CONCLUSIONS This study has underpinned advocacy efforts to secure Indonesian government commitment to HCV elimination, and provides further inputs for HCV strategic planning efforts.
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Affiliation(s)
- Adam Trickey
- Population Health Sciences, University of Bristol, Bristol, UK.,NIHR Health Protection Research Unit in Evaluation of Interventions, University of Bristol, Bristol, UK
| | | | | | - Caroline Thomas
- Persaudaraan Korban Napza Indonesia (PKNI), Jakarta, Indonesia
| | | | - Peter Vickerman
- Population Health Sciences, University of Bristol, Bristol, UK.,NIHR Health Protection Research Unit in Evaluation of Interventions, University of Bristol, Bristol, UK
| | - Carl Schȕtte
- Strategic Development Consultants, Durban, South Africa
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13
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Trickey A, Fraser H, Lim AG, Walker JG, Peacock A, Colledge S, Leung J, Grebely J, Larney S, Martin NK, Degenhardt L, Hickman M, May MT, Vickerman P. Modelling the potential prevention benefits of a treat-all hepatitis C treatment strategy at global, regional and country levels: A modelling study. J Viral Hepat 2019; 26:1388-1403. [PMID: 31392812 PMCID: PMC10401696 DOI: 10.1111/jvh.13187] [Citation(s) in RCA: 9] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 07/01/2019] [Accepted: 07/15/2019] [Indexed: 12/18/2022]
Abstract
The World Health Organization (WHO) recently produced guidelines advising a treat-all policy for HCV to encourage widespread treatment scale-up for achieving HCV elimination. We modelled the prevention impact achieved (HCV infections averted [IA]) from initiating this policy compared with treating different subgroups at country, regional and global levels. We assessed what country-level factors affect impact. A dynamic, deterministic HCV transmission model was calibrated to data from global systematic reviews and UN data sets to simulate country-level HCV epidemics with ongoing levels of treatment. For each country, the model projected the prevention impact (in HCV IA per treatment undertaken) of initiating four treatment strategies; either selected randomly (treat-all) or targeted among people who inject drugs (PWID), people aged ≥35, or those with cirrhosis. The IA was assessed over 20 years. Linear regression was used to identify associations between IA per treatment and demographic factors. Eighty-eight countries (85% of the global population) were modelled. Globally, the model estimated 0.35 (95% credibility interval [95%CrI]: 0.16-0.61) IA over 20 years for every randomly allocated treatment, 0.30 (95%CrI: 0.12-0.53) from treating those aged ≥35 and 0.28 (95%CrI: 0.12-0.49) for those with cirrhosis. Globally, treating PWID achieved 1.27 (95%CrI: 0.68-2.04) IA per treatment. The IA per randomly allocated treatment was positively associated with a country's population growth rate and negatively associated with higher HCV prevalence among PWID. In conclusion, appreciable prevention benefits could be achieved from WHO's treat-all strategy, although greater benefits per treatment can be achieved through targeting PWID. Higher impact will be achieved in countries with high population growth.
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Affiliation(s)
- Adam Trickey
- Population Health Sciences, University of Bristol, Bristol, UK.,National Institute of Health Research (NIHR) Health Protection Research Unit (HPRU) in Evaluation of Interventions, Bristol, UK
| | - Hannah Fraser
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Aaron G Lim
- Population Health Sciences, University of Bristol, Bristol, UK
| | | | - Amy Peacock
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | - Samantha Colledge
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | - Janni Leung
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia.,Centre for Youth Substance Abuse Research, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, QLD, Australia.,Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States
| | - Jason Grebely
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States.,The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Sarah Larney
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | - Natasha K Martin
- Population Health Sciences, University of Bristol, Bristol, UK.,Division of Infectious Diseases and Global Public Health, University of California, San Diego, CA, USA
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | - Matthew Hickman
- Population Health Sciences, University of Bristol, Bristol, UK.,National Institute of Health Research (NIHR) Health Protection Research Unit (HPRU) in Evaluation of Interventions, Bristol, UK
| | - Margaret T May
- Population Health Sciences, University of Bristol, Bristol, UK.,National Institute of Health Research (NIHR) Health Protection Research Unit (HPRU) in Evaluation of Interventions, Bristol, UK.,National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Peter Vickerman
- Population Health Sciences, University of Bristol, Bristol, UK.,National Institute of Health Research (NIHR) Health Protection Research Unit (HPRU) in Evaluation of Interventions, Bristol, UK
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14
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Gardini I, Bartoli M, Conforti M, Mennini FS, Marcellusi A. Estimation of the number of HCV-positive patients in Italy. PLoS One 2019; 14:e0223668. [PMID: 31671120 PMCID: PMC6822946 DOI: 10.1371/journal.pone.0223668] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 03/25/2019] [Accepted: 09/25/2019] [Indexed: 12/17/2022] Open
Abstract
Background HCV is one of the main causes of cirrhosis, hepatocellular carcinoma (HCC) and liver transplantation. Aim The aim of this study was to estimate the number of living individuals diagnosed with hepatitis C in Italy. This study also aimed to stratify these subjects as diagnosed and cured, diagnosed awaiting a cure, and undiagnosed (individuals who were not diagnosed, living or lived with hepatitis C). Methods To quantify the number of ill patients in Italy, an inquiry was conducted based on questionnaires submitted to three nationally representative regions, namely, Campania, Lazio and Piemonte, as representatives of the three main areas of Italy (North, Centre and South regions). The data were collected through a questionnaire to acquire demographic and clinical information on patients in the participating hospitals. The questionnaires contained 6 questions on sex, age, region of residence, disease condition, type of exemption and category. The questionnaires were administered individually to consecutive patients through face-to-face interviews conducted by specialised personnel in each centre. Data were collected between September 2017 and January 2018. Results In total, 2,860 questionnaires were analysed. They were completed by the patients (55% male), who had an average age of 61 years (64 years for women and 59 years for men). In total, 54% of the sample declared that they were still infected with HCV (1,548 patients out of 2,860 respondents), while the remaining subjects declared that they had been cured. The inquiry showed that 46.6% of the sample had at least a 016 exemption (chronic hepatitis), while more than 51% (1,469 interviewed patients out of 2,860 respondents) had a different type of exemption. Only 2% of the respondents declared that they had no exemption. Assuming that the analysed sample is representative of the actual HCV-positive population in Italy and considering the number of 016 exempt patients in the regional data, the model estimates that there are 443,491 cured and HCV-positive living patients and 240,043 ill patients who have yet to be treated. Conclusions Although this study has limitations, it represents a considerable improvement over the previously available studies. This study can help decision-makers implement more effective strategic planning to eliminate hepatitis C.
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Affiliation(s)
- Ivan Gardini
- EpaC Onlus, Italian Liver Patient Association, Rome, Italy
| | - Marco Bartoli
- EpaC Onlus, Italian Liver Patient Association, Rome, Italy
| | | | - Francesco Saverio Mennini
- Centre for Economic and International Study (CEIS), Faculty of Economics, University of Rome "Tor Vergata", Rome, Italy
| | - Andrea Marcellusi
- Department of Accounting, Finance and Informatics, Kingston Business School, Kingston University London, London, United Kingdom
- * E-mail:
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15
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Gomide GPM, Melo CBD, Santos VDS, Salge VD, Camargo FC, Pereira GDA, Cabral SCDO, Molina RJ, Oliveira CDCHBD. Epidemiological survey of hepatitis C in a region considered to have high prevalence: the state of Minas Gerais, Brazil. Rev Soc Bras Med Trop 2019; 52:e20190202. [PMID: 31596352 DOI: 10.1590/0037-8682-0202-2019] [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] [Received: 04/29/2019] [Accepted: 08/19/2019] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION The prevalence of hepatitis C virus (HCV) infection is affected by demographic, virological, clinical, and lifestyle-related factors and varies in different regions in Brazil or worldwide. The present study aimed to clarify the epidemiological patterns of HCV infection in the interior region of Brazil. METHODS This study was conducted in the Southern Triangle Macro-region of the state of Minas Gerais, Brazil, according to the guidelines of the National Program for the Prevention and Control of Viral Hepatitis. The participants answered a structured questionnaire on social and epidemiological factors. Immunochromatographic rapid tests were used for the qualitative detection of antibodies against HCV in whole blood (Alere HCV® Code 02FK10) in adult subjects by a free-standing method. RESULTS Of 24,085 tested individuals, 184 (0.76%) were anti-HCV positive. The majority of anti-HCV-positive individuals were born between 1951 and 1980 (n=146 [79.3%]), with 68 women and 116 men. Identified risk factors included syringe and/or needle sharing (p = 0.003), being in prison (p = 0.004), and having tattoos or piercings (p = 0.005) and were significantly associated with the decade of birth. CONCLUSIONS The study shows the importance of testing populations at risk for HCV infection, including incarcerated individuals, those with tattoos or piercings, those who share or have shared syringes or needles, and those in high-risk birth cohorts (1950s, 1960s, and 1970s) in the Southern Triangle Macro-region.
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Affiliation(s)
- Geisa Perez Medina Gomide
- Universidade Federal do Triângulo Mineiro, Programa de Pós-Graduação em Medicina Tropical e Infectologia, Uberaba, MG, Brasil
| | | | | | - Vanessa Dib Salge
- Universidade Federal do Triângulo Mineiro, Curso de Medicina, Uberaba, MG, Brasil
| | - Fernanda Carolina Camargo
- Universidade Federal do Triângulo Mineiro, Hospital de Clínicas, Gerência de Ensino e Pesquisa, Uberaba, MG, Brasil
| | - Gilberto de Araújo Pereira
- Universidade Federal do Triângulo Mineiro, Hospital de Clínicas, Gerência de Ensino e Pesquisa, Uberaba, MG, Brasil
| | | | - Rodrigo Juliano Molina
- Universidade Federal do Triângulo Mineiro, Hospital de Clínicas, Disciplina de Doenças Parasitárias e Infectologia, Uberaba, MG, Brasil
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16
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Schröeder SE, Pedrana A, Scott N, Wilson D, Kuschel C, Aufegger L, Atun R, Baptista‐Leite R, Butsashvili M, El‐Sayed M, Getahun A, Hamid S, Hammad R, ‘t Hoen E, Hutchinson SJ, Lazarus JV, Lesi O, Li W, Binti Mohamed R, Olafsson S, Peck R, Sohn AH, Sonderup M, Spearman CW, Swan T, Thursz M, Walker T, Hellard M, Howell J. Innovative strategies for the elimination of viral hepatitis at a national level: A country case series. Liver Int 2019; 39:1818-1836. [PMID: 31433902 PMCID: PMC6790606 DOI: 10.1111/liv.14222] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [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: 05/24/2019] [Revised: 08/13/2019] [Accepted: 08/13/2019] [Indexed: 12/12/2022]
Abstract
Viral hepatitis is a leading cause of morbidity and mortality worldwide, but has long been neglected by national and international policymakers. Recent modelling studies suggest that investing in the global elimination of viral hepatitis is feasible and cost-effective. In 2016, all 194 member states of the World Health Organization endorsed the goal to eliminate viral hepatitis as a public health threat by 2030, but complex systemic and social realities hamper implementation efforts. This paper presents eight case studies from a diverse range of countries that have invested in responses to viral hepatitis and adopted innovative approaches to tackle their respective epidemics. Based on an investment framework developed to build a global investment case for the elimination of viral hepatitis by 2030, national activities and key enablers are highlighted that showcase the feasibility and impact of concerted hepatitis responses across a range of settings, with different levels of available resources and infrastructural development. These case studies demonstrate the utility of taking a multipronged, public health approach to: (a) evidence-gathering and planning; (b) implementation; and (c) integration of viral hepatitis services into the Agenda for Sustainable Development. They provide models for planning, investment and implementation strategies for other countries facing similar challenges and resource constraints.
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Affiliation(s)
- Sophia E. Schröeder
- Burnet InstituteMelbourneVICAustralia,School of Public Health and Preventive MedicineMonash UniversityMelbourneVICAustralia
| | - Alisa Pedrana
- Burnet InstituteMelbourneVICAustralia,School of Public Health and Preventive MedicineMonash UniversityMelbourneVICAustralia
| | | | - David Wilson
- Burnet InstituteMelbourneVICAustralia,School of Public Health and Preventive MedicineMonash UniversityMelbourneVICAustralia
| | | | - Lisa Aufegger
- Centre for Health PolicyImperial College LondonLondonUK
| | - Rifat Atun
- Harvard T H Chan School of Public HealthHarvard UniversityBostonMAUSA
| | - Ricardo Baptista‐Leite
- Universidade Catolica PortuguesaLisbonPortugal,Faculty of Health, Medicine and Life SciencesMaastricht UniversityMaastrichtthe Netherlands
| | | | - Manal El‐Sayed
- Department of Pediatrics and Clinical Research CenterAin Shams UniversityCairoEgypt
| | - Aneley Getahun
- School of Public Health and Primary CareFiji National UniversitySuvaFiji
| | | | | | - Ellen ‘t Hoen
- Global Health UnitUniversity Medical CentreGroningenthe Netherlands,Medicines Law & PolicyAmsterdamthe Netherlands
| | - Sharon J. Hutchinson
- School of Health and Life SciencesGlasgow Caledonian UniversityGlasgowUK,Health Protection ScotlandMeridian CourtGlasgowUK
| | - Jeffrey V. Lazarus
- Barcelona Institute for Global Health (ISGlobal)Hospital ClinicUniversity of BarcelonaBarcelonaSpain
| | | | | | | | - Sigurdur Olafsson
- Gastroenterology and HepatologyLandspitali University HospitalReykjavikIceland
| | | | | | - Mark Sonderup
- Division of HepatologyDepartment of MedicineFaculty of Health SciencesUniversity of Cape TownCape TownSouth Africa
| | - Catherine W. Spearman
- Division of HepatologyDepartment of MedicineFaculty of Health SciencesUniversity of Cape TownCape TownSouth Africa
| | | | - Mark Thursz
- Department of HepatologyImperial College LondonLondonUK
| | - Tim Walker
- Department of Gastroenterology and General MedicineCalvary MaterNewcastleNSWAustralia,School of Medicine and Public HealthUniversity of NewcastleNewcastleNSWAustralia
| | - Margaret Hellard
- Burnet InstituteMelbourneVICAustralia,School of Public Health and Preventive MedicineMonash UniversityMelbourneVICAustralia,Hepatitis ServicesDepartment of Infectious DiseasesThe Alfred HospitalMelbourneVICAustralia,Doherty Institute and Melbourne School of Population and Global HealthUniversity of MelbourneMelbourneVICAustralia
| | - Jessica Howell
- Burnet InstituteMelbourneVICAustralia,Department of GastroenterologySt Vincent's HospitalMelbourneVICAustralia,Department of MedicineUniversity of MelbourneMelbourneVICAustralia
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17
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Fourati S, Feld JJ, Chevaliez S, Luhmann N. Approaches for simplified HCV diagnostic algorithms. J Int AIDS Soc 2019; 21 Suppl 2:e25058. [PMID: 29633561 PMCID: PMC5978654 DOI: 10.1002/jia2.25058] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [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: 01/30/2017] [Accepted: 12/24/2017] [Indexed: 12/16/2022] Open
Abstract
Introduction In the light of the advances in HCV antiviral therapy, global control of HCV infection becomes feasible but depends on the capacity of countries to identify infected people and to offer them treatment. To achieve the WHO goal which targets a diagnosis rate of 90% by 2030, simplification of screening and diagnosis will be crucial. Methods Published literature, unpublished data and expert consensus were used to determine key parameters, including point‐of‐care, rapid diagnostic testing, screening, the use of HCV core Ag and dried blood spots; starting from 2008 until November 2017. In addition, a manual search was undertaken to detect relevant papers or websites related to specific data from countries which underwent or are planning a programme of HCV elimination. Results Several strategies have been developed and evaluated these last years to simplify and facilitate access to screening and diagnosis, the development of reliable HCV core antigen tests and new nucleic acid amplification technologies for use in decentralized settings. In high prevalence settings, a one‐step screening and diagnosis strategy could simplify diagnostic algorithms provided the cost is reduced. Finally, genotyping may no longer be required in the context of availability of pangenotypic antiviral therapy. Conclusions Despite relevant advances in HCV screening and diagnosis, the overall diagnosis package is still too expensive today and efforts must be made to allow generalized implementation of reliable tests in low and middle income countries. These efforts will be key factors to foster a real public health approach to HCV elimination.
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Affiliation(s)
- Slim Fourati
- Department of Virology, Henri Mondor Hospital, National Reference Center for Viral Hepatitis B, C and delta D, INSERMU955, Créteil, France
| | - Jordan J Feld
- Toronto Centre for Liver Disease, Sandra Rotman Centre for Global Health, University of Toronto, Toronto, Canada
| | - Stéphane Chevaliez
- Department of Virology, Henri Mondor Hospital, National Reference Center for Viral Hepatitis B, C and delta D, INSERMU955, Créteil, France
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18
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Rojas Rojas T, Di Beo V, Delorme J, Barre T, Mathurin P, Protopopescu C, Bailly F, Coste M, Authier N, Carrieri MP, Rolland B, Marcellin F. Lower HCV treatment uptake in women who have received opioid agonist therapy before and during the DAA era: The ANRS FANTASIO project. Int J Drug Policy 2019; 72:61-8. [PMID: 31129024 DOI: 10.1016/j.drugpo.2019.05.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 05/10/2019] [Accepted: 05/11/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND In the era of direct-acting antivirals (DAA) for the treatment of hepatitis C virus (HCV) infection, HCV treatment uptake remains insufficiently documented in key populations such as people with opioid dependence. Access to opioid agonist therapy (OAT) is facilitated in France through delivery in primary care, and individuals with opioid dependence can be identified as those receiving OAT. Women with opioid dependence are especially vulnerable because of associated sex-related stigma, discrimination, and marginalization, all of which negatively interfere with access to HCV prevention and care. This study, based on data collected between 2012 and 2016 in France, aimed to assess whether (i) chronically HCV-infected women with opioid dependence had lower rates of HCV treatment uptake than their male counterparts during the same period (i.e., study period), and (ii) the advent of DAA resulted in increased treatment uptake rates in these women. METHODS Individuals with opioid dependence were identified as those receiving OAT at least once during the study period. Analyses were based on exhaustive anonymous care delivery data from the French national healthcare reimbursement database. We used multinomial logistic regression to estimate sex-based disparities in HCV treatment uptake (DAA or pegylated-interferon (Peg-IFN)-based treatment versus no treatment) while accounting for potential confounders. RESULTS The study sample comprised 27,127 individuals, including 5640 (20.8%) women. Median [interquartile range] age was 45 [40-49] years. Between 2012 and 2016, 70.9 (women: 77.2; men: 69.3), 17.3 (14.2; 18.2) and 11.7% (8.6%; 12.5%) of the study sample received, respectively, no HCV treatment, DAA and Peg-IFN-based treatment only. After multiple adjustment for potential confounders, women were 41% (adjusted odds-ratio (AOR) [95% confidence interval (CI]): 0.59[0.53-0.65]) and 28% (0.72[0.66-0.78]) less likely than men to have had Peg-IFN-based and DAA treatment, respectively. CONCLUSION Despite increased HCV treatment uptake in women with opioid dependence in the DAA era, rates remain lower than for men. In the coming years, access to DAA treatment will continue to increase in France thanks to a forthcoming simplified model of HCV care which includes primary care as an entry point. Nevertheless, a greater understanding of sex-specific barriers to HCV care and the implementation of appropriate sex-specific measures remain a priority.
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19
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Day E, Broder T, Bruneau J, Cruse S, Dickie M, Fish S, Grillon C, Luhmann N, Mason K, McLean E, Trooskin S, Treloar C, Grebely J. Priorities and recommended actions for how researchers, practitioners, policy makers, and the affected community can work together to improve access to hepatitis C care for people who use drugs. International Journal of Drug Policy 2019; 66:87-93. [DOI: 10.1016/j.drugpo.2019.01.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 12/21/2018] [Accepted: 01/07/2019] [Indexed: 02/08/2023]
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20
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Akahane T, Kurosaki M, Itakura J, Tsuji K, Joko K, Kimura H, Nasu A, Ogawa C, Kojima Y, Hasebe C, Wada S, Uchida Y, Sohda T, Suzuki H, Yoshida H, Kusakabe A, Tamada T, Kobashi H, Mitsuda A, Kondo M, Shigeno M, Ide Y, Morita A, Kitamura T, Abe T, Izumi N. Real-world efficacy and safety of sofosbuvir + ribavirin for hepatitis C genotype 2: A nationwide multicenter study by the Japanese Red Cross Liver Study Group. Hepatol Res 2019; 49:264-270. [PMID: 30171740 DOI: 10.1111/hepr.13246] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [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: 06/19/2018] [Revised: 08/15/2018] [Accepted: 08/27/2018] [Indexed: 12/15/2022]
Abstract
AIM This study aimed to describe the real-world efficacy and safety of sofosbuvir (SOF) + ribavirin (RBV) for chronic hepatitis C, genotype 2. METHODS This was a retrospective analysis of a nationwide, multicenter registry including 914 hepatitis C genotype 2 Japanese patients treated with SOF + RBV for 12 weeks. The rate of sustained virologic response at 12 weeks after treatment (SVR12), incidence of adverse events, and changes in serological parameters were analyzed. RESULTS Treatment was completed in 98.9% of patients. Ribavirin dose reduction was required in 29.7% of patients. The SVR12 rate was 96.8% in the intention-to-treat population and 97.6% in the per-protocol population. Factors associated with SVR12 were absence of advanced fibrosis (odds ratio, 5.76, P = 0.003) and interferon-treatment-naïve status (odds ratio, 4.79, P = 0.017). Dose reduction or total adherence of RBV was not associated with SVR. The resistance-associated substitution S282 T in NS5B was not detected in any patient at virologic failure. Serum albumin levels significantly increased, and the degree of increase was greater in patients with advanced fibrosis than in those without (0.21 ± 0.32 vs. 0.05 ± 0.29, P < 0.0001). Alpha-fetoprotein decreased significantly at end of treatment (P < 0.0001), and the degree of decrease was greater in patients with advanced fibrosis than in those without (21.7 ± 60.8 vs. 2.5 ± 15.5, P < 0.001). The most commonly reported adverse event was anemia (13.7%). CONCLUSIONS Treatment with SOF + RBV was highly effective and safe in Japanese patients with HCV genotype 2 infection.
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Affiliation(s)
- Takehiro Akahane
- Department of Gastroenterology, Japanese Red Cross Ishinomaki Hospital, Ishinomaki, Japan
| | - Masayuki Kurosaki
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Musashino, Japan
| | - Jun Itakura
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Musashino, Japan
| | - Keiji Tsuji
- Department of Gastroenterology, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, Hiroshima, Japan
| | - Kouji Joko
- Center for Liver-Biliary-Pancreatic Diseases, Matsuyama Red Cross Hospital, Matsuyama, Japan
| | - Hiroyuki Kimura
- Department of Gastroenterology, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Akihiro Nasu
- Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Osaka, Japan
| | - Chikara Ogawa
- Department of Gastroenterology, Takamatsu Red Cross Hospital, Takamatsu, Japan
| | - Yuji Kojima
- Department of Hepatology, Japanese Red Cross Ise Hospital, Ise, Japan
| | - Chitomi Hasebe
- Department of Gastroenterology, Japanese Red Cross Asahikawa Hospital, Asahikawa, Japan
| | - Shuichi Wada
- Department of Gastroenterology, Nagano Red Cross Hospital, Nagano, Japan
| | - Yasushi Uchida
- Department of Gastroenterology, Matsue Red Cross Hospital, Matsue, Japan
| | - Tetsuro Sohda
- Department of Hepatology, Japanese Red Cross Fukuoka Hospital, Fukuoka, Japan
| | - Hideyuki Suzuki
- Department of Internal Medicine, Japanese Red Cross Haramachi Hospital, Haramachi, Japan
| | - Hideo Yoshida
- Department of Gastroenterology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Atsunori Kusakabe
- Department of Gastroenterology, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan
| | - Takashi Tamada
- Department of Gastroenterology, Takatsuki Red Cross Hospital, Takatsuki, Osaka, Japan
| | - Haruhiko Kobashi
- Department of Hepatology, Japanese Red Cross Okayama Hospital, Okayama, Japan
| | - Akeri Mitsuda
- Department of Internal Medicine, Tottori Red Cross Hospital, Tottori, Japan
| | - Masahiko Kondo
- Department of Gastroenterology, Japanese Red Cross Otsu Hospital, Otsu, Japan
| | - Masaya Shigeno
- Department of Gastroenterology, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan
| | - Yasushi Ide
- Department of Internal Medicine, Karatsu Red Cross Hospital, Karatsu, Japan
| | - Atsuhiro Morita
- Department of Gastroenterology, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan
| | - Tadashi Kitamura
- Department of Gastroenterology, Shizuoka Red Cross Hospital, Shizuoka, Japan
| | - Takehiko Abe
- Department of Gastroenterology, Japanese Red Cross Maebashi Hospital, Maebashi, Japan
| | - Namiki Izumi
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Musashino, Japan
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Day E, Hellard M, Treloar C, Bruneau J, Martin NK, Øvrehus A, Dalgard O, Lloyd A, Dillon J, Hickman M, Byrne J, Litwin A, Maticic M, Bruggmann P, Midgard H, Norton B, Trooskin S, Lazarus JV, Grebely J. Hepatitis C elimination among people who inject drugs: Challenges and recommendations for action within a health systems framework. Liver Int 2019; 39:20-30. [PMID: 30157316 PMCID: PMC6868526 DOI: 10.1111/liv.13949] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [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: 07/13/2018] [Revised: 08/22/2018] [Accepted: 08/24/2018] [Indexed: 12/19/2022]
Abstract
The burden of hepatitis C infection is considerable among people who inject drugs (PWID), with an estimated prevalence of 39%, representing an estimated 6.1 million people who have recently injected drugs living with hepatitis C infection. As such, PWID are a priority population for enhancing prevention, testing, linkage to care, treatment and follow-up care in order to meet World Health Organization (WHO) hepatitis C elimination goals by 2030. There are many barriers to enhancing hepatitis C prevention and care among PWID including poor global coverage of harm reduction services, restrictive drug policies and criminalization of drug use, poor access to health services, low hepatitis C testing, linkage to care and treatment, restrictions for accessing DAA therapy, and the lack of national strategies and government investment to support WHO elimination goals. On 5 September 2017, the International Network of Hepatitis in Substance Users (INHSU) held a roundtable panel of international experts to discuss remaining challenges and future priorities for action from a health systems perspective. The WHO health systems framework comprises six core components: service delivery, health workforce, health information systems, medical procurement, health systems financing, and leadership and governance. Communication has been proposed as a seventh key element which promotes the central role of affected community engagement. This review paper presents recommended strategies for eliminating hepatitis C as a major public health threat among PWID and outlines future priorities for action within a health systems framework.
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Affiliation(s)
- Emma Day
- Australasian Society for HIV, Viral Hepatitis, and Sexual
Health Medicine, Sydney, New South Wales, Australia
| | - Margaret Hellard
- Disease Elimination Program, Burnet Institute, Melbourne,
Victoria, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Sydney,
New South Wales, Australia
| | - Julie Bruneau
- CHUM Research Centre (CRCHUM), Centre Hospitalier de
l’Université de Montréal, Montréal, Canada
| | - Natasha K Martin
- Division of Global Public Health, University of California,
San Diego, California, United States
| | - Anne Øvrehus
- Department of Infectious Diseases, Odense University
Hospital, Denmark
| | - Olav Dalgard
- Department of Infectious Diseases, Akershus University
Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Andrew Lloyd
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales,
Australia
| | - John Dillon
- Division of Molecular and Clinical Medicine, School of
Medicine, University of Dundee, Dundee, United Kingdom
| | - Matt Hickman
- Population Health Sciences, Bristol Medical School,
University of Bristol, Bristol, United Kingdom
| | - Jude Byrne
- Australian Injecting & Illicit Drug Users League,
Canberra, Australian Capital Territory, Australia
| | - Alain Litwin
- Division of General Internal Medicine, Albert Einstein
College of Medicine, Montefiore Medical Center, New York, United States
| | - Mojca Maticic
- Clinic for Infectious Diseases and Febrile Illnesses,
University Medical Centre Ljubljana, and Faculty of Medicine, University of
Ljubljana, Ljubljana, Slovenia
| | | | - Havard Midgard
- Department of Gastroenterology, Oslo University Hospital,
Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Brianna Norton
- Division of General Internal Medicine, Albert Einstein
College of Medicine, Montefiore Medical Center, New York, United States
| | - Stacey Trooskin
- Philadelphia FIGHT, Philadelphia, Pennsylvania, United
States
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal),
Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Jason Grebely
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales,
Australia
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22
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Ranjbar Kermani F, Amini-kafiabad S, Mousavi Hosseini K, Maghsudlu M, Sharifi Z, Mansournia MA. Distribution of Hepatitis C Virus Genotypes and Related Risk Factors Among Iranian Blood Donors: A Penalized Logistic Regression. Jundishapur J Microbiol 2018; 11. [DOI: 10.5812/jjm.69136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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23
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Marshall AD, Pawlotsky JM, Lazarus JV, Aghemo A, Dore GJ, Grebely J. The removal of DAA restrictions in Europe - One step closer to eliminating HCV as a major public health threat. J Hepatol 2018; 69:1188-1196. [PMID: 29959953 DOI: 10.1016/j.jhep.2018.06.016] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [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: 03/07/2018] [Revised: 05/10/2018] [Accepted: 06/21/2018] [Indexed: 12/20/2022]
Abstract
Of ∼10.2 million people with chronic HCV infection in Europe, 6.7 million live in Eastern Europe, 2.3 million in Western Europe and 1.2 million in Central Europe. HCV transmission continues to occur in parallel with an increasing HCV-related liver disease burden, the result of an ageing population infected during peak HCV epidemics decades earlier. In 2016, the World Health Organization set targets to eliminate HCV infection as a major public health threat by 2030. Across Europe, an estimated 36% of those living with chronic HCV infection have been diagnosed and ∼5% have been treated. A major barrier to enhancing HCV treatment uptake has been restrictions set by payers, including national governments and others, in response to the initially high list prices of direct-acting antiviral (DAA) therapies. The aims of this article are to discuss DAA restrictions in Europe, why DAA restrictions are still in place, what has facilitated the removal of DAA restrictions, and what challenges remain as we attempt to eliminate HCV as a major public health threat in the region by 2030.
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Affiliation(s)
| | - Jean-Michel Pawlotsky
- National Reference Center for Viral Hepatitis B, C and D, Department of Virology, Hôpital Henri Mondor, Université Paris-Est, Créteil, France; INSERM U955, Créteil, France
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain; CHIP, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Alessio Aghemo
- Department of Biomedical Sciences, Humanitas University, Humanitas Clinical and Research Center, Rozzano, Italy
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24
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Younossi Z, Papatheodoridis G, Cacoub P, Negro F, Wedemeyer H, Henry L, Hatzakis A. The comprehensive outcomes of hepatitis C virus infection: A multi-faceted chronic disease. J Viral Hepat 2018; 25 Suppl 3:6-14. [PMID: 30398294 DOI: 10.1111/jvh.13005] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 08/16/2018] [Indexed: 02/06/2023]
Abstract
Treatment of hepatitis C virus (HCV) infection has been revolutionized with the introduction of pangenotypic, interferon- and ribavirin-free regimens associated with high cure rates and a low side effect profile. Additionally, there is evidence that HCV cure reduces HCV complications, improves patient-reported outcomes and is cost-saving in most western countries in the long term. This is a review of the comprehensive burden of HCV and the value of eliminating HCV infection. With the introduction of the interferon-free all-oral, once a day pill treatment regimen for the cure of HCV, the potential to eliminate HCV by 2030 has become a possibility for some regions of the world. Nevertheless, there are barriers to screening, linkage to care, and treatment in many countries that must be overcome in order to reach this goal. In conclusion, globally, work must continue to ensure national policies are in place to support screening, linkage to care and affordable treatment in order to eliminate HCV.
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Affiliation(s)
- Zobair Younossi
- Department of Medicine, Inova Fairfax Hospital, Falls Church, Virginia.,Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia
| | - Georgios Papatheodoridis
- Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens Laiko, Athens, Greece
| | - Patrice Cacoub
- Department of Internal Medicine and Clinical Immunology, AP HP Hôpital La Pitié-Salpêtrière, Paris, France.,CNRS UMR 7087, INSERM UMR S-959, DHU I2B, Sorbonne Université, Paris, France
| | | | | | - Linda Henry
- Center for Outcomes Research in Liver Disease, Washington D.C
| | - Angelos Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School of National and Kapodistrian University of Athens, Athens, Greece.,Hepatitis B and C Public Policy Association, L-2453 , Luxembourg
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25
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Ranjbar Kermani F, Mousavi Hosseini K, Amini Kafi-abad S, Maghsudlu M, Sharifi Z, Mansournia MA, Alavian SM. Update on Transmission Modes of Hepatitis C Virus Among Volunteer Iranian Blood Donors: Analysis of a Matched Case-Control Study by Penalized Conditional Logistic Regression. Hepat Mon 2018; In Press. [DOI: 10.5812/hepatmon.69395] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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26
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Schnell G, Krishnan P, Tripathi R, Beyer J, Reisch T, Irvin M, Dekhtyar T, Lu L, Ng TI, Xie W, Pilot-Matias T, Collins C. Hepatitis C virus genetic diversity by geographic region within genotype 1-6 subtypes among patients treated with glecaprevir and pibrentasvir. PLoS One 2018; 13:e0205186. [PMID: 30286205 PMCID: PMC6171933 DOI: 10.1371/journal.pone.0205186] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 05/30/2018] [Accepted: 09/20/2018] [Indexed: 12/24/2022] Open
Abstract
Hepatitis C virus (HCV) is genetically diverse and includes 7 genotypes and 67 confirmed subtypes, and the global distribution of each HCV genotype (GT) varies by geographic region. In this report, we utilized a large dataset of NS3/4A and NS5A sequences isolated from 2348 HCV GT1-6-infected patients treated with the regimen containing glecaprevir/pibrentasvir (GLE/PIB) to assess genetic diversity within HCV subtypes by geographic region using phylogenetic analyses, and evaluated the prevalence of baseline amino acid polymorphisms in NS3 and NS5A by region/country and phylogenetic cluster. Among 2348 NS3/4A and NS5A sequences, phylogenetic analysis identified 6 genotypes and 44 subtypes, including 3 GT1, 8 GT2, 3 GT3, 13 GT4, 1 GT5, and 16 GT6 subtypes. Phylogenetic analysis of HCV subtype 1a confirmed the presence of two clades, which differed by geographic region distribution and NS3 Q80K prevalence. We detected phylogenetic clustering by country in HCV subtypes 1a, 1b, 2a, 2b, and 5a, suggesting that genetically distinct virus lineages are circulating in different countries. In addition, two clades were detected in HCV GT4a and GT6e, and NS5A amino acid polymorphisms were differentially distributed between the 2 clades in each subtype. The prevalence of NS3 and NS5A baseline polymorphisms varied substantially by genotype and subtype; therefore, we also determined the activity of GLE or PIB against replicons containing NS3/4A or NS5A from HCV GT1-6 clinical samples representing 6 genotypes and 21 subtypes overall. GLE and PIB retained activity against the majority of HCV replicons containing NS3/4A or NS5A from HCV GT1-6 clinical samples, with a median EC50 of 0.29 nM for GLE and 1.1 pM for PIB in a transient replicon assay. The data presented in this report expands the available data on HCV epidemiology, subtype diversity by geographic region, and NS3 and NS5A baseline polymorphism prevalence.
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Affiliation(s)
- Gretja Schnell
- Research & Development, AbbVie Inc., North Chicago, Illinois, United States of America
| | - Preethi Krishnan
- Research & Development, AbbVie Inc., North Chicago, Illinois, United States of America
| | - Rakesh Tripathi
- Research & Development, AbbVie Inc., North Chicago, Illinois, United States of America
| | - Jill Beyer
- Research & Development, AbbVie Inc., North Chicago, Illinois, United States of America
| | - Thomas Reisch
- Research & Development, AbbVie Inc., North Chicago, Illinois, United States of America
| | - Michelle Irvin
- Research & Development, AbbVie Inc., North Chicago, Illinois, United States of America
| | - Tatyana Dekhtyar
- Research & Development, AbbVie Inc., North Chicago, Illinois, United States of America
| | - Liangjun Lu
- Research & Development, AbbVie Inc., North Chicago, Illinois, United States of America
| | - Teresa I. Ng
- Research & Development, AbbVie Inc., North Chicago, Illinois, United States of America
| | - Wangang Xie
- Research & Development, AbbVie Inc., North Chicago, Illinois, United States of America
| | - Tami Pilot-Matias
- Research & Development, AbbVie Inc., North Chicago, Illinois, United States of America
| | - Christine Collins
- Research & Development, AbbVie Inc., North Chicago, Illinois, United States of America
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27
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Yamasaki K, Tanaka J, Kurisu A, Akita T, Ohisa M, Sakamune K, Ko K, Sugiyama A, Yasaka T, Shirahama S. Natural course of persistent hepatitis B virus infection in hepatitis B e antigen-positive and hepatitis B e antigen-negative cohorts in Japan based on the Markov model. J Med Virol 2018; 90:1800-1813. [PMID: 29995323 DOI: 10.1002/jmv.25260] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 06/14/2018] [Indexed: 01/29/2023]
Abstract
This population-based study examined the natural course of hepatitis B e antigen (HBeAg)-positive or HBeAg-negative persistent hepatitis B virus (HBV) infection, adjusted by age and liver disease states using a Markov model. Using 12 417 person-years data (n = 862), annual transition probabilities were estimated, and age-adjusted cumulative incidence and natural history of persistent HBV infection were simulated in both sexes of groups 1 (HBeAg-negative status with HBV DNA level <4.0 log IU/mL at entry) and 2 (persistent HBeAg-positive status throughout the study). In group 1, 15.26% of 30-years old men with chronic hepatitis (CH) were expected to remain in the same state at age 65 years, 28.32% subsided into an hepatitis B surface antigen (HBsAg)-negative state, and 13.20% developed hepatocellular carcinoma (HCC). The expectations for 40-years old men in group 1 were 21.43%, 19.86%, and 15.04%, respectively. The expectations for 30 years women in group 1 were 30.57%, 21.15%, and 4.08%, respectively. These results suggest that HBeAg positivity caused a higher risk of HCC onset in persistent HBV infection after adjustments for age, sex, and liver disease state. HCC was likely to develop, but unlikely to subside into HBsAg clearance, remaining in a CH state with aging, regardless of HBeAg state. Furthermore, both HCC development and HBsAg clearance occurred more frequently in men than in women, irrespective of HBeAg status.
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Affiliation(s)
- Kazumi Yamasaki
- Clinical Research Center, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Junko Tanaka
- Department of Epidemiology, Infectious Disease Control and Prevention, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Akemi Kurisu
- Department of Epidemiology, Infectious Disease Control and Prevention, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Tomoyuki Akita
- Department of Epidemiology, Infectious Disease Control and Prevention, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Masayuki Ohisa
- Department of Epidemiology, Infectious Disease Control and Prevention, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Kazuaki Sakamune
- Department of Epidemiology, Infectious Disease Control and Prevention, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Ko Ko
- Department of Epidemiology, Infectious Disease Control and Prevention, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Aya Sugiyama
- Department of Epidemiology, Infectious Disease Control and Prevention, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
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28
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Isakov V, Gankina N, Morozov V, Kersey K, Lu S, Osinusi A, Svarovskaia E, Brainard DM, Salupere R, Orlova-Morozova E, Zhdanov K. Ledipasvir-Sofosbuvir for 8 Weeks in Non-Cirrhotic Patients with Previously Untreated Genotype 1 HCV Infection ± HIV-1 Co-Infection. Clin Drug Investig 2018; 38:239-47. [PMID: 29177645 DOI: 10.1007/s40261-017-0606-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVES: The efficacy of < 12 weeks of hepatitis C virus (HCV) treatment in patients co-infected with HCV and human immunodeficiency virus type 1 (HIV-1) has not been established. We assessed the efficacy and safety of ledipasvir-sofosbuvir for 8 weeks in HCV mono-infected and HCV/HIV-1 co-infected patients. METHODS We enrolled patients mono-infected with genotype 1 HCV or co-infected with HCV and HIV-1 who were HCV treatment-naive and did not have cirrhosis. HCV/HIV-1 co-infected patients were either not receiving antiretroviral treatment and had a CD4 T-cell count > 500 cells/mm3 or were receiving a protocol-approved antiretroviral regimen for ≥ 8 weeks (or ≥ 6 months for abacavir-containing regimens) and had HIV-1 RNA < 50 copies/mL and a CD4 T-cell count > 200 cells/mm3. Patients received ledipasvir-sofosbuvir (90/400 mg) once daily for 8 weeks. The primary efficacy endpoint was sustained virologic response 12 weeks after treatment discontinuation (SVR12). RESULTS The SVR12 rate was 100% (67/67) for HCV mono-infected patients and 97% (57/59) for HCV/HIV-1 co-infected patients. Two patients relapsed by the week 4 post-treatment visit. Overall, the most common adverse events were headache (52%) and upper abdominal pain (26%). There were no serious adverse events or treatment discontinuations due to adverse events. No HCV/HIV-1 co-infected patients receiving antiretroviral treatment experienced HIV virologic rebound, and no clinically meaningful changes in CD4 T-cell counts were observed in any co-infected patient. CONCLUSIONS Non-cirrhotic, treatment-naive patients with genotype 1 HCV mono-infection and HCV/HIV-1 co-infection achieved high rates of SVR12 with 8 weeks of treatment with ledipasvir/sofosbuvir. ClinicalTrials.gov identifier: NCT02472886.
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29
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Pawlowska M, Sobolewska-Pilarczyk M, Domagalski K. Hepatitis C virus infection in children in the era of direct-acting antiviral. World J Gastroenterol 2018; 24:2555-2566. [PMID: 29962813 PMCID: PMC6021773 DOI: 10.3748/wjg.v24.i24.2555] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 03/27/2018] [Revised: 05/10/2018] [Accepted: 06/01/2018] [Indexed: 02/06/2023] Open
Abstract
Hepatitis C virus (HCV) infection remains an important global health problem with chronic infection affecting approximately 11 million children worldwide. The emergence of direct-acting antiviral (DAA) therapies and the development of non-invasive methods for the determination of liver fibrosis will significantly improve the management of paediatric patients with chronic HCV infection in subsequent years. For paediatric patients, a new era of highly effective DAA agents is beginning, and the first results of available clinical trials are very promising. In this era, the identification and monitoring of patients continues to be an important issue. The availability of non-invasive serological and imaging methods to measure hepatic fibrosis enables the identification of patients with significant or advanced liver fibrosis stages. This article summarizes the current data on the epidemiology and progress of research aimed to evaluate the new therapies and non-invasive methods for liver injury in paediatric patients with chronic hepatitis C.
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Affiliation(s)
- Malgorzata Pawlowska
- Department of Paediatric Infectious Diseases and Hepatology, Faculty of Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz 85-030, Poland
| | - Malgorzata Sobolewska-Pilarczyk
- Department of Paediatric Infectious Diseases and Hepatology, Faculty of Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz 85-030, Poland
| | - Krzysztof Domagalski
- Centre For Modern Interdisciplinary Technologies, Nicolaus Copernicus University, Toruń 87-100, Poland
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30
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Scott N, Ólafsson S, Gottfreðsson M, Tyrfingsson T, Rúnarsdóttir V, Hansdottir I, Hernandez UB, Sigmundsdóttir G, Hellard M. Modelling the elimination of hepatitis C as a public health threat in Iceland: A goal attainable by 2020. J Hepatol 2018; 68:932-939. [PMID: 29274408 DOI: 10.1016/j.jhep.2017.12.013] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 12/03/2017] [Accepted: 12/11/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND & AIMS In Iceland a nationwide program has been launched offering direct-acting antiviral (DAA) treatment for everyone living with hepatitis C virus (HCV). We estimate (i) the time and treatment scale-up required to achieve the World Health Organization's HCV elimination target of an 80% reduction in incidence; and (ii) the ongoing frequency of HCV testing and harm reduction coverage among people who inject drugs (PWID) required to minimize the likelihood of future HCV outbreaks occurring. METHODS We used a dynamic compartmental model of HCV transmission, liver disease progression and the HCV cascade of care, calibrated to reproduce the epidemic of HCV in Iceland. The model was stratified according to injecting drug use status, age and stage of engagement. Four scenarios were considered for the projections. RESULTS The model estimated that an 80% reduction in domestic HCV incidence was achievable by 2030, 2025 or 2020 if a minimum of 55/1,000, 75/1,000 and 188/1,000 PWID were treated per year, respectively (a total of 22, 30 and 75 of the estimated 400 PWID in Iceland per year, respectively). Regardless of time frame, this required an increased number of PWID to be diagnosed to generate enough treatment demand, or a 20% scale-up of harm reduction services to complement treatment-as-prevention incidence reductions. When DAA scale-up was combined with annual antibody testing of PWID, the incidence reduction target was reached by 2024. Treatment scale-up with no other changes to current testing and harm reduction services reduced the basic reproduction number of HCV from 1.08 to 0.59, indicating that future outbreaks would be unlikely. CONCLUSION HCV elimination in Iceland is achievable by 2020 with some additional screening of PWID. Maintaining current monitoring and harm reduction services while providing ongoing access to DAA therapy for people diagnosed with HCV would ensure that outbreaks are unlikely to occur once elimination targets have been reached. LAY SUMMARY In Iceland, a nationwide program has been launched offering treatment for the entire population living with hepatitis C virus (HCV). A mathematical model was used to estimate the additional health system requirements to achieve the HCV elimination targets of the World Health Organization (WHO), as well as the year that this could occur. With some additional screening of people who inject drugs, Iceland could reach the WHO targets by 2020, becoming one of the first countries to achieve HCV elimination. The model estimated that once elimination targets were reached, maintaining current monitoring and harm reduction services while providing ongoing access to DAA therapy for people diagnosed with HCV would ensure that future HCV outbreaks are unlikely to occur.
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Affiliation(s)
- Nick Scott
- Disease Elimination Program, Burnet Institute, Melbourne, VIC 3004, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Clayton, VIC 3008, Australia.
| | - Sigurður Ólafsson
- Department of Gastroenterology and Hepatology, Landspitali University Hospital, Reykjavik, Iceland; Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Magnús Gottfreðsson
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland; Department of Infectious Diseases, Landspitali University Hospital, Reykjavik, Iceland; Department of Science, Landspitali University Hospital, Reykjavik, Iceland
| | | | | | - Ingunn Hansdottir
- Vogur Hospital, SAA - National Center of Addiction Medicine, Reykjavik, Iceland; Faculty of Psychology, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | | | | | - Margaret Hellard
- Disease Elimination Program, Burnet Institute, Melbourne, VIC 3004, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Clayton, VIC 3008, Australia; Department of Infectious Diseases, The Alfred and Monash University, Melbourne, VIC 3004, Australia
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Yada M, Miyazaki M, Tanaka K, Masumoto A, Motomura K. Hepatocellular carcinoma or interferon-based therapy history attenuates sofosbuvir/ribavirin for Japanese genotype 2 hepatitis C virus. World J Gastroenterol 2018; 24:1478-1485. [PMID: 29632428 PMCID: PMC5889827 DOI: 10.3748/wjg.v24.i13.1478] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 02/26/2018] [Accepted: 03/06/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the real-world efficacy and safety of sofosbuvir/ribavirin (SOF/RBV) therapy for Japanese patients with genotype 2 hepatitis C virus (GT2-HCV).
METHODS A total of 182 patients with GT2-HCV infection who received SOF/RBV therapy for 12 wk at our hospital were enrolled. The patients comprised 122 men and 60 women (age range: 17-84 years; mean age ± SD: 60.1 ± 12.1 years). Relationships between virological response and clinical data were examined by logistic regression analyses.
RESULTS The proportions of patients with liver cirrhosis and history of hepatocellular carcinoma (HCC) were 29.0% and 17.3%, respectively. The proportion of patients with prior interferon (IFN)-based therapy was 25.6%. SOF/RBV therapy rapidly decreased HCV RNA levels. Several patients required RBV dose reduction because of anemia or fatigue. Four patients discontinued the therapy. The rates of sustained virological response at 12 wk after the end of treatment were 87.9% (intention to treat: 160/182) and 94.1% (per protocol: 159/169). Multivariate analyses showed that history of HCC or IFN-based therapy independently reduced the efficacy of SOF/RBV therapy.
CONCLUSION SOF/RBV therapy for GT2-HCV is safe, highly tolerated, and effective. History of HCC or IFN-based therapy independently reduces the efficacy of this treatment.
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Affiliation(s)
- Masayoshi Yada
- Department of Hepatology, Iizuka Hospital, Iizuka, Fukuoka 820-8505, Japan
| | - Masayuki Miyazaki
- Department of Hepatology, Iizuka Hospital, Iizuka, Fukuoka 820-8505, Japan
| | - Kosuke Tanaka
- Department of Hepatology, Iizuka Hospital, Iizuka, Fukuoka 820-8505, Japan
| | - Akihide Masumoto
- Department of Hepatology, Iizuka Hospital, Iizuka, Fukuoka 820-8505, Japan
| | - Kenta Motomura
- Department of Hepatology, Iizuka Hospital, Iizuka, Fukuoka 820-8505, Japan
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32
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Mansberg K, Kull K, Salupere R, Prükk T, Margus B, Kariis T, Remmel T, Suurmaa K, Ott K, Jaago K, Šmidt J. A Population-Based Surveillance Study on the Epidemiology of Hepatitis C in Estonia. ACTA ACUST UNITED AC 2018; 54:medicina54010009. [PMID: 30344240 PMCID: PMC6037246 DOI: 10.3390/medicina54010009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 02/18/2018] [Revised: 03/20/2018] [Accepted: 03/21/2018] [Indexed: 02/07/2023]
Abstract
Background and objective: The hepatitis C virus (HCV)-infected patients serve as a reservoir for transmission of the disease to others and are at risk of developing chronic hepatitis C, cirrhosis, and hepatocellular carcinoma. Although the epidemiological data of high rate HCV infection have been obtained in many countries, such data are insufficient in Estonia. Therefore, the aim of the study was to analyze country-specific data on HCV patients. Materials and methods: Data about age, gender, diagnosis, possible risk factors, coinfections, HCV genotypes, liver fibrosis stages and extrahepatic manifestations were collected from 518 patients. Results: The most common risk factors for hepatitis C were injection drug use and tattooing in the 30–39 and 40–49 year age groups, and blood transfusion in the 50–59 and 60–69 year age groups. The other risk factors established were profession-related factors and sexual contact. The prevailing viral genotype among the HCV infected patients was genotype 1 (69% of the patients) followed by genotype 3 (25%). Genotypes 1 and 3 correlated with blood transfusions before 1994, drug injections and tattooing. Conclusions: Our study provides the best representation of genotype distribution across Estonia. As a result of the study, valuable data has been collected on hepatitis C patients in Estonia.
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Affiliation(s)
- Kairi Mansberg
- Department of Gastroenterology, Tartu University Hospital, University of Tartu, 51014 Tartu, Estonia.
- Internal Disease Clinic, Tartu University Hospital, University of Tartu, 51014 Tartu, Estonia.
| | - Karin Kull
- Department of Gastroenterology, Tartu University Hospital, University of Tartu, 51014 Tartu, Estonia.
- Internal Disease Clinic, Tartu University Hospital, University of Tartu, 51014 Tartu, Estonia.
| | - Riina Salupere
- Department of Gastroenterology, Tartu University Hospital, University of Tartu, 51014 Tartu, Estonia.
- Internal Disease Clinic, Tartu University Hospital, University of Tartu, 51014 Tartu, Estonia.
| | - Tiina Prükk
- Department of Gastroenterology, Tartu University Hospital, University of Tartu, 51014 Tartu, Estonia.
- Internal Disease Clinic, Tartu University Hospital, University of Tartu, 51014 Tartu, Estonia.
| | - Benno Margus
- Department of Gastroenterology, East Tallinn Central Hospital, 10138 Tallinn, Estonia.
| | - Toomas Kariis
- Department of Gastroenterology, East Tallinn Central Hospital, 10138 Tallinn, Estonia.
| | - Triin Remmel
- Department of Gastroenterology, East Tallinn Central Hospital, 10138 Tallinn, Estonia.
| | - Külliki Suurmaa
- Department of Gastroenterology and Infectios Diseases Clinic, West Tallinn Central Hospital, 10138 Tallinn, Estonia.
| | - Kristi Ott
- Department of Gastroenterology and Infectios Diseases Clinic, West Tallinn Central Hospital, 10138 Tallinn, Estonia.
| | - Krista Jaago
- Internal Disease Clinic, Pärnu Hospital, 80010 Pärnu, Estonia.
| | - Jelena Šmidt
- Internal Disease Clinic, East Viru Central Hospital, 31024 Kohtla-Järve, Estonia.
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33
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Lamoury FMJ, Bajis S, Hajarizadeh B, Marshall AD, Martinello M, Ivanova E, Catlett B, Mowat Y, Marks P, Amin J, Smith J, Ezard N, Cock V, Hayllar J, Persing DH, Kleman M, Cunningham P, Dore GJ, Applegate TL, Grebely J. Evaluation of the Xpert HCV Viral Load Finger-Stick Point-of-Care Assay. J Infect Dis 2018. [DOI: 10.1093/infdis/jiy114] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Affiliation(s)
| | - Sahar Bajis
- The Kirby Institute, UNSW Sydney, Sydney, Australia
| | | | | | | | - Elena Ivanova
- Foundation for Innovative New Diagnostics, Geneva, Switzerland
| | - Beth Catlett
- St Vincent’s Applied Medical Research, Darlinghurst, Sydney, New South Wales
| | - Yasmin Mowat
- The Kirby Institute, UNSW Sydney, Sydney, Australia
| | | | - Janaki Amin
- The Kirby Institute, UNSW Sydney, Sydney, Australia
- Macquarie University, Sydney, New South Wales
| | - Julie Smith
- Matthew Talbot Hostel, St Vincent de Paul Society New South Wales Support Services, Sydney
| | - Nadine Ezard
- Alcohol and Drug Service, St Vincent’s Hospital, Sydney, New South Wales
- Faculty of Medicine, University of New South Wales, Sydney
| | - Victoria Cock
- Drug and Alcohol Services of South Australia, Adelaide
| | - Jeremy Hayllar
- Alcohol and Drug Service, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | | | | | - Philip Cunningham
- St Vincent’s Applied Medical Research, Darlinghurst, Sydney, New South Wales
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34
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Mizuochi T, Takano T, Yanagi T, Ushijima K, Suzuki M, Miyoshi Y, Ito Y, Inui A, Tajiri H. Epidemiologic features of 348 children with hepatitis C virus infection over a 30-year period: a nationwide survey in Japan. J Gastroenterol 2018; 53:419-426. [PMID: 28567493 DOI: 10.1007/s00535-017-1351-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 05/19/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Although the epidemiology of hepatitis C virus (HCV) infection among children may be rapidly changing, few reports have characterized large nationwide cohorts of children with HCV infection. We, therefore, sought to clarify the epidemiology and natural history of HCV infection in Japanese children born over the last three decades. METHODS Sixty-five pediatric centers retrospectively and prospectively recruited consecutive, otherwise-healthy HCV-infected children born during 1986 to 2015. RESULTS Entry criteria were met by 348 children. Age at initial diagnosis of infection has decreased significantly in recent years. Cirrhosis and hepatocellular carcinoma were not identified. Prevalence of spontaneous clearance and of interferon treatment with/without ribavirin were 9 and 54%, respectively. Maternal transmission has increased significantly, representing over 99% of cases in the last decade. No transfusion-related cases have been seen after 1994. HCV genotype 2 has increased to become the most prevalent in Japanese children. Histopathology examination of liver specimens showed no or mild fibrosis in most children with chronic hepatitis C; none showed cirrhosis. CONCLUSIONS This largest nationwide cohort study of Asian children with HCV infection spanned the last three decades. None of these Japanese children developed cirrhosis or hepatocellular carcinoma. Maternal transmission increased to account for 99% of cases during the last decade. Genotype 2 now is most prevalent in these children. Histopathologically, most children with chronic hepatitis C showed mild fibrosis or none.
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Affiliation(s)
- Tatsuki Mizuochi
- Department of Pediatrics and Child Health, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan.
| | - Tomoko Takano
- Department of Pediatrics, Osaka General Medical Center, Osaka, Japan
| | - Tadahiro Yanagi
- Department of Pediatrics and Child Health, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan
| | - Kosuke Ushijima
- Department of Pediatrics and Child Health, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan
| | - Mitsuyoshi Suzuki
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Yoko Miyoshi
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yoshinori Ito
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ayano Inui
- Department of Pediatric Hepatology and Gastroenterology, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Hitoshi Tajiri
- Department of Pediatrics, Osaka General Medical Center, Osaka, Japan
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35
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Marshall AD, Cunningham EB, Nielsen S, Aghemo A, Alho H, Backmund M, Bruggmann P, Dalgard O, Seguin-Devaux C, Flisiak R, Foster GR, Gheorghe L, Goldberg D, Goulis I, Hickman M, Hoffmann P, Jancorienė L, Jarcuska P, Kåberg M, Kostrikis LG, Makara M, Maimets M, Marinho RT, Matičič M, Norris S, Ólafsson S, Øvrehus A, Pawlotsky JM, Pocock J, Robaeys G, Roncero C, Simonova M, Sperl J, Tait M, Tolmane I, Tomaselli S, van der Valk M, Vince A, Dore GJ, Lazarus JV, Grebely J. Restrictions for reimbursement of interferon-free direct-acting antiviral drugs for HCV infection in Europe. Lancet Gastroenterol Hepatol 2018; 3:125-133. [DOI: 10.1016/s2468-1253(17)30284-4] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 08/18/2017] [Accepted: 08/18/2017] [Indexed: 01/15/2023]
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36
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Benova L, Awad SF, Abu-Raddad LJ. Estimate of vertical transmission of Hepatitis C virus in Pakistan in 2007 and 2012 birth cohorts. J Viral Hepat 2017; 24:1177-1183. [PMID: 28662284 DOI: 10.1111/jvh.12748] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 11/04/2016] [Accepted: 06/06/2017] [Indexed: 12/12/2022]
Abstract
UNLABELLED Despite a combination of high Hepatitis C virus (HCV) prevalence, a large adult population and high fertility, no published estimates of the scale and contribution of vertical transmission to HCV incidence in Pakistan exist. The objective of this study was to estimate the number of new HCV infections occurring in Pakistan as a result of vertical transmission. We adapted a published mathematical model based on HCV antibody and viraemia prevalence, fertility rates, risk of HCV vertical transmission and children mortality rates to estimate the number of infections in the 2007 and 2012 birth cohorts nationally and in four subnational regions. We estimated that 19 708 (95% uncertainty interval [UI]: 15 941-23 819) children were vertically infected by HCV in 2007 and 21 676 (95% UI: 17 498-26 126) in 2012. The majority of these cases (72.9% and 72.5% in 2007 and 2012, respectively) occurred in Punjab. We estimated that vertical transmission as a mode of exposure accounted for a quarter of HCV infections among children under 5 years of age (25.2% in 2007 and 24.0% in 2012). CONCLUSION Our results showed that one in 260 children born in Pakistan in 2007 and 2012 acquired HCV vertically. While currently no interventions during pregnancy and childbirth are recommended to reduce this risk, prevention, testing and treatment strategies should be considered to reduce the burden of vertical HCV infections among young children. Other routes of transmission appear to contribute the majority of HCV infections among children and must also be clarified and urgently addressed.
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Affiliation(s)
- Lenka Benova
- Infectious Disease Epidemiology Group, Weill Cornell Medical College - Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar.,Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Susanne Faissal Awad
- Infectious Disease Epidemiology Group, Weill Cornell Medical College - Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
| | - Laith Jamal Abu-Raddad
- Infectious Disease Epidemiology Group, Weill Cornell Medical College - Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar.,Department of Healthcare Policy and Research, Weill Cornell Medical College, Cornell University, New York, NY, USA.,College of Public Health, Hamad bin Khalifa University, Doha, Qatar
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37
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Affiliation(s)
- Jason Grebely
- Viral Hepatitis Clinical Research Program, The Kirby Institute, UNSW Sydney, Sydney, Australia
| | - Tanya L. Applegate
- Viral Hepatitis Clinical Research Program, The Kirby Institute, UNSW Sydney, Sydney, Australia
| | - Philip Cunningham
- St Vincent’s Centre for Applied Medical Research, Darlinghurst, Sydney, Australia
| | - Jordan J. Feld
- Toronto Centre for Liver Disease, Sandra Rotman Centre for Global Health, University of Toronto, Toronto, Canada
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38
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Abstract
Globally, 12 million people are estimated to have injected drugs in the past year, 50% of whom have chronic HCV infection, with people who have previously injected drugs presenting an additional large reservoir of infection. The availability of simple and tolerable interferon-free direct-acting antiviral agents (DAAs) for HCV infection, which have a cure rate of >95% represents one of the most exciting advances in clinical medicine in the past few decades. Adherence and response to DAA therapy among people who inject drugs (PWID) receiving opioid substitution therapy (OST) in clinical trials are comparable to populations without a history of injecting drugs. Further data are required among current PWID not receiving OST. Given the potential prevention benefits of treatment, DAAs have enhanced cost-effectiveness among PWID. As HCV therapy is expanded to populations of PWID with high-risk behaviours for re-exposure, acknowledgement that HCV reinfection will occur is crucial, and appropriate strategies must be in place to maximize prevention of reinfection and offer retreatment for reinfection. This Review will also discuss essential components for broadening access to HCV care for PWID as we strive for the global elimination of HCV infection.
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Affiliation(s)
- Jason Grebely
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales 2052, Australia
| | - Behzad Hajarizadeh
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales 2052, Australia
| | - Gregory J Dore
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales 2052, Australia
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39
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Maaroufi A, Vince A, Himatt SM, Mohamed R, Fung J, Opare-Sem O, Workneh A, Njouom R, Al Ghazzawi I, Abdulla M, Kaliaskarova KS, Owusu-Ofori S, Abdelmageed MK, Adda D, Akin O, Al Baqali A, Al Dweik N, Al Ejji K, Al Kaabi S, Al Naamani K, Al Qamish J, Al Sadadi M, Al Salman J, AlBadri M, Al-Busafi SA, Al-Romaihi HE, Ampofo W, Antonov K, Anyaike C, Arome F, Bane A, Blach S, Borodo MM, Brandon SM, Bright B, Butt MT, Cardenas I, Chan HLY, Chen CJ, Chen DS, Chen PJ, Chien RN, Chuang WL, Cuellar D, Derbala M, Elbardiny AA, Estes C, Farag E, Gamkrelidze I, Garcia V, Genov J, Ghandour Z, Ghuloom M, Gomez B, Gunter J, Habeeb J, Hajelssedig O, Hamoudi W, Hrstic I, Hu CC, Huang CF, Hui YT, Jahis R, Jelev D, John AK, Kamel Y, Kao JH, Khamis J, Khattabi H, Khoudri I, Konysbekova A, Kotzev I, Lai MS, Lao WC, Layden J, Lee MH, Lesi O, Li M, Lo A, Loo CK, Lukšić B, Malu AO, Mateva L, Mitova R, Morović M, Murphy K, Mustapha B, Nde H, Nersesov A, Ngige E, Njoya O, Nonković D, Obekpa S, Oguche S, Okolo EE, Omede O, Omuemu C, Ondoa P, Phillips RO, Prokopenko YN, Razavi H, Razavi-Shearer D, Redae B, Reic T, Rinke de Wit T, Rios C, Robbins S, Roberts LR, Sanad SJ, Schmelzer JD, Sharma M, Simonova M, Su TH, Sultan K, Tan SS, Tchernev K, Tsang OTY, Tsang S, Tzeuton C, Ugoeze S, Uzochukwu B, Vi R, Wani HU, Wong VWS, Yacoub R, Yesmembetov KI, Youbi M, Yuen MF, Razavi-Shearer K. Historical epidemiology of hepatitis C virus in select countries-volume 4. J Viral Hepat 2017; 24 Suppl 2:8-24. [PMID: 29105285 DOI: 10.1111/jvh.12762] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [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: 06/19/2017] [Accepted: 07/03/2017] [Indexed: 12/11/2022]
Abstract
Due to the introduction of newer, more efficacious treatment options, there is a pressing need for policy makers and public health officials to develop or adapt national hepatitis C virus (HCV) control strategies to the changing epidemiological landscape. To do so, detailed, country-specific data are needed to characterize the burden of chronic HCV infection. In this study of 17 countries, a literature review of published and unpublished data on HCV prevalence, viraemia, genotype, age and gender distribution, liver transplants and diagnosis and treatment rates was conducted, and inputs were validated by expert consensus in each country. Viraemic prevalence in this study ranged from 0.2% in Hong Kong to 2.4% in Taiwan, while the largest viraemic populations were in Nigeria (2 597 000 cases) and Taiwan (569 000 cases). Diagnosis, treatment and liver transplant rates varied widely across the countries included in this analysis, as did the availability of reliable data. Addressing data gaps will be critical for the development of future strategies to manage and minimize the disease burden of hepatitis C.
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Affiliation(s)
- A Maaroufi
- National Institute of Health Administration, Rabat, Morocco
| | - A Vince
- Medical School University of Zagreb, University Hospital of Infectious Diseases Zagreb, Zagreb, Croatia
| | - S M Himatt
- Ministry of Public Health Qatar, Doha, Qatar
| | - R Mohamed
- University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - J Fung
- Department of Medicine, The University of Hong Kong, Hong Kong, SAR, China
| | - O Opare-Sem
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - A Workneh
- Non-Communicable Diseases Programme, World Health Organization, Addis Ababa, Ethiopia.,Federal Ministry of Health, Addis Ababa, Ethiopia
| | - R Njouom
- Virology Department, Centre Pasteur of Cameroon, Yaounde, Cameroon
| | - I Al Ghazzawi
- GI and Hepatology Department, Jordan Royal Medical Services, Amman, Jordan
| | - M Abdulla
- Salmaniya Medical Complex, Manama, Bahrain
| | - K S Kaliaskarova
- Ministry of Healthcare and Social Development of the Republic of Kazakhstan, Astana, Kazakhstan.,Republican Coordination Center for Hepatology and Gastroenterology, Astana, Kazakhstan
| | | | | | - D Adda
- Civil Society Network on Hepatitis, Abuja, Nigeria.,Chagro-Care Trust (CCT), Jalingo, Nigeria
| | - O Akin
- Federal Ministry of Health, Abuja, Nigeria
| | - A Al Baqali
- Al Kindi Specialised Hospital, Manama, Bahrain
| | - N Al Dweik
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - K Al Ejji
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - S Al Kaabi
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - K Al Naamani
- Division of Gastroenterology and Hepatology, Department of Medicine, Armed Forces Hospital, Muscat, Oman
| | - J Al Qamish
- Gastroenterolgy Clinic, IBN Al-Nafees Hospital, Manama, Bahrain
| | | | | | - M AlBadri
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - S A Al-Busafi
- Division of Gastroenterology, Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | | | - W Ampofo
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - K Antonov
- University Hospital "St. Ivan Rilski", Sofia, Bulgaria
| | - C Anyaike
- Federal Ministry of Health, Abuja, Nigeria
| | - F Arome
- Advocacy for the Prevention of Hepatitis in Nigeria, Jos, Nigeria
| | - A Bane
- Gastroenterology and Hepatology, Addis Ababa University Medical School, Addis Ababa, Ethiopia.,Ethiopian Gastroenterological Association, Addis Ababa, Ethiopia
| | - S Blach
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | - M M Borodo
- Aminu Kano Teaching Hospital, Kano, Nigeria.,Bayero University, Kano, Nigeria
| | - S M Brandon
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | - B Bright
- LiveWell Initiative (LWI), Lagos, Nigeria
| | - M T Butt
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - I Cardenas
- Communicable Diseases Division, Ministry of Health and Social Protection, Bogota, Colombia
| | - H L Y Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, SAR, China.,Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | | | - D S Chen
- Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
| | - P J Chen
- National Taiwan University, Taipei, Taiwan
| | - R N Chien
- Liver Research Unit, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - W L Chuang
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
| | - D Cuellar
- Department of Epidemiology and Demography, Ministry of Health and Social Protection, Bogota, Colombia
| | - M Derbala
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | | | - C Estes
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | - E Farag
- Ministry of Public Health Qatar, Doha, Qatar
| | - I Gamkrelidze
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | - V Garcia
- Ministry of Public Health, Santo Domingo, Dominican Republic
| | - J Genov
- University Hospital "Queen Joanna", Sofia, Bulgaria
| | - Z Ghandour
- BDF Hospital, Royal Medical Services, Riffa, Bahrain
| | - M Ghuloom
- Salmaniya Medical Complex, Manama, Bahrain
| | - B Gomez
- Pan American Health Organization, Washington, DC, USA
| | - J Gunter
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | - J Habeeb
- Salmaniya Medical Complex, Manama, Bahrain
| | - O Hajelssedig
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - W Hamoudi
- Department of Gastroenterology & Hepatology, Al Bashir Hospital, Amman, Jordan.,Jordan Ministry of Health, Amman, Jordan
| | - I Hrstic
- General Hospital Pula, Pula, Croatia
| | - C C Hu
- Liver Research Unit, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - C F Huang
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
| | - Y T Hui
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong, SAR, China
| | - R Jahis
- Disease Control Division, Ministry of Health, Putrajaya, Malaysia
| | - D Jelev
- University Hospital "St. Ivan Rilski", Sofia, Bulgaria
| | - A K John
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Y Kamel
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar.,Department of Medicine, Miniya University, Minya, Egypt
| | - J H Kao
- Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan
| | - J Khamis
- Salmaniya Medical Complex, Manama, Bahrain
| | - H Khattabi
- Eastern Mediterranean Regional Office, World Health Organization, Cairo, Egypt
| | - I Khoudri
- National Institute of Health Administration, Rabat, Morocco
| | - A Konysbekova
- Republican Diagnostic Center, Astana, Kazakhstan.,University Medical Center, Astana, Kazakhstan
| | - I Kotzev
- University Hospital "St. Marina", Varna, Bulgaria
| | - M S Lai
- Department of Medicine, North District Hospital, Hong Kong, SAR, China
| | - W C Lao
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong, SAR, China
| | - J Layden
- Department of Public Health Sciences, Loyola University Chicago, Chicago, IL, USA
| | - M H Lee
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - O Lesi
- University of Lagos, Lagos, Nigeria.,Lagos University Teaching Hospital, Lagos, Nigeria
| | - M Li
- Division of Gastroenterology and Hepatology, Department of Medicine and Geriatrics, Tuen Mun Hospital, Hong Kong, SAR, China
| | - A Lo
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - C K Loo
- Department of Medicine and Geriatrics, Kwong Wah Hospital, Hong Kong, SAR, China
| | - B Lukšić
- Clinical Department of Infectious Diseases, Split University Hospital and Split University Medical School, Split, Croatia
| | - A O Malu
- Benue State University Teaching Hospital, Makurdi, Nigeria
| | - L Mateva
- University Hospital "St. Ivan Rilski", Sofia, Bulgaria
| | - R Mitova
- University Hospital "Queen Joanna", Sofia, Bulgaria
| | - M Morović
- Department of Infectious Diseases, Zadar General Hospital, Zadar, Croatia
| | - K Murphy
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | | | - H Nde
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | - A Nersesov
- National Research Institute of Cardiology and Internal Diseases, Almaty, Kazakhstan
| | - E Ngige
- Federal Ministry of Health, Abuja, Nigeria
| | - O Njoya
- Research Laboratory on Viral Hepatitis & Health Communication, Faculty of Medicine, University of Yaoundé, Yaoundé, Cameroon
| | - D Nonković
- Department of Epidemiology, Institute of Public Health, County of Dalmatia, Split, Croatia
| | - S Obekpa
- Advocacy for the Prevention of Hepatitis in Nigeria, Jos, Nigeria.,Benue State University Teaching Hospital, Makurdi, Nigeria
| | - S Oguche
- Department of Pediatrics, University of Jos, Jos, Nigeria.,Department of Medicine, University of Jos, Jos, Nigeria.,Jos University Teaching Hospital, Jos, Nigeria
| | - E E Okolo
- Beacon Youth Initiative, Lafia, Nigeria
| | - O Omede
- Federal Ministry of Health, Abuja, Nigeria
| | - C Omuemu
- University of Benin, Benin City, Nigeria
| | - P Ondoa
- Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands.,African Society of Laboratory Medicine, Addis Ababa, Ethiopia
| | - R O Phillips
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Y N Prokopenko
- Republican Coordination Center for Hepatology and Gastroenterology, Astana, Kazakhstan
| | - H Razavi
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | | | - B Redae
- Ethiopian Gastroenterological Association, Addis Ababa, Ethiopia.,St. Paul's Hospital Millennium College, Addis Ababa, Ethiopia
| | - T Reic
- European Liver Patients Association, Sint-Truiden, Belgium
| | - T Rinke de Wit
- PharmAccess Foundation, Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - C Rios
- Department of Health Promotion and Disease Prevention, Ministry of Health and Social Protection, Bogota, Colombia
| | - S Robbins
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | - L R Roberts
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - S J Sanad
- BDF Hospital, Royal Medical Services, Riffa, Bahrain
| | - J D Schmelzer
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | - M Sharma
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - M Simonova
- Clinic of Gastroenterology, Military Medical Academy, Sofia, Bulgaria
| | - T H Su
- Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan
| | - K Sultan
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - S S Tan
- Department of Hepatology, Selayang Hospital, Selangor, Malaysia
| | | | - O T Y Tsang
- Department of Medicine and Geriatrics, Princess Margaret Hospital Authority, Hong Kong, SAR, China
| | - S Tsang
- Department of Medicine, Tseung Kwan O Hospital, Hong Kong, SAR, China
| | - C Tzeuton
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - S Ugoeze
- Federal Medical Centre, Jalingo, Nigeria
| | - B Uzochukwu
- Institute of Public Health, University of Nigeria, Nsukka, Nigeria
| | - R Vi
- Republican Coordination Center for Hepatology and Gastroenterology, Astana, Kazakhstan.,International HepatoTransplant Group, Astana, Kazakhstan
| | - H U Wani
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - V W S Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, SAR, China.,State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - R Yacoub
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - K I Yesmembetov
- National Scientific Center of Oncology and Transplantology, Astana, Kazakhstan
| | - M Youbi
- National Institute of Health Administration, Rabat, Morocco
| | - M F Yuen
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, SAR, China
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Abstract
Hepatitis C virus (HCV) is a major global public health issue, with an estimated 71 million people living with HCV infection and a rising burden of cirrhosis, hepatocellular carcinoma (HCC) and liver-related mortality. The advent of interferon-free, direct acting antiviral-based (DAA) therapies, with short duration (8-12 weeks), high efficacy, excellent tolerability and ease of delivery (once daily oral dosing), is one of the major advances in clinical medicine in recent decades, and provides the opportunity to address this growing global HCV burden. In May 2014, January 2015 and December 2015, three supplements were published in the Journal of Viral Hepatitis presenting data from 47 countries on the historical epidemiology of HCV, the current HCV-related morbidity and mortality and potential strategies to manage the HCV disease burden in the future. The countries included in those manuscripts were from multiple regions including North and South America, Europe, Asia, the Middle East, Africa and Oceania. In this supplement, data from an additional 17 countries are presented, following a similar pattern as in the previous manuscripts. These countries represent a mixture of high-, middle- and low-income countries that hail from five geographical regions: Africa, Asia, Europe, Middle East and South America. Expert advisory panels were convened in each country to identify the best data sources to use and to review the assumptions and outputs from the model. In the countries considered in the current analyses, there is a wide variance in the availability of robust data.
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Affiliation(s)
- G J Dore
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - A Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, Athens, Greece
| | - F Negro
- Divisions of Gastroenterology and Hepatology and of Clinical Pathology, University Hospital, Genève, Switzerland
| | - I Waked
- National Liver Institute, Menoufiya, Egypt
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41
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Abdulaziz S, Halabi H, Omair MA, Attar S, Alghamdi A, Shabrawishi M, Neyazi A, Alnazzawi H, Meraiani N, Almoallim H. Biological therapy in arthritis patients with hepatitis B or C infection: a multicenter retrospective case series. Eur J Rheumatol 2017; 4:194-199. [PMID: 29164002 DOI: 10.5152/eurjrheum.2017.17003] [Citation(s) in RCA: 7] [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] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 04/10/2017] [Indexed: 12/27/2022] Open
Abstract
Objective Reactivation of viral hepatitis B (HBV) and C (HCV) has been reported in various case reports of patients with arthritis on biological therapy. The objective of this study was to describe the clinical characteristics and outcomes of arthritis patients with HBV or HCV treated with biological therapy. Material and Methods This is a retrospective case series including all patients above 13 years of age with arthritis patients from four centers in Saudi Arabia with concurrent chronic viral hepatitis infection (HBV or HCV) who received biological agents in the rheumatology clinics during their course of their disease from duration of the disease onset until last outpatient visit up to November 2015. Demographic information, full details about the hepatitis status of each patient, rheumatic disease diagnosis and different therapies used were reviewed. Results We identified 10 cases each with HBV and HCV on biological therapy. The mean age in the HBV group was 51 (34-85) years and 80% were females. Eight patients had rheumatoid arthritis (RA), one patient had RA/systemic lupus erythematosus, and one had human immunodeficiency virus related-arthritis. Seven were chronic inactive HBsAg carriers and three had chronic active HBV. Nine HBV patients received prophylactic antiviral therapy. Two cases with chronic HBV had reactivation with no elevation of the transaminases.The mean age in the HCV group was 54 (23-79) years and all were female RA patients. Three had detectable hepatitis C virus-ribonuecleic acid (HCV-RNA) before the start of biological therapy. Nine HCV patients received antiviral treatment and seven had a sustained virologic response (SVR) before start of biological treatment. Three patients had detectable HCV-RNA during the course of biological therapy. One of the three was a non-responder and two were relapsers. One of the patients with HCV relapse was started on sofosbuvir plus ribavirin and achieved SVR on follow-up. Conclusion We report the successful use of biological therapy in arthritis patients with hepatitis B infection with antiviral therapy with no detoriation of their viral status. Due to the lack of sufficient prospective studies demonstrating the rate of HCV flare on biological therapy, caution should be exercised and careful monitoring with liver enzymes and viral load is mandated in vulnerable HCV RNA patients. Treatment should be individualized by the rheumatologist in collaboration with the hepatologist to minimize complications.
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Affiliation(s)
- Sultana Abdulaziz
- Unit of Rheumatology, Department of Medicine, King Fahd Hospital, Jeddah, Saudi Arabia
| | - Hussein Halabi
- Department of Medicine, King Faisal Specialist Hospital, Jeddah, Saudi Arabia
| | - Mohammed A Omair
- Division of Rheumatology, Department of Medicine, King Saud University College of Medicine, Riyadh, Saudi Arabia
| | - Suzan Attar
- Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abdullah Alghamdi
- Unit of Gastroenterology, Department of Medicine, King Fahd Hospital, Jeddah, Saudi Arabia
| | | | - Abdulwahab Neyazi
- Department of Medicine, Umm Alqura University School of Medicine, Makkah, Saudi Arabia
| | - Haneen Alnazzawi
- Department of Medicine, Umm Alqura University School of Medicine, Makkah, Saudi Arabia
| | - Nuha Meraiani
- Department of Medicine, King Faisal Specialist Hospital, Jeddah, Saudi Arabia
| | - Hani Almoallim
- Department of Medicine, Umm Alqura University School of Medicine, Makkah, Saudi Arabia.,Department of Medicine, Dr. Soliman Fakeeh Hospital, Jeddah, Saudi Arabia.,Alzaidi Chair of Research Diseases, Umm Alqura University School of Medicine, Makkah, Saudi Arabia
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Grebely J, Bruneau J, Lazarus JV, Dalgard O, Bruggmann P, Treloar C, Hickman M, Hellard M, Roberts T, Crooks L, Midgard H, Larney S, Degenhardt L, Alho H, Byrne J, Dillon JF, Feld JJ, Foster G, Goldberg D, Lloyd AR, Reimer J, Robaeys G, Torrens M, Wright N, Maremmani I, Norton BL, Litwin AH, Dore GJ. Research priorities to achieve universal access to hepatitis C prevention, management and direct-acting antiviral treatment among people who inject drugs. Int J Drug Policy 2017; 47:51-60. [PMID: 28683982 PMCID: PMC6049820 DOI: 10.1016/j.drugpo.2017.05.019] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Revised: 04/11/2017] [Accepted: 05/05/2017] [Indexed: 02/06/2023]
Abstract
Globally, it is estimated that 71.1 million people have chronic hepatitis C virus (HCV) infection, including an estimated 7.5 million people who have recently injected drugs (PWID). There is an additional large, but unquantified, burden among those PWID who have ceased injecting. The incidence of HCV infection among current PWID also remains high in many settings. Morbidity and mortality due to liver disease among PWID with HCV infection continues to increase, despite the advent of well-tolerated, simple interferon-free direct-acting antiviral (DAA) HCV regimens with cure rates >95%. As a result of this important clinical breakthrough, there is potential to reverse the rising burden of advanced liver disease with increased treatment and strive for HCV elimination among PWID. Unfortunately, there are many gaps in knowledge that represent barriers to effective prevention and management of HCV among PWID. The Kirby Institute, UNSW Sydney and the International Network on Hepatitis in Substance Users (INHSU) established an expert round table panel to assess current research gaps and establish future research priorities for the prevention and management of HCV among PWID. This round table consisted of a one-day workshop held on 6 September, 2016, in Oslo, Norway, prior to the International Symposium on Hepatitis in Substance Users (INHSU 2016). International experts in drug and alcohol, infectious diseases, and hepatology were brought together to discuss the available scientific evidence, gaps in research, and develop research priorities. Topics for discussion included the epidemiology of injecting drug use, HCV, and HIV among PWID, HCV prevention, HCV testing, linkage to HCV care and treatment, DAA treatment for HCV infection, and reinfection following successful treatment. This paper highlights the outcomes of the roundtable discussion focused on future research priorities for enhancing HCV prevention, testing, linkage to care and DAA treatment for PWID as we strive for global elimination of HCV infection.
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Affiliation(s)
- Jason Grebely
- The Kirby Institute, UNSW Sydney, Sydney, Australia.
| | - Julie Bruneau
- CHUM Research Centre (CRCHUM), Centre Hospitalier de l'Université de Montréal, Montréal, Canada; Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montréal, Canada
| | - Jeffrey V Lazarus
- CHIP, Rigshospitalet, University of Copenhagen, Denmark; Barcelona Institute of Global Health (ISGlobal), Hospital Clínic, Barcelona, Spain
| | - Olav Dalgard
- Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway; University of Oslo, Oslo, Norway
| | | | - Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Matthew Hickman
- School of Social & Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Margaret Hellard
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
| | | | - Levinia Crooks
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia; Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine, Sydney, Australia
| | - Håvard Midgard
- Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway; Institute for Clinical Medicine, University of Oslo, Norway; Department of Gastroenterology, Oslo University Hospital, Norway
| | - Sarah Larney
- National Drug and Alcohol Research Centre, UNSW Australia, Sydney, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Australia, Sydney, Australia
| | - Hannu Alho
- University of Helsinki, Helsinki, Finland; National Institute for Health and Welfare, Helsinki, Finland; Abdominal Center, Helsinki University Hospital, Helsinki, Finland
| | - Jude Byrne
- Australian Injecting & Illicit Drug Users League, Canberra, Australia
| | - John F Dillon
- Ninewells Hospital and Medical School, Dundee, United Kingdom
| | - Jordan J Feld
- Toronto Centre for Liver Disease, Sandra Rotman Centre for Global Health, University of Toronto, Toronto, Canada
| | - Graham Foster
- The Liver Unit, Queen Mary University of London, London, United Kingdom
| | - David Goldberg
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom; Health Protection Scotland, Glasgow, United Kingdom
| | | | - Jens Reimer
- Centre for Interdisciplinary Addiction Research, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Geert Robaeys
- Department of Gastroenterology and Hepatology, Ziekenhuis Oost Limburg, Genk, Belgium; Department of Hepatology, UZ Leuven, Leuven, Belgium; Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Marta Torrens
- Institute of Neuropsychiatry & Addictions-Hospital del Mar, IMIM (Hospital del Mar Medical Research Institute), Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Icro Maremmani
- Santa Chiara University Hospital, University of Pisa, Italy
| | - Brianna L Norton
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, United States
| | - Alain H Litwin
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, United States
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43
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Bajis S, Dore GJ, Hajarizadeh B, Cunningham EB, Maher L, Grebely J. Interventions to enhance testing, linkage to care and treatment uptake for hepatitis C virus infection among people who inject drugs: A systematic review. International Journal of Drug Policy 2017; 47:34-46. [DOI: 10.1016/j.drugpo.2017.07.002] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 06/17/2017] [Accepted: 07/10/2017] [Indexed: 12/26/2022]
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Abstract
It is critical to recognize that hepatitis C virus (HCV) infection is, in fact, a multifaceted systemic disease with both hepatic and extrahepatic complications. It is also important to recognize that the comprehensive burden of HCV should include not only its clinical burden but also its burden on the economic and patient-reported outcomes. It is only through this comprehensive approach to HCV infection that we can fully appreciate its true burden and understand the full benefit of curing HCV for the patient and the society.
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Affiliation(s)
- Zobair M Younossi
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, 3300 Gallows Road, Falls Church, VA 22042, USA; Department of Medicine, Center for Liver Disease, Inova Fairfax Hospital, 3300 Gallows Road, Falls Church, VA 22042, USA.
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45
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Grebely J, Dore GJ, Morin S, Rockstroh JK, Klein MB. Elimination of HCV as a public health concern among people who inject drugs by 2030 - What will it take to get there? J Int AIDS Soc 2017; 20:22146. [PMID: 28782335 PMCID: PMC5577699 DOI: 10.7448/ias.20.1.22146] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 07/13/2017] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Globally, there is a considerable burden of HCV and HIV infections among people who inject drugs (PWID) and transmission of both infections continues. Needle and syringe programme (NSP) and opioid substitution therapy (OST) coverage remains low, despite evidence demonstrating their prevention benefit. Direct-acting antiviral therapies (DAA) with HCV cure >95% among PWID provide an opportunity to reverse rising trends in HCV-related morbidity and mortality and reduce incidence. However, HCV testing, linkage to care, and treatment remain low due to health system, provider, societal, and patient barriers. Between 2015 and 2030, WHO targets include reducing new HCV infections by 80% and HCV deaths by 65%, and increasing HCV diagnoses from <5% to 90% and number of eligible persons receiving HCV treatment from <1% to 80%. This commentary discusses why PWID should be considered as a priority population in these efforts, reasons why this goal could be attainable among PWID, challenges that need to be overcome, and key recommendations for action. DISCUSSION Challenges to HCV elimination as a global health concern among PWID include poor global coverage of harm reduction services, restrictive drug policies and criminalization of drug use, poor access to health services, low HCV testing, linkage to care and treatment, restrictions for accessing DAA therapy, and the lack of national strategies and government investment to support WHO elimination goals. Key recommendations for action include reforming drug policies (decriminalization of drug use and/or possession, or providing alternatives to imprisonment for PWID; decriminalization of the use and provision of sterile needles-syringes; and legalization of OST for people who are opioid dependent), scaling up and improving funding for harm reduction services, making health services accessible for PWID, supporting community empowerment and community-based programmes, improving access to affordable diagnostics and medicines, and eliminating stigma, discrimination, and violence against PWID. CONCLUSIONS The ambitious targets for HCV elimination set by WHO are achievable in many countries, but will require researchers, healthcare providers, policy makers, affected communities, advocates, the pharmaceutical and diagnostics industries, and governments around the world to work together to make this happen.
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Affiliation(s)
- Jason Grebely
- The Kirby Institute, UNSW Sydney, Sydney, Australia
- Executive Board, International Network on Hepatitis in Substance Users, Zurich, Switzerland
| | - Gregory J. Dore
- The Kirby Institute, UNSW Sydney, Sydney, Australia
- Executive Board, International Network on Hepatitis in Substance Users, Zurich, Switzerland
| | - Sébastien Morin
- HIV Programmes and Advocacy, International AIDS Society, Geneva, Switzerland
| | - Jürgen K. Rockstroh
- Department of Medicine I, University Hospital Bonn, Bonn, Germany
- Governing Council, International AIDS Society, Geneva, Switzerland
| | - Marina B. Klein
- Governing Council, International AIDS Society, Geneva, Switzerland
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Canada
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46
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Grebely J, Lamoury FMJ, Hajarizadeh B, Mowat Y, Marshall AD, Bajis S, Marks P, Amin J, Smith J, Edwards M, Gorton C, Ezard N, Persing D, Kleman M, Cunningham P, Catlett B, Dore GJ, Applegate TL. Evaluation of the Xpert HCV Viral Load point-of-care assay from venepuncture-collected and finger-stick capillary whole-blood samples: a cohort study. Lancet Gastroenterol Hepatol 2017; 2:514-520. [DOI: 10.1016/s2468-1253(17)30075-4] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 02/27/2017] [Accepted: 02/27/2017] [Indexed: 01/10/2023]
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47
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Abstract
Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections pose serious problems in terms of public health and clinical intervention in a country with approximately 250 million people, who live in more than 17,000 islands. Efforts to combat HBV and HCV have been made through the implementation of universal infant hepatitis B immunization, blood screening, and other health promotion actions, and building epidemiological data to develop intervention strategies. A nationwide study in 2013 revealed hepatitis B surface antigen (HBsAg) prevalence of 7.1%, which indicates that Indonesia has moved from high to moderate endemicity of hepatitis B, leaving the prevalence of 9.4% in 2007. The occurrences of new hepatitis B cases still continue in early childhood period, which may root from low coverage of birth-dose hepatitis B immunization in remote islands, and the potential mother-to-child transmission of HBV from HBsAg-positive pregnant mothers. Other problems still exist including the high HBV infection rates among young adults in remote islands, the presence of occult hepatitis B, as well as the substantial prevalence of HCV infection in general population, who do not have access to diagnosis and treatment. Effective preventive and control strategies are being developed tailored to the local capacity, infrastructures, socioeconomics, and culture, as well as geographical aspects of the country. How to cite this article: Muljono DH. Epidemiology of Hepatitis B and C in Republic of Indonesia. Euroasian J Hepato-Gastroenterol 2017;7(1):55-59.
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Affiliation(s)
- David H Muljono
- Eijkman Institute for Molecular Biology, Jakarta, Republic of Indonesia; Faculty of Medicine, Universitas Hasanuddin, Makassar, Republic of Indonesia; Sydney Medical School, University of Sydney, Australia
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48
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Affiliation(s)
- James E Squires
- Division of Gastroenterology, Hepatology, and Nutrition Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center Pittsburgh PA
| | - William F Balistreri
- Division of Gastroenterology Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine Cincinnati OH
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49
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Buzzetti E, Parikh PM, Gerussi A, Tsochatzis E. Gender differences in liver disease and the drug-dose gender gap. Pharmacol Res 2017; 120:97-108. [PMID: 28336373 DOI: 10.1016/j.phrs.2017.03.014] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [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: 08/12/2016] [Revised: 03/17/2017] [Accepted: 03/17/2017] [Indexed: 12/14/2022]
Abstract
Although gender-based medicine is a relatively recent concept, it is now emerging as an important field of research, supported by the finding that many diseases manifest differently in men and women and therefore, might require a different treatment. Sex-related differences regarding the epidemiology, progression and treatment strategies of certain liver diseases have long been known, but most of the epidemiological and clinical trials still report results only about one sex, with consequent different rate of response and adverse reactions to treatment between men and women in clinical practice. This review reports the data found in the literature concerning the gender-related differences for the most representative hepatic diseases.
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Affiliation(s)
- Elena Buzzetti
- UCL Institute for Liver and Digestive Health, Royal Free Hospital, London, UK.
| | - Pathik M Parikh
- UCL Institute for Liver and Digestive Health, Royal Free Hospital, London, UK
| | - Alessio Gerussi
- UCL Institute for Liver and Digestive Health, Royal Free Hospital, London, UK; Internal Medicine Unit, Department of Experimental and Clinical Medical Sciences, University of Udine, Udine, Italy
| | - Emmanuel Tsochatzis
- UCL Institute for Liver and Digestive Health, Royal Free Hospital, London, UK
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50
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Mori N, Imamura M, Kawakami Y, Nagaoki Y, Kawaoka T, Tsuge M, Hiramatsu A, Hayes CN, Aikata H, Miki D, Ochi H, Honda Y, Takaki S, Tsuji K, Chayama K. IFNL4 polymorphism effects on outcome of simeprevir, peginterferon, and ribavirin therapy for older patients with genotype 1 chronic hepatitis C. Hepatol Res 2017; 47:E5-E13. [PMID: 27027531 DOI: 10.1111/hepr.12715] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 01/17/2016] [Revised: 03/09/2016] [Accepted: 03/25/2016] [Indexed: 12/17/2022]
Abstract
AIM Older patients with chronic hepatitis C have a lower virological response to interferon (IFN)-based treatments compared to younger patients. A single nucleotide polymorphism in the IFN-λ-4 (IFNL4) gene has a potent predictive effect on treatment response to IFN-based treatments. The efficacy of simeprevir (SMV) plus pegylated-IFN (PEG-IFN) and ribavirin therapy and the predictive value of IFNL4 on the outcome of therapy for older patients have not been addressed. METHODS This retrospective multicenter study included 234 consecutive Japanese patients with genotype 1 chronic hepatitis C. We assessed the predictive factors for sustained virological response (SVR) to SMV, PEG-IFN, and ribavirin triple therapy in 170 younger (<70 years) and 64 older (≥70 years) patients. IFNL4 polymorphism ss469415590 was analyzed by Invader assay. RESULTS The SVR rate for older patients was similar to that for younger patients (63.9% and 72.0%, respectively). The SVR rate for the IFNL4 TT/TT group was significantly higher than the IFNL4 TT/ΔG or ΔG/ΔG group both in younger (93.6% and 46.1%, respectively, P < 0.01) and older patients (84.4% and 33.3%, respectively, P < 0.001). In multivariate regression analysis, IFNL4 TT/TT genotype, response to previous treatment and IFNL4 TT/TT genotype were identified as independent predictive factors for SVR in older and younger patients, respectively. Decrease in hemoglobin level was similar between the two groups. CONCLUSION The virological response to SMV triple therapy in older patients was similar to that of younger patients. Analysis of IFNL4 polymorphisms is a valuable predictor in both younger and older patients.
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Affiliation(s)
- Nami Mori
- Department of Gastroenterology/Liver Center, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, Hiroshima, Japan
| | - Michio Imamura
- Department of Gastroenterology and Metabolism, Applied Life Science, Institute of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan
| | - Yoshiiku Kawakami
- Department of Gastroenterology and Metabolism, Applied Life Science, Institute of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan
| | - Yuko Nagaoki
- Department of Gastroenterology and Metabolism, Applied Life Science, Institute of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan
| | - Tomokazu Kawaoka
- Department of Gastroenterology and Metabolism, Applied Life Science, Institute of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan
| | - Masataka Tsuge
- Department of Gastroenterology and Metabolism, Applied Life Science, Institute of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan
| | - Akira Hiramatsu
- Department of Gastroenterology and Metabolism, Applied Life Science, Institute of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan
| | - C Nelson Hayes
- Department of Gastroenterology and Metabolism, Applied Life Science, Institute of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan
| | - Hiroshi Aikata
- Department of Gastroenterology and Metabolism, Applied Life Science, Institute of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan
| | - Daiki Miki
- Department of Gastroenterology and Metabolism, Applied Life Science, Institute of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan.,Laboratory for Digestive Diseases, SNP Research Center, The Institute of Physical and Chemical Research (RIKEN), Hiroshima, Japan
| | - Hidenori Ochi
- Department of Gastroenterology and Metabolism, Applied Life Science, Institute of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan.,Laboratory for Digestive Diseases, SNP Research Center, The Institute of Physical and Chemical Research (RIKEN), Hiroshima, Japan
| | - Yohji Honda
- Department of Gastroenterology/Liver Center, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, Hiroshima, Japan
| | - Shintaro Takaki
- Department of Gastroenterology/Liver Center, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, Hiroshima, Japan
| | - Keiji Tsuji
- Department of Gastroenterology/Liver Center, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, Hiroshima, Japan
| | - Kazuaki Chayama
- Department of Gastroenterology and Metabolism, Applied Life Science, Institute of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan.,Laboratory for Digestive Diseases, SNP Research Center, The Institute of Physical and Chemical Research (RIKEN), Hiroshima, Japan
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